Important: This page is for general information only and is not a diagnosis. If you are worried about a symptom, please see a doctor.

What are lymph nodes?

Lymph nodes are small, bean-shaped glands that are part of the body’s immune system. They filter lymph fluid and help fight infection. There are hundreds of lymph nodes throughout the body; the ones most easily felt under the skin are in the neck, armpits (axilla), and groin.

When the body fights an infection, lymph nodes often swell and become tender — this is a normal immune response. Swollen lymph nodes are one of the most common symptoms seen by doctors and are almost always caused by infection.

The most important thing to know: TB is the most common cause in India

In India, tuberculosis (TB) lymphadenitis is the single most common cause of persistently swollen lymph nodes — especially in the neck. TB can infect lymph nodes even when there is no obvious chest or lung involvement. The nodes can become large, matted together, and may feel firm or fluctuant (soft in the centre if the node has formed an abscess). TB lymphadenitis is treatable with a standard course of TB medication.

If you have swollen neck nodes, do not panic and assume cancer. The most likely cause in Bihar is a common infection or TB. However, a doctor must evaluate you to determine the cause — and the same tests that diagnose TB can also rule out cancer.

When is a swollen lymph node a warning sign for cancer?

Certain features make a swollen lymph node more likely to require investigation for cancer:

  • The node is painless — painful nodes are more typical of infection; painless, hard nodes raise more concern
  • The node is hard or rubbery in texture
  • The node is larger than 1 cm (roughly the size of a marble or larger)
  • The swelling has persisted for more than 2 weeks without any obvious infection to explain it
  • Multiple nodes are swollen in different areas of the body at the same time (neck, armpit, and groin together)
  • You also have B symptoms — a group of three symptoms that together are a significant warning sign in lymphoma:
    • Drenching night sweats — sweating so much at night that you need to change your sheets or clothing
    • Unexplained fever lasting days or weeks without obvious infection
    • Unexplained weight loss — losing more than 10% of body weight over 6 months without trying

If you have swollen lymph nodes alongside any B symptoms, please see a doctor promptly.

Hodgkin lymphoma vs Non-Hodgkin lymphoma — a brief explanation

Lymphoma is a cancer of the lymphatic system. The two main types are:

  • Hodgkin lymphoma (HL) — tends to affect younger adults (20s–30s) and older adults (over 55). Characteristically spreads in an orderly, predictable way from one lymph node group to the next. Usually presents with swollen lymph nodes in the neck or chest. It responds very well to treatment, and many patients are cured.
  • Non-Hodgkin lymphoma (NHL) — a broader group of lymphomas. More common overall; can affect lymph nodes anywhere in the body and also organs such as the spleen, liver, or bone marrow. Treatment and outcomes vary depending on the specific subtype.

Both types can occur at any age. Swollen lymph nodes with B symptoms and no infection to explain them are the hallmark presentation.

Other possible causes

Beyond infections and TB, other causes of swollen lymph nodes include:

  • Viral infections — such as dengue, scrub typhus, or glandular fever (infectious mononucleosis from the Epstein-Barr virus)
  • Bacterial skin or throat infections — a swollen neck node after a throat infection or dental abscess is very common
  • Metastatic cancer — cancer from another site (such as the head and neck, breast, or lung) can spread to lymph nodes. This is different from lymphoma, which starts in the lymph nodes themselves
  • Autoimmune conditions — such as lupus or rheumatoid arthritis, which cause generalised lymph node swelling

Warning signs that need prompt attention

See a doctor within 2 weeks if you have:

  • A lymph node swelling that has been present for more than 2 weeks with no infection to explain it
  • A painless, firm, or hard swollen node anywhere in the neck, armpit, or groin
  • Swollen nodes in multiple areas of the body at the same time

See a doctor urgently (within days) if you have swollen nodes combined with:

  • Drenching night sweats
  • Unexplained fever lasting more than 1 week
  • Significant unexplained weight loss
  • Difficulty breathing or a feeling of pressure in the chest

What tests a doctor will recommend

  1. Physical examination — the doctor will carefully feel all the lymph node areas in the body (neck, armpits, groin, abdomen) to assess the size, number, texture, and tenderness of any swollen nodes
  2. Blood tests — complete blood count (CBC) to look for abnormal blood cells; ESR and CRP to assess inflammation; tests for TB (Mantoux test or IGRA blood test)
  3. Chest X-ray — important to look for lymph node enlargement inside the chest (mediastinal lymphadenopathy), which is a common finding in both TB and Hodgkin lymphoma
  4. FNAC (fine needle aspiration cytology) — a needle is inserted into the swollen node and a small sample of cells is withdrawn and examined under a microscope. FNAC is minimally invasive, widely available across India including at district hospitals, and is usually the first tissue test done. It can diagnose TB, infection, or suggest cancer
  5. Excision biopsy — if FNAC is inconclusive, the entire lymph node is surgically removed and sent to the laboratory. This is the definitive test for lymphoma because it allows the pathologist to examine the architecture of the whole node, not just individual cells
  6. CT scan — to map the extent of lymph node involvement throughout the body and to look for involvement of organs

Where to get help in Bihar

  • Mahavir Cancer Sansthan, Phulwarisharif, Patna — has haematology and oncology services; FNAC and biopsy facilities; CT scan and staging available
  • AIIMS Patna — haematology and oncology outpatient departments; advanced diagnostics including flow cytometry and bone marrow biopsy for blood cancers
  • Government district hospitals — can perform blood tests, chest X-ray, and FNAC as a first step; will refer for biopsy or specialist care as needed

See our full hospital directory at /find-care/hospitals/.

For guidance, call the Indian Cancer Society helpline: 1800-22-1951 (free). For emergencies, call 108 or 112.