Cervical lymphadenitis

Disease Description (Causes and Symptoms)

• Definition: Cervical lymphadenitis (cervical lymph node enlargement) refers to a condition in which the lymph nodes around the neck become enlarged due to infection, inflammation, or malignant lesions. In normal adults, the lymph nodes in the neck are generally not palpable, and after age 5–6, a diameter of 1 cm or less is considered within the normal range.
• Main causes: Upper respiratory tract infections (tonsillitis, common cold), dental infections, viruses (measles, rubella, mumps, etc.), bacterial infections (streptococci and staphylococci), tuberculous lymphadenitis, lymphoma, metastatic carcinoma, and others.
• Pathophysiology: In response to an infectious agent, lymphocytes and macrophages proliferate within the lymph nodes and blood vessels dilate → lymph node swelling and nodule formation. Suppuration and abscess formation may occur with bacterial infections.
• Main symptoms: Localized tenderness (pain), fever, localized redness and warmth, a painless, slowly enlarging nodule (potentially suggestive of a tumor), and pain around the ear or neck or difficulty speaking or swallowing (when large or severe).
• Warning signs (suggesting cancer or serious infection): A hard, fixed nodule; 2 cm or larger or progressively enlarging; persistent, painless enlargement on only one side (unilateral); and systemic symptoms such as weight loss, night sweats, and persistent fever.

Treatment Methods

• General principles: Treatment according to the cause. Most cases are reactive (infectious) and improve with conservative treatment.
• Conservative/symptomatic treatment: Rest, adequate fluid intake, antipyretic analgesics (acetaminophen and NSAIDs), warm compresses (to improve local blood flow), and improved oral and dental hygiene.
• Antibiotics: When a bacterial infection is suspected (such as localized suppuration, high fever, unilateral involvement, or acute onset), empiric oral antibiotics are administered (targeting streptococci and staphylococci). Local resistance and MRSA prevalence should be considered. If treatment fails or an abscess is suspected, a change of antibiotics and detailed culture testing are necessary.
• Abscess formation: Incision and drainage (surgical drainage) are necessary.
• Tuberculous lymphadenitis: Long-term treatment with antituberculosis drugs (multidrug [four-drug] therapy) under the direction of a tuberculosis specialist.
• Neoplastic conditions (lymphoma and metastatic cancer): After confirmation through a biopsy (excisional biopsy or fine-needle aspiration), appropriate treatment such as anticancer therapy, radiation therapy, or surgery is provided in collaboration with medical oncology, otolaryngology, and hematology-oncology.
• Precautions/self-care: Never press or squeeze the lymph node, complete the full course of prescribed antibiotics, and seek medical attention again immediately if symptoms worsen.

Outpatient Visit Checkpoints (Including Preparation Items and Example Questions)

• Preparation items and information:
  • When the symptoms began and their progression (when they started, changes in size, and whether there is pain)
  • Whether fever or systemic symptoms (weight changes, night sweats, and fatigue) are present
  • Recent upper respiratory tract infections, dental treatment, contact with animals, travel history, and possible exposure to tuberculosis
  • Current medications (including antibiotics and immunosuppressants) and history of allergies
  • Bring any previous blood test or imaging results (ultrasound or CT), if available
• Example questions for the outpatient visit:
  • The date the symptoms began and the pattern of change (size, pain, fever, etc.)
  • Whether pain has developed and whether there is any discharge such as skin redness or pus
  • Whether there has been a recent infection (pharyngitis or periodontitis) or trauma

Examples of General Questions to Ask the Doctor

• "How long will it take for this swollen lymph node to return to normal?"
• "What are the side effects of the medication you plan to prescribe, and what precautions should I take?"
• "How likely is it that a biopsy (fine-needle aspiration or excisional biopsy) will be needed?"
• "What should I be careful about in daily life (exercise, diet, wound care, etc.)?"

Examples of Condition-Specific Questions

• "If the lymph node does not decrease in size after more than 2 weeks or continues to grow, is a biopsy necessary?"
• "When a lymph node slowly enlarges without pain, how likely is it to be a malignant tumor (lymphoma or metastasis), and what additional tests are needed?"

Additional guidance: If persistent or severe symptoms or signs of worsening (rapid enlargement, difficulty breathing or swallowing, general weakness, etc.) are present, prompt evaluation by a specialist is recommended.