Why lymph nodes enlarge
Lymph nodes are part of the immune system and enlarge when they are reacting to infection, inflammation or a vaccine. Most reactive nodes settle within a few weeks. Persistent enlargement can also be caused by tuberculosis, autoimmune disease, a drug reaction or a lymphoma.
The history matters as much as the size. A short history with a sore throat, fever or skin infection suggests a reactive cause. A painless, rubbery or hard node that grows over weeks, a supraclavicular node, or nodes with unexplained weight loss, drenching night sweats and fever need faster investigation.
Related: Haematology → · Dr. Sachita Baniya profile → · All conditions →
When to investigate
Assessment considers the node's location, size, consistency, mobility and duration, together with the person's age, symptoms, travel and tuberculosis exposure, medicines and family history. A complete blood count, blood film, inflammatory markers, liver and kidney tests, and infection tests are selected based on the story.
Ultrasound helps characterise the node and guide a decision. Fine needle aspiration is useful for some questions, but an excisional biopsy is generally preferred when lymphoma is suspected because it preserves the architecture needed for diagnosis and classification. A biopsy is a safe procedure and does not spread cancer.
| Pattern | Possible interpretation | Next step |
|---|---|---|
| Tender node with sore throat or skin infection | Reactive | Treat the cause and review |
| Persistent painless node over 4 to 6 weeks | Needs tissue diagnosis | Ultrasound and biopsy assessment |
| Supraclavicular node at any size | Higher concern | Prompt specialist evaluation |
| Nodes with fever, night sweats and weight loss | Systemic illness or lymphoma | Urgent blood tests and biopsy |
Tests and what happens next
If lymphoma is diagnosed, staging uses imaging, usually PET-CT or CT, and sometimes a bone marrow biopsy. Treatment depends on the lymphoma subtype, stage, symptoms and fitness. Some lymphomas are cured with chemotherapy and radiotherapy; others are monitored or treated with targeted therapy.
Not every enlarged node needs a biopsy, and not every biopsy shows cancer. The goal is to avoid missing a treatable lymphoma while sparing people unnecessary procedures. A second opinion on the pathology or the plan is reasonable when the diagnosis is uncertain.
Access and booking
Dr. Baniya consults at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, and also practises at Kathmandu Cancer Center (KCC) Nepal, Civil Service Hospital, Kathmandu, and Advanced Care Hospital. Appointments are arranged at the Durbar Marg clinic or through the respective hospital or cancer centre. Bring all blood counts, blood film, marrow, flow cytometry and molecular reports.