Swollen Lymph Nodes: Key Questions and Concerns

Cervical lymph nodes

Hello Dr.
Chen,
About a month ago, I discovered a painful swollen lymph node in the left submandibular triangular area.
After a week, I noticed another painful swollen lymph node in the right submandibular triangular area.
I have seen an ENT specialist, and I underwent endoscopy and ultrasound examinations.
Since the ultrasound showed no abnormalities, a fine needle aspiration was not performed.
The doctor informed me that the test results were normal and prescribed antibiotics, advising me to monitor the situation.
Currently, the lymph nodes feel like they have decreased somewhat in size and are no longer painful, although I do experience some discomfort when I touch them.
The sizes are approximately 0.8 cm and 0.9 cm, they are mobile, and have a firm texture.
I would like to ask the doctor a few questions:
1.
After a month, the lymph nodes have not completely resolved but seem to be slightly smaller than initially, and they do not appear to be enlarging.
Is this concerning (such as lymphoma or malignancy)? During this time, I have frequently touched them; could this have contributed to their swelling, or is it possible they have not fully resolved?
2.
I had two ultrasounds on the right side, one showing 0.8 cm and the recent one showing about 1 cm.
Is this an indication of growth, or could it be due to variations in the angle or precision of the ultrasound? Is this considered a reasonable range?
3.
Occasionally, I experience slight swelling and numbness on both sides of the mandible, but it resolves quickly.
I am unsure if this is related to the lymph node swelling and whether it is normal.
4.
Is there a possibility that my condition could be lymphoma or a malignant tumor? How can I differentiate between these conditions?
5.
The doctor advised me to monitor the situation.
How long should I observe before considering it stable?
I apologize for the numerous questions, as I have been quite worried about the lymph node issue recently.
Thank you for taking the time to address my concerns, and I appreciate your understanding.
Thank you.

Youren de ren, 30~39 year old female. Ask Date: 2020/06/21

Dr. Chen Sirong reply Oncology

Concerned individual / 38 years old / Male.
The lymph nodes feel reduced, with no pain.
1.
After a month, the lymph nodes have not completely disappeared but feel slightly smaller than initially; they do not seem to have increased in size.
Is this a bad sign (such as lymphoma or malignant tumors)? During this time, I frequently palpated them; could this have caused them to enlarge, or is it possible they haven't fully resolved? A: If they have reduced somewhat, it is less likely to be malignant, as malignancies tend to grow continuously.
Avoid frequent palpation, as it may stimulate further growth.
Self-examination once a week is sufficient.
2.
I had two ultrasounds on the right side; one showed 0.8 cm, and the recent one showed about 1 cm.
Is this an indication of growth, or could it be due to the angle or precision of the ultrasound? Is this within a reasonable range? A: The angle may affect the measurements; I recommend continued observation.
3.
Occasionally, I experience slight swelling and numbness on both sides of the jaw, but it resolves quickly.
I am unsure if this is related to the lymphadenopathy and whether it is normal.
A: If you have already seen a doctor, it should be fine.
As for the relationship with lymph node enlargement, I suggest not to overthink it.
4.
Is it possible that my condition could be lymphoma or a malignant tumor? How can I differentiate? A: It is not your responsibility to make that distinction; see a doctor every three to six months for evaluation.
5.
The doctor advised me to monitor the situation.
How long should I observe before considering it stable? A: Everyone should continuously observe their own body! If there are changes, you can consult a doctor, such as if there is enlargement or color change.
If there are no changes, you do not need to worry excessively.
Some lymph nodes may remain enlarged without any issues.
Wishing you good health and happiness.
Taoyuan Hospital, Dr.
Chen Sih-Rong.

Reply Date: 2020/06/21

More Info

Understanding swollen lymph nodes can be a source of anxiety for many patients, especially when they are accompanied by pain or discomfort. Based on your description, it seems you have been experiencing swollen lymph nodes in the submandibular area for about a month, with some improvement noted. Let’s address your concerns systematically.

1. Persistence of Swollen Lymph Nodes: It is not uncommon for lymph nodes to remain enlarged for some time after an infection or inflammation has resolved. The fact that your lymph nodes have decreased in size and are no longer painful is a positive sign. Lymph nodes can take weeks to months to return to their normal size after an infection. Constantly palpating the lymph nodes may cause some irritation, but it is unlikely to cause significant enlargement. As for your concern about lymphoma or malignancy, persistent enlargement is typically more concerning, especially if the nodes are hard, fixed, or associated with systemic symptoms like fever, night sweats, or unexplained weight loss. Given that your nodes are mobile and have decreased in size, this is reassuring.

2. Variability in Ultrasound Measurements: Variations in ultrasound measurements can occur due to several factors, including the angle of the ultrasound probe, the technique of the technician, and the inherent variability in the lymph node itself. A change from 0.8 cm to 1.0 cm is not necessarily indicative of significant growth, especially if the lymph node remains mobile and soft. It is essential to consider the overall clinical picture rather than focusing solely on size.

3. Sensation of Pressure or Tingling: The occasional sensation of pressure or tingling in the jaw area could be related to muscle tension, nerve irritation, or even the lymph nodes themselves. If these sensations are transient and not associated with other concerning symptoms, they are likely benign. However, if they persist or worsen, it would be advisable to discuss this with your healthcare provider.

4. Risk of Lymphoma or Malignancy: While the presence of swollen lymph nodes can be concerning, the characteristics you describe (soft, mobile, and decreasing in size) are more consistent with reactive lymphadenopathy rather than lymphoma. Lymphoma typically presents with firm, non-tender, and often fixed lymph nodes. If you have no systemic symptoms and your healthcare provider has reassured you after examinations, the likelihood of malignancy is low. However, if you have ongoing concerns, it may be worth discussing further imaging or a biopsy with your doctor.

5. Observation Period: The duration for which you should observe the lymph nodes can vary. Generally, if there is no significant change in size or symptoms over a period of 4 to 6 weeks, it is often considered stable. However, if you notice any new symptoms or changes in the nodes, it is crucial to follow up with your healthcare provider sooner.

In conclusion, while it is natural to feel anxious about swollen lymph nodes, the characteristics you describe suggest a benign process, likely related to a previous infection. Continue to monitor your symptoms, and maintain open communication with your healthcare provider. If you have any new concerns or if the lymph nodes change in character, do not hesitate to seek further evaluation. Your health and peace of mind are paramount.

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