When should I consider referring a patient with lymphadenopathy for specialist evaluation?

Consider referring a patient with lymphadenopathy for specialist evaluation in the following situations:

• If lymphadenopathy persists or grows progressively after 7 days despite suspected viral infection, or if it has not resolved after 2–4 weeks following antibiotic treatment for suspected bacterial infection, arrange urgent referral to an ear, nose, and throat (ENT) surgeon for further investigation depending on clinical judgement ¹.
• If there are clinical features suggestive of a malignant primary tumour of the head and neck, arrange urgent referral using a 2-week suspected cancer pathway ¹.
• For unexplained lymphadenopathy, especially if generalized, arrange an urgent full blood count within 48 hours to assess for leukaemia and manage accordingly ¹.
• Consider referral using a 2-week suspected cancer pathway to exclude lymphoma in adults aged 25 years or more with unexplained lymphadenopathy or splenomegaly; for children and young people up to 24 years, consider very urgent referral within 48 hours depending on clinical judgement ¹,³.
• For people aged 40 years and over with supraclavicular or persistent cervical lymphadenopathy, consider an urgent chest X-ray within 2 weeks to exclude lung cancer, tuberculosis, or sarcoidosis, and arrange onward management ¹.
• If lymphadenopathy is persistent with unexplained oral cavity ulceration lasting more than 3 weeks, consider referral using a 2-week suspected cancer pathway to exclude oral cancer ¹.
• In children and young people with unexplained lymphadenopathy accompanied by systemic symptoms such as night sweats, weight loss, pruritus, or splenomegaly, consider very urgent referral for specialist assessment within 48 hours to exclude lymphoma ²,³.
• In adults with unexplained lymphadenopathy and associated symptoms like fever, night sweats, weight loss, pruritus, or alcohol-induced lymph node pain, consider referral via a suspected cancer pathway ²,³.
• If there is suspected upper airway obstruction, stridor, superior vena cava obstruction, or dysphagia with aspiration, arrange emergency hospital admission ¹.