Cancer Lymphoma Symptoms What Are Enlarged Retroperitoneal Lymph Nodes? Not all potential reasons for enlargement are cancerous By Indranil Mallick, MD Indranil Mallick, MD LinkedIn Twitter Indranil Mallick, MD, DNB, is a radiation oncologist with a special interest in lymphoma. Learn about our editorial process Updated on June 22, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Doru Paul, MD Medically reviewed by Doru Paul, MD Doru Paul, MD, is board-certified in internal medicine, medical oncology, and hematology. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Frequently Asked Questions Lymph nodes are small, bean-shaped structures located all over the body. They are part of the lymph system, a network of nodes, vessels, and ducts that function like immune outposts. The lymph system filters fluids from tissues to help defend against infection and minimize toxic exposure. Retroperitoneal lymph nodes are located in the abdominal cavity. They can be found immediately behind the part of the intestine that is closer to your backbone than your belly button. The swelling of the nodes is referred to as lymphadenopathy. Lymph nodes in the abdomen may become enlarged for a number of reasons, such as an infection like tuberculosis or as a result of a condition in a nearby organ. Not all causes of enlarged retroperitoneal lymph nodes are cancerous. In fact, in most cases, cancer is the last concern on the list. Still, there are certain patterns of enlargement that require more extensive evaluation. This article discusses the symptoms, causes, diagnosis, and treatment of enlarged lymph nodes. Verywell / Gary Ferster Symptoms Unlike other types of lymph nodes, retroperitoneal lymph nodes generally cannot be felt or seen when enlarged. Because of this, doctors will often only discover an enlargement after an imaging scan of the abdomen and pelvis, such as a computed tomography (CT). Some conditions that cause enlarged retroperitoneal lymph nodes may have associated symptoms. Specifically, people who have enlarged retroperitoneal lymph nodes related to lymphoma may also experience: Abdominal pain and bloatingFatigueFeverAnemia When retroperitoneal lymph nodes are enlarged due to metastatic cancer, symptoms might include: Abdominal pain and bloatingPain that radiates through the lower backJaundice (yellowing of the skin and eyes)Poor appetite Causes Causes of enlarged retroperitoneal lymph nodes can be primary or secondary. Primary causes arise in the lymph nodes themselves. Secondary causes are related to other conditions in nearby organs. Primary Causes Oftentimes, lymph nodes in the abdomen become enlarged as a result of an infection. If the infection is confined to the abdomen, the enlarged lymph nodes will be found only in a small area. If it's a systemic infection that involves the whole body, the enlarged lymph nodes will be more spread out. Some of the causes of swollen retroperitoneal lymph nodes include: Infections like tuberculosis Inflammatory conditions such as sarcoidosis Cancers that spread (metastasize) to the lymph nodes Blood cancers that develop in the lymph nodes or spread to the lymph nodes Rare, noncancerous conditions like Castleman disease, which cause the overgrowth of lymph nodes Secondary Causes More often than not, the cause of swollen retroperitoneal lymph nodes will be secondary. This means they happen because of a disease or disorder affecting an organ within or near the retroperitoneum. These include organs such as: Adrenal glands Ascending or descending colon and duodenum Esophagus Kidneys and ureters Pancreas Sometimes a disease that affects one of these organs will also affect the associated lymph nodes and vice versa. For instance, the ureters carry urine from the kidney to the bladder. Masses in this area can block a ureter, triggering inflammation and the production of inflammatory cytokines, which are molecules that play a role in the immune response. When this happens, retroperitoneal lymphadenopathy will almost always occur. Cancers Cancer is clearly the most concerning cause of retroperitoneal lymphadenopathy. Two of the most common malignancies associated with this are lymphoma and testicular cancer. Lymphoma Lymphomas are a group of cancers that are considered lymphoproliferative. This means they cause excessive production of white blood cells called lymphocytes. Lymphomas usually start in the lymph nodes, typically the retroperitoneal lymph nodes. There are two main categories of lymphoma: Hodgkin lymphoma (HL), which primarily affects the lymph nodes Non-Hodgkin lymphoma (NHL), which affects the lymph nodes and other organs Testicular Cancer Cancers can often spread from a primary tumor to retroperitoneal lymph nodes. One such cancer is testicular cancer. Diagnosis Swollen lymph nodes by themselves can't tell much about the underlying illness. Still, there are some red flags healthcare providers will look for. Certain patterns of enlargement are worrisome. For example, a large mass of lymph nodes that appears stuck together on an imaging scan may be a sign of metastatic cancer. In instances like these, your healthcare provider may recommend additional tests such as: A biopsy, which is a procedure where a sample of tissue is removed for evaluation A positron emission tomography (PET) scan, which is able to detect