Persistent Lymph Nodes: Autoimmune Disease or Cancer Risk?

The lymph nodes have been swollen for nearly three years?

Hello doctor, I was diagnosed with an autoimmune disease - multiple sclerosis two to three years ago.
I started receiving interferon treatment in July 2013.
In November of the same year, I experienced full-body itching for several days, during which my skin was also very dry.
Later, I discovered a lymph node under my right armpit that is less than one centimeter, and a mass in my right groin area that is no more than two centimeters.
Both are elastic, smooth, movable, and painless, and they have not increased in size since then.
During this time, I consulted with a dermatologist and my neurologist, and they both said it likely wasn't a significant concern and would resolve soon, but it has been several years and I want to know why they haven't disappeared.
Is there a possibility that this could be cancer, or is it related to my autoimmune disorder? Additionally, should a biopsy be performed?

Annie, 20~29 year old female. Ask Date: 2016/06/18

Dr. Lai Yicheng reply Oncology

Dear Miss Annie,
Thank you for your letter.
In response to your inquiry, are you very thin? In thin patients, it is sometimes possible to palpate the inguinal or cervical lymph nodes.
If the lymph nodes have not continued to enlarge over the past 2-3 years, they are likely benign lymphadenitis.
However, if you are still concerned, a biopsy is recommended.
Wishing you all the best,
Dr.
Lai Yi-Cheng
Department of Radiation Oncology
Changhua Hospital

Reply Date: 2016/06/18

More Info

Understanding persistent lymph nodes in the context of autoimmune diseases and the potential risk of cancer is a complex issue that requires careful consideration of various factors. Given your history of multiple sclerosis (MS) and the presence of lymph nodes that have remained stable over the years, it is important to approach this situation with a clear understanding of what these findings may indicate.

Firstly, lymph nodes are an integral part of the immune system, and their enlargement can occur for a variety of reasons, including infections, inflammatory conditions, and malignancies. In your case, the lymph nodes you mentioned—located in the axilla (armpit) and groin—are described as being elastic, smooth, mobile, and non-tender. These characteristics are generally reassuring and suggest that the lymph nodes are likely reactive rather than malignant. Reactive lymphadenopathy can occur in response to infections or other immune system stimuli, and it is not uncommon for lymph nodes to remain palpable even after the initial cause has resolved.

The fact that these lymph nodes have not increased in size over the past few years is also a positive sign. In general, lymph nodes that are stable in size and do not exhibit other concerning features (such as hard consistency, fixed position, or associated systemic symptoms like weight loss or fever) are less likely to be malignant. However, it is essential to remain vigilant, especially given your autoimmune condition, which can sometimes complicate the clinical picture.

Regarding your concerns about cancer, while it is understandable to be anxious about the possibility, the likelihood of malignancy in stable, non-tender lymph nodes that have not changed over several years is relatively low. Autoimmune diseases, including multiple sclerosis, can lead to various immune responses that may cause lymphadenopathy. However, the persistence of lymph nodes does not automatically imply cancer. It is crucial to consider the overall clinical context, including any other symptoms you may be experiencing and your medical history.

As for the question of whether a biopsy is necessary, this decision typically depends on several factors, including the characteristics of the lymph nodes, your clinical history, and the judgment of your healthcare provider. If your doctors have assessed the lymph nodes and deemed them to be benign based on their examination and your history, they may recommend a watchful waiting approach rather than immediate biopsy. However, if there are any changes in the characteristics of the lymph nodes or if you develop new symptoms, further evaluation, including a biopsy, may be warranted.

In conclusion, while the presence of persistent lymph nodes can be concerning, the characteristics you described suggest that they are likely benign, especially given their stability over time. It is essential to maintain regular follow-ups with your healthcare providers, who can monitor your condition and provide guidance based on any new developments. If you have ongoing concerns or if there are changes in your health, do not hesitate to seek further evaluation. Regular communication with your healthcare team is key to managing your health effectively, especially in the context of an autoimmune disease.

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