Lymph Node Swelling: When to Seek Further Evaluation

Q: Lymph Node Swelling: When to Seek Further Evaluation

Hello： After reviewing the first part of your description, it actually does not resemble the typical presentation of a true lymphoma patient that we usually encounter in our specialty (your symptoms of fever and sweating do not seem to fit). <br>Regarding the numerous small lymph

Multiple palpable lymph nodes?

Hello Dr.
Chen,
I can feel 2 to 3 lymph nodes, each about 1 cm in size, in my neck, just below my chin, which have been present for almost a month.
The one under my chin was discovered later.
On both sides of my groin (the left side is slightly larger, over 1 cm), there are several smaller nodes on the right side that have also been there for a month.
Additionally, I can feel one lymph node under 1 cm in each armpit.
This widespread lymphadenopathy is causing me significant concern.
Yesterday afternoon, my ear became red and warm for about an hour; I’m not sure if that constitutes a fever, but I did not experience chills or fatigue.
Last night, I also sweated a lot while sleeping, but my clothes were not completely soaked.
I wonder if this could be due to anxiety, although I feel relatively calm.

Two weeks ago, I visited a hematologist for tests, including X-rays and blood tests, and the doctor said everything was normal and advised me to continue monitoring.
However, I later discovered another lymph node under my chin that is 1 cm in size.

Could you please advise if the redness and warmth in my ear indicate a fever? I do not have a thermometer to measure my temperature.
If this were malignant, would I not have more significant lymphadenopathy? I have many 1 cm lymph nodes, some of which have been present for a month, but none are particularly large.
Previous doctors I consulted said they were not significant, so I have not undergone fine-needle aspiration or biopsy.

Should I request a biopsy if I go for further examination, or should I continue to monitor for any growth? Is it still acceptable to have many lymph nodes at this size? Thank you, doctor.

Mr. Hong, 20~29 year old female. Ask Date: 2015/08/22

Dr. Chen Yunfang reply Oncology

Hello: After reviewing the first part of your description, it actually does not resemble the typical presentation of a true lymphoma patient that we usually encounter in our specialty (your symptoms of fever and sweating do not seem to fit).
Regarding the numerous small lymph nodes on your body, it is generally accepted that lymph nodes with pathological changes are usually greater than 1 cm (the vast majority of actual lymphoma patients have lymph nodes measuring between 3-10 cm), and they tend to be firmer.
If lymph nodes appear suddenly and increase in size rapidly, often doubling in size over a short period, this would raise a high suspicion for lymphoma, warranting a biopsy.
Although you have many lymph nodes, they are not large enough to require immediate biopsy; therefore, I would recommend monitoring them for 2-3 weeks.
At that time, we can reassess their size.
If there is a significant increase, we will arrange for a biopsy; if they remain the same or decrease in size, we can continue to observe.
Thank you for your understanding.

Reply Date: 2015/08/22

More Info

When it comes to swollen lymph nodes, especially when they are present in multiple areas of the body, it is understandable to feel concerned. Lymph nodes can swell for a variety of reasons, including infections, inflammatory conditions, and malignancies. In your case, you have noted several lymph nodes that are around 1 cm in size in various regions, including the neck, groin, and axilla.
Firstly, the presence of lymph nodes that are 1 cm in size is not uncommon, and many people have lymph nodes that are palpable without any underlying serious condition. In fact, lymph nodes can react to infections or inflammation in the body, which is often a benign process. The fact that you have had recent evaluations, including X-rays and blood tests, which returned normal results is a positive sign. It suggests that there is no immediate evidence of a serious underlying condition.

Regarding your symptoms of redness and warmth in the ear, this could indicate a localized infection or inflammation, but without a fever or other systemic symptoms, it may not be a cause for alarm. Sweating at night can also be related to anxiety, infections, or other benign causes. However, if these symptoms persist or worsen, it would be wise to seek further evaluation.

In terms of monitoring your lymph nodes, the general recommendation is to observe them for changes. If they remain stable in size and there are no accompanying symptoms such as fever, significant weight loss, or night sweats, it may be appropriate to continue monitoring them. However, if you notice any increase in size, the development of new symptoms, or if your anxiety about the situation increases, it would be prudent to consult your healthcare provider again.

As for the need for a biopsy, this is typically reserved for lymph nodes that are larger than 2 cm, or if there are concerning features such as rapid growth, firmness, or associated systemic symptoms. Since your lymph nodes are around 1 cm and have been assessed by multiple doctors without significant concern, it may not be necessary to pursue a biopsy at this time. However, if you feel that your situation is changing or if you have persistent concerns, discussing the option of a biopsy with your healthcare provider could provide clarity.

In summary, while the presence of multiple swollen lymph nodes can be concerning, the context of your recent evaluations and the size of the lymph nodes suggest that they may be reactive rather than malignant. Continuous observation is often the best approach unless there are significant changes. If you experience any new symptoms or if your anxiety about the situation increases, do not hesitate to seek further medical advice. Your health and peace of mind are paramount, and it is always better to err on the side of caution when it comes to your health.

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