metastatic cancer better than other imaging technologies Metastatic testicular cancer usually spreads in a predictable fashion. It tends to move progressively through the lymphatic system and typically establishes in the nodes of retroperitoneum. A CT scan may also provide other indications of the potential cause. For example, If both the liver and spleen are enlarged along with the retroperitoneal lymph nodes, this may be a sign of lymphoma. With HL, the pattern of enlargement typically moves from one lymph node group to the next. With NHL, the distribution is more scattershot. It may involve distant lymph nodes and organ systems, primarily the gastrointestinal tract. Treatment Treatment of enlarged lymph nodes in the abdomen usually involves treating the underlying cause. For example, tuberculosis is typically treated with a combination of antibiotics. Retroperitoneal lymph nodes can be removed if the cause of the enlargement is metastatic cancer. This is done during an operation called a retroperitoneal lymph node dissection (RPLND). During RPLND, the retroperitoneal lymph nodes are removed through an incision in the abdomen. The procedure is done under general anesthesia, which means you will be in a sleep-like state. It usually takes 3.5 to 5 hours. Summary Retroperitoneal lymph nodes are located in the abdomen. They may become enlarged because of primary or secondary causes. Primary causes include things like infections or cancers that develop in the lymph nodes. Secondary causes include conditions affecting nearby organs like the kidneys or pancreas. To treat enlarged retroperitoneal lymph nodes, healthcare providers typically treat the underlying cause. Sometimes enlarged retroperitoneal lymph nodes happen when cancer spreads from another part of the body. This is a less common cause of this condition. A Word From Verywell The significance of enlarged lymph nodes in the retroperitoneum depends on many other factors, such as medical history and the pattern of enlargement. One important aspect of enlarged nodes in this particular location is that they are quite isolated from the rest of the body. This means they are not as easily detected as lymph nodes in other places such as the neck, armpits or groin. Sometimes lymph nodes are "borderline-enlarged" on imaging. This means they are slightly larger than usual, but not necessarily a cause for concern. In this case, you may need follow-up imaging and comparison to past studies to see if your lymph nodes are becoming larger over time. Always talk to your healthcare team if you have questions about the significance of enlarged retroperitoneal lymph nodes. Frequently Asked Questions What are the survival rates for lymphoma? For Hodgkin's lymphoma, the five-year survival rates are:Localized (has not spread): 94%Regional (spread to nearby tissues): 91%Metastatic (spread to distant organs): 81%For non-Hodgkin's lymphoma, the rates are:Localized: 73%Regional: 73%Metastatic: 57% What are the survival rates for testicular cancer? The relative five-year survival rate for testicular cancer that stays localized to the testicles is 99%. If the cancer spreads to nearby structures or lymph nodes, the survival rate is 96%, and if it metastasizes to distant organs or lymph nodes, the survival rate is 73%. Can retroperitoneal lymph nodes be removed? Yes, retroperitoneal lymph nodes can be removed, and this is often used as a treatment option for testicular cancer. It can also be used to diagnose stages of cancer. The procedure is called a retroperitoneal lymph node dissection. How Lymphadenopathy Is Diagnosed Was this page helpful? Thanks for your feedback! Limiting processed foods and red meats can help ward off cancer risk. These recipes focus on antioxidant-rich foods to better protect you and your loved ones. Sign up and get your guide! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 11 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Zhang S, Chen M, Li CM, Song GD, Liu Y. Differentiation of lymphoma presenting as retroperitoneal mass and retroperitoneal fibrosis: evaluation with multidetector-row computed tomography. Chin Med J (Engl). 2017;130(6):691-697. doi:10.4103/0366-6999.201606 Yan H, Luo M, Wang L, et al. Clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the palliative treatment of retroperitoneal metastatic lymph nodes. Cancer Imaging. 2020;20(1):1-11. doi:10.1186/s40644-020-00299-x Merck Manual. Swollen lymph nodes. Gaddey H, Riegel A. Unexplained lymphadenopathy: evaluation and differential diagnosis. Am Fam Physician. 2016;94(11):896-903. Coursey moreno C, Small WC, Camacho JC, et al. Testicular tumors: what radiologists need to know--differential diagnosis, staging, and management. Radiographics. 2015;35(2):400-15. doi:10.1148/rg.352140097 Gallamini A, Zwarthoed C, Borra A. Positron emission tomography (PET) in oncology. Cancers (Basel). 2014;6(4):1821-89. doi:10.3390/cancers6041821 American Cancer Society. Tests for Non-Hodgkin Lymphoma. American Cancer Society. Survival rates for Hodgkin lymphoma. American Cancer Society. Survival rates and factors that affect prognosis (outlook) for non-Hodgkin lymphoma. American Cancer Society. Testicular cancer survival rates. Cleveland Clinic. Retroperitoneal lymph nodes dissection. Additional Reading Radiopaedia.org. Retroperitoneal organs (mnemonic).