Tuesday, December 21, 2010

When To Be Concerned About Lymph Nodes

Lymphoma is a disease of white blood cells called lymphocytes, usually the particular type known (as in the case of follicular lymphoma) as B-cells. It typically begins as painless, firm or hard swelling of one or more lymph nodes. The lymph nodes, popularly (and incorrectly) known as "glands," are components of the immune system. There are hundreds around the body, but the most easily felt ("palpable") nodes can be found in the neck, the armpits, and the groin. Swollen lymph nodes are extremely common, and are almost always an indication that the body is fighting off an infection. Lymphoma is only one (uncommon) explanation for swollen lymph nodes. In some cases, lymph nodes are permanently swollen after an infection and never shrink again. Frequently poking and prodding at swollen lymph nodes may prevent them from shrinking normally.

It is difficult to identify a set of characteristics which automatically indicate or rule out lymphoma as a cause of swollen lymph nodes. In general, healthy nodes are more likely soft; cancerous nodes are more likely firm, rubbery, or hard. Multiple nodes are more concerning than single nodes, especially if they are dispersed through multiple node regions (see the image below).



Nodes that keep growing are more worrying than nodes that remain the size, and nodes that shrink are most reassuring of all. Nodes that feel tender or warm to the touch are more often caused by infections. Doctors may be more inclined to dismiss nodes in younger patients, since lymphoma usually occurs only in older people.

Size also does not necessarily indicate lymphoma, although it is a common indicator of when further investigation is necessary. Nodes less than 1 cm (under half an inch) are usually dismissed by doctors as normal and unconcerning. Nodes that are more than 2 cm long are most worrying. While such large nodes are still usually benign, doctors usually attempt to identify the cause of large nodes quickly, in order to rule out serious disease.

As a general rule, you should not attempt to decide for yourself whether an enlarged lymph node is enlarged; instead, report the matter to your doctor, and seek a second opinion if you are not reassured. Doctors who suspect underlying conditions will order tests, usually beginning with a chest X-ray or a complete blood count (CBC), or both. They will be particularly concerned if you also report other systemic symptoms, including a long flu-like illness, fatigue, and the classic constitutional or "B" symptoms of lymphoma: drenching night sweats, a fever, and/or unexplained weight loss (typically defined as more than 10% of total body weight in less than 6 months).

In rare cases, lymphoma can also be first noticed in other sites around the body. This is referred to as "primary follicular lymphoma of the gastrointestinal tract," "primary follicular lymphoma of the small intestine," and so on. These are very uncommon presentations, but there are published case reports of lymphoma beginning in the fallopian tubes, the digestive tract, the small intestines, the testes, the bile duct, the lining of the brain, the eye, and the skin. It is much more common for follicular lymphoma to begin in the lymph nodes and spread to other sites of the body than the other way around, however.

As the disease progresses, cancerous cells spread to all the sites around the body which the immune system normally reaches -- which is to say, pretty much all of the body. In advanced (Stage IV) disease, it can invade the bone marrow and proliferate there, eventually reaching threatening levels. Because most follicular lymphoma diagnoses do not occur until the disease is advanced, many people already have bone marrow involvement at diagnosis.

In all cancers, localized disease is easier to treat than disseminated (metastatic) disease, and uncompromised bone marrow is always preferable to compromised bone marrow. Having said that, the spread of lymphoma is always less concerning than the spread of other solid tumours, such as lung cancer, breast cancer, or stomach cancer. This is because B-cells in the immune system are expected to migrate around the body normally, and chemotherapy is generally effective in treating them, even in the bone marrow. In contrast, it is far more concerning when cancerous cells from the lungs or another organ migrate to distant and abnormal locations, including the bone marrow.

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  3. My lymph node decreases in size if I don't touch it but it doesn't go completely.. When will it go completely I'm afraid.. Please help me

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  4. My lymph node decreases in size if I don't touch it but it doesn't go completely.. When will it go completely I'm afraid.. Please help me

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