Swollen Lymph Nodes (Adenopathy) in Cancer

Common symptom may mean something else in cancer

doctor palpating woman's lymph nodes
Universal Images Group/Getty Images

Adenopathy (also known as lymphadenopathy) refers to lymph nodes that have become enlarged or swollen due to an infection, the most common cause, or as a result of other health issues, such as autoimmune disorders or cancer.

With cancer, adenopathy can be caused by a malignancy that starts in the lymph nodes themselves. It can also occur when a cancer spreads (metastasizes) from other parts of the body to the lymph nodes.

The Lymph System

Your body has a lymphatic system that is comprised of lymph vessels, lymphatic fluid, and lymph nodes. The network of lymph vessels transports lymphatic fluid throughout the body. This fluid, among its other functions, collects waste products and disease-causing microorganisms (like viruses and bacteria) on its journey through tissues.

The lymph nodes themselves are small, bean-shaped organs that produce and store blood cells (called lymphocytes) that help fight infection and disease. There are roughly 600 of these nodes located throughout the body. Their primary role is to filter waste from lymphatic fluid. As they do so, the army of lymphocytes aims to neutralize any foreign agent it encounters.

While some lymph nodes are located superficially—in the groin, armpit, and neck, for example—others are situated deeper in the body, such as in the chest or abdomen.

During an active infection or injury, the lymph nodes become swollen and tender.

When this happens, adenopathy can take several forms:

  • It can be localized (occurring in one area of the body), bilateral (on both sides of the body), or generalized (occurring throughout the body).
  • It can be acute (happening suddenly and resolving quickly) or chronic (persistent).
  • It can be characterized by the location of the nodes, such as around the neck (cervical), groin (inguinal), chest (mediastinal), armpits (axillary), or abdomen (mesenteric).

    Cancer Adenopathy

    Cancer adenopathy is the term used to describe the swelling of the lymph nodes due to cancer. Cancers that start in the lymph nodes are called lymphoma. Two of the more common types are Hodgkin lymphoma or non-Hodgkin lymphoma. Each behaves and develops differently, but both originate in the lymphocytes themselves. Adenopathy is just one of the features of these diseases.

    More commonly, cancer adenopathy will occur when a malignancy in one part of the body (known as the primary tumor) spreads to other parts of the body to create new (secondary) tumors. The lymph nodes are the organs most commonly affected this.

    How Cancer Spreads Through the Lymph Nodes

    When a tumor metastasizes, cancer cells break away from the primary tumor and spread to other parts of the body through either the circulatory (blood) system or the lymphatic system.

    When the cells are in the blood, they are swept along in the blood flow until they get stuck somewhere, usually a capillary. From this point, the cell can slip through the capillary wall and create a new tumor wherever it landed.

    A similar thing happens with the lymphatic system. In this case, the cancer cells break off and are carried to the lymph nodes where they get stuck.

    While the nodes will respond with an aggressive immune attack, some of the cancer cells will survive to form a new tumor.

    But here is where the difference lies: Unlike the circulatory system, which can carry cancer cells to almost any part of the body, the distribution of cancer through the lymphatic system is more constrained. The nodes nearest the tumor will typically be the first affected. From there, additional cells can break off and move to distant nodes in other parts of the body.

    Because of the way in which lymph nodes are affected, doctors will routinely check them to see if cancer has started to spread and, if so, by how much.

    How Adenopathy Is Detected

    The enlargement of superficial lymph nodes can often be detected through a physical examination. Imaging tests such as computed tomography (CT) scans can also be used, particularly for lymph nodes in the chest or abdomen.

    Additionally, the doctor may order a lymph node biopsy. The biopsy involves the removal of lymph node tissue for examination under a microscope. It would be used either to see if cancer has spread from a primary tumor or in cases where lymphoma is suspected.

    The biopsy can either be performed by surgically removing a node or, less commonly, by removing cells using a less invasive procedure called fine needle aspiration. The results of the biopsy are important for both the diagnosis and staging of the cancer.

    How Adenopathy Affects Cancer Treatment

    Adenopathy on its own does not alter the course of cancer treatment. However, having cancer cells in your lymph nodes can affect treatment insofar as it will inform the stage of your disease.

    One of the most common systems for staging cancer is the TNM system, ​which is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of metastasis (M). If there is no cancer found in the lymph nodes near the tumor, the N will be assigned a value of 0. If nearby or distant nodes show cancer, the N will be assigned a value of either 1, 2, or 3 depending on:

    • How many nodes are involved
    • Where the nodes are located
    • How big the nodes are
    • How much cancer is in them

    The recommended course of treatment will largely be based on the staging. The staging will also be used to provide the diagnosis ICD-10 code, which your health insurer will use to approve treatment.

    Cancer Adenopathy vs. Infection-Related Adenopathy

    Not all adenopathies are the same. Cancerous nodes tend to be hard, painless, and firmly affixed to surrounding tissue. Benign or non-cancerous lymph nodes, by contrast, are usually painful to the touch and will decrease in size and density as the infection resolves.

    With that being said, you cannot diagnose the cause of adenopathy by physical characteristics alone. In some cases, as a cancerous node may press on a nearby nerve and cause pain. In others, a benign node may be hard and relatively painless (such as those that can happen with persistent generalized lymphadenopathy seen in HIV).

    Do I Have Cancer If I Have Swollen Lymph Nodes?

    Adenopathy is a non-specific symptom that can be caused by any number of things. On its own, adenopathy has no diagnostic value. More often than not, however, adenopathy will be caused by an infection rather than by cancer.

    With that being said, if lymph nodes are persistently swollen and/or become larger, you should seek medical attention. If you are already receiving treatment for cancer, advise your doctor if you find any swollen lymph nodes in any part of your body.

    Sources:

    Nieweg, O.; Uren, O.; and Thompson, J. "The History of Sentinel Lymph Node Biopsy." Canc J. 2015; 12(1);3-6; DOI 10.1097/PPO.0000000000000091.

    West, H. and Jin, J. "Lymph Nodes and Lymphadenopathy in Cancer." JAMA Oncol. 2016; 2(7):971; DOI 10.1001/jamaoncol.2015.3509.

    Continue Reading