Cervical adenopathy

The neck is the site of a rich lymphatic drainage network punctuated by lymph nodes. Naturally present, their size should not exceed 1 to 1.5 cm in perfect health. Nodes can become too large, be felt by palpating the neck, or even be visible by deforming the neck.

There are many different mechanisms that can cause cervical lymph nodes to increase in size.

• Increase in the number of lymph node cells (lymphocytes) in response to an external agent called an antigen.
• Infiltration of the lymph node by cancer cells from elsewhere: this is called lymph node metastasis.
• Infiltration by inflammatory cells as part of an infection: this is called lymphadenitis;
• Malignant multiplication of immune system cells in the lymph node: this is known as lymphoma or lymph node cancer.

The work-up required to find the cause of these abnormal lymph nodes depends very much on the context (young/old age, tobacco and alcohol consumption, fatigue, weight loss, return from travel, infectious syndrome, work exposed to animals, etc.).

The ENT specialist will prescribe an assessment adapted to each case (imaging, blood biology). He will also perform an exeresis biopsy or adenectomy if necessary to obtain a histological diagnosis during an exploratory cervicotomy. Histological analysis during the operation (known as extemporaneous analysis) may also lead to systematic curage of the neck lymph nodes, with the patient’s prior agreement.

The most common causes of pathological nodes in the neck are :

• viral or bacterial infection of the head or neck (from the scalp to the tonsils)
• a disease of the lymphatic system, such as lymphoma
• metastasis of cancer of the face, neck, thorax or abdomen

There are many different mechanisms and causes of cervical lymph node enlargement. Many diseases can give rise to these mechanisms, from the simplest (such as a dental infection) to the rarest and most complicated.

1. Infections: viral (HBV, HIV, Cytomegalovirus, Rubella, Epstein Barr virus (mononucleosis)), bacterial (brucellosis (cattle breeders’ disease), bartonellosis (cat scratch disease), borreliosis (tick-borne Lyme disease), streptococcal… or parasitic (toxoplasmosis, trypanosomiasis…).
2. Autoimmune or inflammatory diseases: lupus, rheumatoid arthritis or Kawasaki syndrome, Gaucher’s disease,
3. Cancers: head and neck cancer, lung cancer, digestive cancer, lymphoma, etc
   Depending on the pathology in question, cervical adenopathy may be located in different places: under the chin or mandible for dental infections, at the back of the neck for rubella, above the clavicles for lung or digestive cancer metastases (left side for digestive cancers).

Depending on the pathology involved, it may be associated with other symptoms such as :

• fever
• local redness
• signs of ENT infection (angina),
• dental lesions,
• signs of altered general condition, such as fatigue or weight loss.
• breathing difficulties (shortness of breath, bloody sputum)
• digestive problems (constipation, diarrhoea, abdominal pain, blood loss)
• joint pain

During the consultation, the doctor performs a clinical examination and palpates the lymph nodes in the patient’s cervical region (under the chin, under the angle of the jaw, on the sides of the neck and above the collarbone). The examination should check for location, size, consistency, mobility, pain and inflammation of the skin. Once the patient has been examined, a specific diagnostic approach can be proposed (imaging, blood tests, biopsies, etc.). Treatment of cervical adenopathy is based on management of the causative disease.