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Forum Name: Lymphoma

Question: Non-painful hard lymph node side of neck


 HydragonWarrior - Wed Jan 04, 2006 12:05 pm

First off, my current state. 23 years old, healthy, but I caught a cold a few days ago - runny nose, etc. This lead to my sore throat that I now have (second day with it now).

However, what does bother me enough to send this message is that I randomly touched my neck and found this lump at the back of my neck (midarea, only on the left hand side of the neck). From what I've read, it's a swollen lymph gland. It's pretty hard - circular, but not painful. I'm not sure what it means for it to be mobile, but when I press down it, it does shift a little (when my neck is relaxed).

However, I wasn't too worried because when I was a kid I've had something fairly hard and swollen which felt the same, and by x-ray and doctors it was just a normal neck gland thing. Right now, I'm thinking it's just a regular swollen gland that came with the cold I got. But since I checked the internet (foolishly), it said that I have to be careful with swollen lymph nodes that are painless and hard.

There is certainly no pain when I touch the node, and it does feel hard. But from what I read, what defines a normal lymph node to be OK? Is a normal one supposed to be sponge or jello soft? I want to clarify this cause I'm not sure how "hard" they mean (especially if swollen) and to know what it means for a lymph node to "feel" normal.

Anyway, should I be immediately concerned and tell the doctor? I've been visiting the doc for a while (as in, in the past 5 months, I think 9-10 visits) and I'm beginning to think this is annoying him (I think they've all been for legitimate reason up til now, although a big part was cause II worried myself stupid from looking up these thingson the net). My most recent was just last week on Thursday (but for something completely unrelated to this lump), so if possible I want to avoid visiting the doc right away, but I will if you guys recommend I do so.

Or should I just wait for the sore throat to subside and see if the node shrinks any afterwards?

Thank you for your time,

Hydragon

P.S. I did the foolish thing and tried looking up a symptom like this lump thing on the internet to know what it was. I know all that does in the end is freak out and worry a person who knows nothing about this stuff (like me, for example, or else I wouldn't have written this message).

Thankfully, I've learned my lesson and I'll only be using google only for topics that I like. To people out there who know what I'm talking about - spread the word: DON'T USE THE NET TO DIAGNOSE YOURSELF! Don't replace your own common sense with google search!
 Dr. Tamer Fouad - Wed Jan 04, 2006 2:24 pm

User avatar Hello HydragonWarrior,
Sometimes a lymph node enlargement is considered normal, while at other times it is not. The basis of differentiation between what is considered normal and what is not, rests on the clinical significance of the finding. Let me review a few points to clarify what is considered a clinically significant lymph node enlargement.

An increase in nodal size on serial examinations is significant. Hence nodes that continue to grow in size are important and those that regress in size tend to be more reassuring.

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 [1,2].

Little information exists to suggest that a specific diagnosis can be based on node size. However, in one series [3] 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.

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.

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.[4]

In primary care settings, patients 40 years of age and older with unexplained lymphadenopathy have about a 4 percent risk of cancer versus a 0.4 percent risk in patients younger than age 40.[4]

Given the limitations of the internet in clinical evaluation, you are advised to seek medical attention. In your case the most probable outcome of your evaluation would be to put you under observation for 3 to 4 weeks and then re-evaluate these nodes. The doctor may also recommend a course of antibiotics based on his evaluation.

If it persists after a period of observation then the patient should seek medical attention for further investigations using ultrasonography and FNAC or an excisional biopsy.

References:
===========
1. Libman H. Generalized lymphadenopathy. J Gen Intern Med 1987;2:48-58.
2. Morland B. Lymphadenopathy. Arch Dis Child 1995; 73:476-9.
3. Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol 1993;20:570-82.
4. 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.
 HydragonWarrior - Sat Jan 14, 2006 1:08 am

Haha, been given the perfect bill of health. I got anxious over nothing, but it does give me peace of mind.

The lump on my neck I've had since childhood, and my doc verified it's nothing to be concerned about. Since i've had x-rays and the like previously on that area as a kid, that conclusion was already drawn that my gland was just like that. I'm guessing it might have been since I removed my tonsils - I dunno. But that was several years ago, and I guess I forgot what it was - I suppose it wasn't important to me cause I was a kid.

But I'm told I'm completely healthy and OK, and I feel much better mentally! And the sore throat was just a sore throat, and after some antibiotics it's pretty much gone.

Anyway, thanks for the fast reply, Doctor. Talking to my family doc eased my mind a lot.

Cheers!

-Hydragon

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