Typical investigations for enlarged lymph nodes

These will depend on your age, symptoms and what other tests you have already had.

blood tests
In children and young adults, having swollen lymph nodes usually means you're fighting an infection. Blood tests may rule out an infection (eg. toxoplasmosis, glandular fever) or other disease. The doctor will also want to look at the general blood count, and to check liver function.

needle biopsy
In an adult with an enlarged node the initial test is often a fine needle biopsy of the node. This is done as an outpatient and is usually only mildly uncomfortable. The results can take up to a week as the pathologist does many tests on the cells to determine their nature.

nodal excision
If the needle biopsy indicates a cancer arising from elsewhere, the doctor wil do other investigations to determine the site of origin. The lump in this situation would be considered a lymph node metastasis.

If the needle biopsy indicates a lymphoma is likely, the pathologist will request that the node be excised to get more information about the particular type (Hodgkin's vs non Hodgkin's) and grade of lymphoma. If the pathologist sees the classic large abnormal cells known as Reed-Sternberg cells the diagnosis of Hodgkin's Lymphoma is made. The lymphoma may be found to be growing slowly (low grade), growing at a moderate rate (intermediate grade) or growing rapidly (high grade). Knowing the type and grade will go a long way in determining which treatment is best.

Ultrasound scan
Dr McIvor may organize an ultrasound or do it himself depending on what he is looking for. This is a simple outpatient procedure that takes about 30 minutes and gives valuable information on the number, shape, size, and location of nodes. It also enables an accurate needle biopsy of a node if required. Ultrasound is painless unless the node is very tender.

CT /MRI scans
Scans of the neck, chest, abdomen and pelvis may be necessary to determine the extent of nodal involvement in the body and whether other organs are involved. In adults over 40, an enlarged node may represent a metastasis from a cancer in the nose, mouth or throat region. The scan will give vital information on the characteristics of both the node and primary tumour.

PET scans
Overseas doctors are also increasingly using positron emission tomography (PET) scanning to detect cancer. For this test, a small amount of a radioactive tracer is injected into your body. This tracer is then absorbed by the tissues in your body. Tumors are typically more metabolically active than other tissues, so they absorb more of the tracer. True PET scanning is not yet available in New Zealand

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