Enlarged Lymph Nodes: Causes, Concerns, and Next Steps

Abnormal lymphadenopathy?

Hello Dr.
Chen,
Three weeks ago, I noticed swelling of the lymph nodes on both sides of my lower jaw where it connects to my neck.
It is not visible externally, but I felt pain when I looked down, which is how I discovered it.
Initially, there was tenderness upon touch, and the lymph nodes were mobile.
They are not hard, more like firm.
I visited a hospital where a doctor performed a physical examination, a nasopharyngoscopy, and an ultrasound.
The left lymph node measures 0.8 cm, and the right one is 0.9 cm.
The doctor initially diagnosed it as benign lymphadenopathy and prescribed antibiotics.
Currently, the pain has decreased, and they feel slightly smaller (upon touch), but the difference is not significant.
They remain mobile.
The doctor has scheduled a follow-up ultrasound in three months.
I have a few questions for you, Dr.
Chen:
1.
It has been over three weeks, but the lymph nodes have not completely disappeared.
What could be the reason for this? Is there a possibility they could develop into lymphadenitis or lymphoma?

2.
Occasionally, I experience sharp or aching pain in the lymph node area or on both sides of my lower jaw, but it resolves quickly.
I am unsure of the cause.
Could it be related to my touching them, or is there a concern for a more serious tumor?
3.
I am quite worried about the possibility of lymphoma or a malignant tumor.
Based on my current situation, is there a likelihood of lymphoma, and how can I differentiate it?
4.
I am continuing to monitor the situation, but I am concerned that frequent touching may cause the lymph nodes to remain swollen.
How often should I observe them?
I apologize for having so many questions, but I am truly anxious.
Thank you for helping me address my concerns.

Fanxin de ren, 30~39 year old female. Ask Date: 2020/06/18

Dr. Chen Sirong reply Oncology

1.
It's been over three weeks, but the lymph nodes have not completely disappeared.
What could be the reason? Could it turn into lymphadenitis or lymphoma?
A: In some individuals, enlarged lymph nodes may not return to their normal size.
This is a possible scenario; if there is no change in size or color, you can continue to monitor it.
If there is an increase in size or a change in color, you should see a doctor.
2.
Sometimes I experience sharp or aching pain in the lymph area or on both sides of my jaw, but it goes away quickly.
I'm not sure what the cause is.
Could it be related to my touching it, or is it a sign of a serious tumor?
A: I cannot provide a specific reason.
If the pain resolves quickly, it is likely not a concern.
However, if the pain persists or the frequency increases to the point of affecting function, you should consult a doctor.
3.
I am really worried about the possibility of lymphoma or a malignant tumor.
Can you tell me if my current situation suggests lymphoma, and how can I differentiate it?
A: Worrying is not helpful; the only way to determine this is through a doctor's examination.
It is not possible to self-diagnose.
If there are changes in size or color, you should see a doctor.
4.
I am currently monitoring the situation, but I am concerned that constant touching may cause the lymph nodes to remain enlarged.
How often should I observe them?
A: There is a suggestion that frequent touching may contribute to persistent enlargement of the lymph nodes.
I recommend that you observe them once a week.

Reply Date: 2020/06/18

More Info

Hello! It sounds like you have a lot of concerns regarding the enlarged lymph nodes you've been experiencing. Let's break down your questions and provide some clarity on the situation.

1. Why are the lymph nodes still enlarged after three weeks?
Lymph nodes can remain enlarged for several reasons. In your case, since you mentioned that you had a recent infection (which is common), the lymph nodes may still be responding to that infection. Lymph nodes can take time to return to their normal size after an infection or inflammation. The fact that they are soft and mobile is a good sign, as these characteristics are typically associated with benign conditions. However, if they do not decrease in size over time or if they continue to grow, further evaluation may be warranted. The risk of developing an abscess (lymphadenitis) or lymphoma is generally low, especially if the nodes are responding to antibiotics and showing signs of improvement.

2. What about the pain and tenderness?
The pain you are experiencing could be due to several factors, including inflammation in the lymph nodes or surrounding tissues. Touching or manipulating the lymph nodes can also cause temporary discomfort or pain. If the pain is transient and resolves quickly, it is likely not a cause for concern. However, if you experience persistent or worsening pain, it would be wise to consult your healthcare provider.

3. Concerns about lymphoma or malignancy:
It's completely normal to worry about the possibility of lymphoma or other malignancies when dealing with enlarged lymph nodes. However, the characteristics you described (soft, mobile, and responsive to antibiotics) are more indicative of a benign process, such as reactive lymphadenopathy due to infection. To differentiate between benign and malignant conditions, doctors often consider factors such as the size, consistency, mobility, and tenderness of the lymph nodes, as well as any associated symptoms (like fever, night sweats, or weight loss). If your doctor has assessed the nodes and believes they are benign, it is likely that they are not overly concerned about lymphoma at this stage.

4. Observation and follow-up:
Your doctor has recommended a follow-up ultrasound in three months, which is a standard approach for monitoring enlarged lymph nodes that are suspected to be benign. It is essential to avoid excessive manipulation of the lymph nodes, as this could potentially cause irritation or inflammation. If you are feeling anxious about the situation, it might be helpful to discuss your concerns with your doctor, who can provide reassurance and possibly adjust the follow-up schedule if necessary.

In summary, while it is understandable to be concerned about enlarged lymph nodes, the signs you have described suggest a benign process, likely related to a recent infection. Continuing to monitor the situation with your healthcare provider is the best course of action. If you notice any significant changes, such as increased size, persistent pain, or new symptoms, do not hesitate to reach out to your doctor sooner than the scheduled follow-up. Remember, open communication with your healthcare provider is key to addressing your concerns and ensuring your peace of mind.

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