Which lymph node is not dangerous?
Reactive enlargement is the most common situation, and it has quite recognizable features.
- Appeared after a sore throat, cold, tooth inflammation, scratch or bite - that is, there is an obvious reason nearby
- Painful when pressed, soft-elastic, mobile, not fused to the skin
- Size is usually up to 1–1.5 cm
- Reduces within 2–4 weeks after recovery
- Located where lymph flows from the site of inflammation: submandibular for diseases of the teeth and throat, inguinal for wounds on the legs
- Several nodes of one group were enlarged at once, all of approximately the same size and movable
- In children and adolescents, such a picture after a viral infection is common and is not alarming in itself
It is useful to understand why a lymph node enlarges in the first place. This is not a breakdown, but normal operation: the node is a filter through which lymph passes from a certain area of the body, and when an infection occurs, immune cells quickly multiply in it. An increase means the system has worked. This is why lymph nodes in children can be palpated more often and more easily than in adults: their immunity encounters most infections for the first time.
When a node needs attention
The warning signs form a fairly recognizable picture, and are assessed together rather than individually. A single item on a list rarely means anything; a combination of two or three is already a reason to see a doctor without waiting for it to “resolve on its own.”
- Painless, dense, gradually grows and does not decrease longer than 4–6 weeks
- The size is more than 2 cm or several groups of nodes are simultaneously enlarged
- Fused with surrounding tissues, inactive
- Located above the collarbone, especially on the left, or in the axilla for no apparent reason
- Accompanied by fever, night sweats, weight loss, itching
- The density of the knot is closer to “rubbery” or rocky, rather than soft-elastic
- The nodule appears in a person who is immunocompromised or is receiving immunosuppressive drugs
- The liver and spleen are simultaneously enlarged or the general blood test is changed
- The node appeared without any previous infection, trauma or inflammation nearby
- The increase persists and increases against the background of the already administered course of antibiotics
- There is pressure from within: hoarseness, cough, difficulty swallowing, swelling of the arm or face
Separately, it is worth mentioning a rare but very characteristic sign of Hodgkin lymphoma: pain in enlarged lymph nodes a few minutes after drinking alcohol. It occurs infrequently, but in other conditions it almost never occurs, and it is worth telling your doctor about it if it is noticed.
Common symptoms that influence stage
In hematology, there are three common presentations that are assessed in every patient with suspected lymphoma. Their presence changes the stage designation and affects the choice of treatment, so the doctor asks about them in particular detail.
- Unexplained fever above 38 degrees, recurring without signs of infection
- Heavy night sweats - not “sweating a little”, but the need to change clothes and bedding
- Losing more than 10 percent of body weight in the last 6 months without changing diet or lifestyle
They are accompanied by two more signs that are not formally included in this list, but mean a lot. The first is skin itching without any rash, debilitating, often at night, not responding to conventional remedies. The second is rapid fatigue, disproportionate to the load. Both are nonspecific and occur in dozens of other conditions, but in combination with an enlarged lymph node they noticeably change the picture and speed up the examination.
Types of lymphomas
The word “lymphoma” does not mean one disease, but dozens of diseases with very different courses, treatment and prognosis. Therefore, the phrase “I have lymphoma” without indicating a specific option says almost nothing, and forecasts found on the Internet by a general name usually have nothing to do with a specific person.
- Hodgkin's lymphoma is a separate group with characteristic cells in the tissue of the node; is more common in young people and is one of the most curable cancers
- Non-Hodgkin's lymphomas are a large and heterogeneous group, combining dozens of variants with different courses
- Aggressive lymphomas grow quickly, produce vivid symptoms and require immediate treatment
- Slow-onset lymphomas may not produce symptoms for years; they are not always treated immediately, but are monitored for many years
- Some slow-moving forms are capable of becoming aggressive over time, and this is what is monitored during observation
- Some gastric lymphomas are associated with Helicobacter pylori infection and respond to its treatment at an early stage
- Separately, lymphomas of the skin, stomach, central nervous system and other extranodal forms are distinguished
- Some lymphomas come from one type of cell, some from another, and this also determines the choice of drugs
- The stage is indicated by a number from the first to the fourth, but with lymphomas, the fourth stage does not mean hopelessness: it speaks of the prevalence, not the outcome
Extra-nodal forms are worth highlighting separately, because they do not give the usual picture of an enlarged node on the neck. Lymphoma of the stomach is manifested by heaviness, pain and loss of appetite and is detected by gastroscopy; skin lymphoma - persistent spots and plaques that are treated for years like eczema or psoriasis. The diagnosis in such cases is made by biopsy of the affected organ, and that is why, with persistent, untreatable changes, doctors return to the question of a biopsy.
How to make a diagnosis
The examination solves two problems in turn: first, to establish that it is lymphoma and what variant it is, then to determine how widely the process has spread. The first is done by biopsy, the second by imaging methods. It is impossible to skip the first stage and start treatment based on CT data.
- Осмотр всех групп лимфоузлов, печени и селезёнки.
- Общий и биохимический анализ крови, ЛДГ, показатели воспаления.
- Анализы на ВИЧ, гепатиты B и C, при показаниях — на вирус Эпштейна — Барр.
- УЗИ лимфоузлов и органов брюшной полости, рентген или КТ грудной клетки.
- Биопсия лимфоузла: удаление узла целиком с гистологическим и иммуногистохимическим исследованием. Это единственный способ поставить диагноз и определить вариант лимфомы.
- ПЭТ-КТ для оценки распространённости процесса и последующего контроля ответа на лечение.
- Трепанобиопсия костного мозга при необходимости.
- Оценка работы сердца, лёгких и почек до начала лечения — от неё зависит выбор схемы.
- Пересмотр гистологических препаратов опытным специалистом при малейших сомнениях: варианты лимфом различаются тонко, и от точности зависит вся дальнейшая тактика.
The common fear that a biopsy will “disturb” the tumor and accelerate its growth has not been confirmed. Delay brings incomparably more harm: months of observation and courses of antibiotics “just in case” for a growing painless node remain the most common reason for a late diagnosis.
Treatment and prognosis
Treatment of lymphomas is one of the most successful areas of oncology, and this is not a comforting statement, but a statistic. The regimen is selected for a specific option and stage, and the effectiveness is assessed as treatment progresses, usually after the first few courses, and if necessary, the tactics are changed.
- Chemotherapy according to protocols selected for a specific type of lymphoma
- Immunotherapy with monoclonal antibodies that target tumor cells
- Radiation therapy to affected areas
- High-dose therapy with transplantation of one's own stem cells in case of relapse
- Observational tactics for slowly occurring forms without symptoms
- Cell therapy for relapses of certain variants is a direction that has been actively developing in recent years
- Surgical treatment for lymphomas is almost never used: surgery is needed for a biopsy, not to remove the tumor
- Accompanying treatment: prevention of infections, support of blood counts, control of side effects
- Discussion of fertility preservation issues before starting therapy - for young patients this is a separate and important stage
The prognosis depends on the variant, stage, age and how the disease responded to the first courses of treatment. With Hodgkin's lymphoma, complete recovery is achieved in most patients, including those with advanced stages. Among non-Hodgkin's lymphomas, the results vary more widely, but even there, a significant part of the aggressive forms are cured, and the slow ones are successfully controlled for years.