Synopsis
Assess enlarged lymph nodes and spleen by distribution, tempo and systemic context, identify malignancy or infection requiring urgent action and choose imaging, blood or tissue tests that preserve diagnostic value.
- Confirm that a lump is a lymph node and map every region. Size alone is insufficient; site, consistency, tenderness, fixation, matting, skin change, duration and progression all alter probability.
- Localised tender nodes usually follow drainage from infection or inflammation, while generalised lymphadenopathy broadens the differential to viral infection, HIV, tuberculosis, medicines, autoimmune disease and haematological malignancy.
- Supraclavicular, persistent hard or fixed nodes, progressive enlargement, unexplained splenomegaly, cytopenias and systemic symptoms justify urgent cancer-pathway or haematology assessment under current NICE criteria.
Key red flags
Stridor, dysphagia, facial swelling, venous distension or neurological deficit with cervical or mediastinal adenopathy indicates airway, vascular or neural compression.
Investigation priorities
Identify cytopenia, lymphocytosis, blasts, myeloid proliferation, haemolysis and hypersplenic response.
Management branches
Nodes or spleen are associated with airway, vascular, neurological or haemodynamic compromise.
- Use ABCDE, senior surgical, haematology, oncology and critical-care help, cross-sectional or bedside imaging chosen for stability, and blood-bank preparation when internal bleeding is possible.
- Preferred management preserves diagnostic tissue while stabilising the threatened organ; corticosteroid, radiotherapy, surgery or endovascular alternatives require specialist choice because each can alter later pathology.