The short answer, no, not always. There are many causes of enlarged lymph nodes in the chest. While some cancers such as lung and lymphoma can present with enlarged lymph nodes, infections, systemic conditions, reactions to drugs, lung diseases, amongst others also present with enlarged lymph nodes in the chest.
Enlarged lymph nodes in the chest are most frequently discovered on CT scans done for various reasons. An enlarged lymph node means it’s bigger then 1 centimeter, although some use different criteria. There may be one lymph node that is enlarged or many. They can be enlarged in one area of the chest or in multiple.
A few mildly enlarged nodes in the chest are sometimes not significant in an otherwise healthy patient while large bulky nodes often mean cancer, either primary, or that which has spread to the chest. There are many cases where the findings are between those extremes and are not clear.
The reason for the test and the patients clinical history are most important to sort the causes out. For example, in a patient with cancer, any enlarged nodes may mean spread or recurrence of cancer. A patient who is otherwise healthy with a few enlarged nodes may mean nothing and the patient may only need follow up. A patient with a pneumonia or lung disease may have some enlarged nodes which are reactive, or simply your body fighting the infection or lung disease.
So what to do if you have enlarged nodes? Your primary care doctor or a lung specialist can manage your particular case depending on your circumstances and history. In some cases, where the nodes are big, a biopsy will be needed. On the other extreme, a few mildly enlarged nodes may not mean much.
In between, options include follow up in 3 to 6 months to see if they grow more. If they grow, it still doesn’t mean cancer, but a biopsy may be needed. If you have a pneumonia, then a follow up may be needed sooner. The nodes should get smaller as the pneumonia clears. In chronic lung diseases, the nodes may be enlarged for a long time and have some change over different scans.
In other cases, a PET scan may be ordered. This is a test which looks at glucose metabolism of tissues. The thinking is that those tissues that are cancerous will be more active and hotter looking. If there are hot nodes on this test, then a biopsy may be needed. Hot nodes, doesn’t necessarily mean cancer either.
In some cases, a cause for the enlarged nodes may be sought by looking for systemic disease such as sarcoidosis, infections, cancer workup amongst other possibilities. This will often include a detailed history and additional testing. Therefore, enlarged lymph nodes in the chest do not indicate cancer in many cases.