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Forum Name: Lymphoma

Question: Painless swollen neck nodes


 Kristen - Sun Dec 18, 2005 6:32 pm

Hello and thank you for your time. My question is with regards to swollen painless neck lymph nodes. I have had painless swelling in nodes on both sides of my neck for at least 3-4 months. I also have generalized itching and occasional night sweats. Is it at all possible for these nodes to be cancerous even though they have been about the same size and they are not fixed? My GP does not want to biopsy because he said it could cause damage to the nerves in my neck and the nodes are not "characteristic of cancer". I also have constant fatigue. Does it not seem that there is enough reason to push for a biopsy? Any insite would be appreciated. Thank you.
 Dr. Tamer Fouad - Mon Dec 19, 2005 1:04 am

User avatar Hello Kristen,
Abnormal lymph node enlargement tends to commonly result from infection / immune response, cancer and less commonly due to infiltration of macrophages filled with metabolite deposits (eg, storage disorders).
Infected Lymph nodes however, tend to be firm, tender, enlarged and warm. Inflammation can spread to the overlying skin, causing it to appear reddened.
Lymph nodes harboring malignant disease tend to be firm, non-tender, matted (ie, stuck to each other), fixed (ie, not freely mobile but rather stuck down to underlying tissue), and increase in size over time.
Sometimes, following infection lymph nodes occasionally remain permanently enlarged, though they should be non-tender, small (less the 1 cm), have a rubbery consistency and none of the characteristics described for malignancy or for infection. These are also known as 'Shotty Lymph nodes'.

Findings from a Dutch study revealed that only 10 percent of patients with unexplained adenopathy required referral to a subspecialist, 3 percent required a biopsy and only 1 percent had a malignancy.[1]

An increase in nodal size on serial examinations is significant.

Nodes are generally considered to be normal if they are up to 1 cm in diameter; however, some authors suggest that epitrochlear nodes larger than 0.5 cm or inguinal nodes larger than 1.5 cm should be considered abnormal [2,3].
Little information exists to suggest that a specific diagnosis can be based on node size. However, in one series [4] of 213 adults with unexplained lymphadenopathy, no patient with a lymph node smaller than 1 cm2 had cancer, while cancer was present in 8 percent of those with nodes from 1 cm2 to 2.25 cm2 in size, and in 38 percent of those with nodes larger than 2.25 cm2. These studies were performed in referral centers, and conclusions may not apply in primary care settings.

Surgical dissection of the neck for a biopsy is not recommended even when the likelihood of cancer is high. The reason being it distorts the plains and may have bad effects on further management if it turns out that it is a result of cancer.

As you can see from the above information that the likelihood of cancer is not so high. If still concerned, however, and since your question relates more to the 'character of the lymph nodes', I would suggest that you seek a second clinical examination by another doctor. If they both find that the clinical features of your lymph nodes not alarming then you forget about the whole thing.

References:
=========
1. Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Pract 1988;27: 373-6.
2. Libman H. Generalized lymphadenopathy. J Gen Intern Med 1987;2:48-58.
3. Morland B. Lymphadenopathy. Arch Dis Child 1995; 73:476-9.
4. Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol 1993;20:570-82.

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