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Lymphadenopathy

 

This guideline applies to adults

 

Introduction

Lymphadenopathy occurs in a range of infective, inflammatory and neoplastic conditions. Isolated lymphadenopathy frequently results from local infection or neoplasia.

Lymphadenopathy caused by acute viral upper respiratory tract infection is usually self-limiting and subsides within 3–6 weeks after symptoms resolve. (1)

Persistent generalised lymphadenopathy may represent haematological malignancy such as lymphoma or leukaemia.

 

In scope

  • Lymphadenopathy

 

Not in scope

  • Other haematological conditions.  
     
  • Paediatrics - For children with unexplained generalised lymphadenopathy or features consistent with haematological malignancy discuss the same day with the on-call paediatrician - Paediatric Suspected Cancer

  • For children with cervical lymphadenopathy see  Cervical Lymphadenopathy in Children


 

Red Flag Features

  • Generalised or progressive lymphadenopathy greater than 1cm persistent for more than 6 weeks
  • Hepatosplenomegaly
  • B symptoms: for example >10% weight loss in 6 months, unexplained fevers / night sweats, alcohol induced lymph node pain, pruritus, shortness of breath (signs of lymphoma)
  • Pallor, fatigue, fever, persistent infection, bruising, and bleeding (signs of leukaemia)

*This list is non exhaustive 


 

Investigations prior to referral

If not meeting fast track criteria, consider

  • FBC +/-blood film  
  • Glandular fever screen
  • HIV testing
  • CXR


 

Management optimisation

In the absence of red flags, where localised lymphadenopathy occurs due to a suspected underlying cause (eg viral URTI / localised infection) treat this appropriately and then review.



 

Advice and Guidance

Haematology A&G can be accessed via ERS: Haematology Advice & Guidance

This service should not be used for suspected fast track referrals.


 

Referral

Emergency referral criteria

  • If a blood film suggests an acute leukaemia arrange an immediate admission via the on-call haematologist.

 

Fast Track referral criteria

Refer via fast track to haematology if:

  • Generalised or progressive lymphadenopathy greater than 1cm persistent for more than 6 weeks

OR

  • Generalised lymphadenopathy < 6weeks and one or more of the following –
    • Hepatosplenomegaly
    •  ‘B’ symptoms
    • Blood film suggestive of haematological malignancy (other than acute leukaemia – arrange same day admission as above)  

OR

  • Other unexplained isolated lymphadenopathy that is not an isolated neck or axillary node – see below

 

Urgent Referral to Other Specialities

In the absence of red flag or B symptoms:

Follow fast track ENT criteria for:

  • Previously not investigated, unexplained palpable lump in anterior and lateral neck (anterior to trapezius, includes thyroid, parotid and submandibular gland)
     
  • Posterior neck masses should be referred via either the suspected cancer sarcoma or dermatology referral pathway depending on clinical suspicion.

(see Neck Lumps in Adults for more information)

 

Follow suspected cancer and symptomatic breast referral criteria for:

  • Women aged 30 and over with unexplained lump in the axilla

(see Breast Lumps And Suspected Breast Cancer (Female) for more information)

  • Males with unexplained lump in the axilla

(see Male Breast Symptoms for information)

 

Referral Instructions

Information to be included in referral:

  • Duration of symptoms
  • Site(s) of lymphadenopathy
  • Any systemic / B symptoms
  • History of preceding viral infection
  • Medication
  • Results of any recent blood tests or imaging

 

Supporting Information

For professionals

 

For patients  

 

References

 

Page Review Information

Review date

08 July 2025

Next review date

08 July 2027

Clinical editor

Dr Laura Lomas

Contributors

Dr Michelle Furtado,

Peninsula Cancer Alliance,

Haematology Site Specific Group,

Advice and Guidance for non-haematological conditions, October 2024