When do swollen lymph nodes mean cancer

If your doctor thinks your swollen lymph nodes could be cancer, tests and imaging can confirm the diagnosis or point to something else. Based on where the cancer might be, you could get a chest X-ray, an ultrasound, a CT scan, or an MRI. A scan called FDG-PET, which stands for fluorodeoxyglucose with positron emission tomography, can help find lymphoma and other cancers. And you’ll probably get a biopsy. They’ll take either a sample of cells from a node, typically using a needle, or remove a whole node. The sample gets sent to a lab so a specialist can check it with a microscope for cancer.

When Do Swollen Lymph Nodes Mean Cancer?

When you have swollen lymph nodes, your first thought shouldn’t be, “I have cancer.” They’re much more likely to be caused by infections or a disease that affects your immune system, and they will often clear up as your body heals.

But sometimes, cancer cells will travel through your bloodstream and end up in your lymph nodes, or even start there.

Your doctor can help you figure out what’s causing the changes in your body.

Why Lymph Nodes Swell

There are more than 600 small, kidney bean-shaped lymph nodes in clusters throughout your body — under your neck, in your armpits and groin, and in the middle of your chest and belly. These store immune cells and act as filters to remove germs, dead and damaged cells, and other waste from your body.

Swollen lymph nodes are a sign that they’re working hard. More immune cells may be going there, and more waste could be building up. Swelling usually signals an infection of some kind, but it could also be from a condition like rheumatoid arthritis or lupus, or rarely, cancer.

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Often, swollen lymph nodes will be close to where the problem is. When you have strep throat, lymph nodes in your neck may swell. Shingles will cause swollen lymph nodes in the area where the rash breaks out.Women who have breast cancer may get swollen lymph nodes in their armpit.

When several areas of lymph nodes are swollen, that suggests the problem is throughout your body. It could be something like chickenpox, HIV, or a cancer such as leukemia or lymphoma.

When to See a Doctor

You’ll often have a good idea why a lymph node is swollen — you’ve got a cold, your tooth is infected, or you have a cut that isn’t healing well. If you can’t come up with an explanation, it may be time to get checked out.

Lymph nodes that are around 1/2 inch or bigger aren’t normal. They shouldn’t feel hard or rubbery, and you should be able to move them. The skin over them should not be red, irritated, or warm. And the swelling should go away within a couple of weeks. You should see your doctor if your lymph nodes appear abnormal.”

Other symptoms are also a reason to make an appointment:

• Trouble breathing or swallowing
• Night sweats
• Fever that doesn’t break
• Losing weight without trying to
• Fatigue

Getting a Diagnosis

Your doctor will probably try to rule out reasons other than cancer first. They’ll do a physical exam and ask about things that have happened, like if you’ve:

• Been scratched by a cat
• Been bitten by a tick
• Eaten undercooked meat
• Had risky sex or injected street drugs
• Traveled to certain places or areas

They’ll want to know what medications you’re taking and other symptoms you have.

Swollen nodes that are close to your collarbone or the lower part of your neck when you’re over 40 are more likely to be cancer. On the right side, related to the lungs and esophagus; on the left, organs in your belly. Swollen lymph nodes in your armpit when you don’t have a rash or sores on your arm can also be suspect.

If your doctor thinks your swollen lymph nodes could be cancer, tests and imaging can confirm the diagnosis or point to something else. Based on where the cancer might be, you could get a chest X-ray, an ultrasound, a CT scan, or an MRI. A scan called FDG-PET, which stands for fluorodeoxyglucose with positron emission tomography, can help find lymphoma and other cancers. And you’ll probably get a biopsy. They’ll take either a sample of cells from a node, typically using a needle, or remove a whole node. The sample gets sent to a lab so a specialist can check it with a microscope for cancer.

Otherwise, you’ll usually start with a complete blood count (CBC) to get a picture of your general health as well as more detailed information about your white blood cells, which fight infection. Depending on your other symptoms and your history, your doctor may want additional blood tests or x-rays, too.

If these tests don’t show another cause and the swollen nodes don’t go away in 3-4 weeks, your doctor will probably do a biopsy. Since the swelling will often go away or another cause will be found while you’re waiting to do a biopsy, the delay prevents people from getting procedures they don’t need. And even if it is cancer, you should still be able to treat it effectively.

When you have swollen lymph nodes throughout your body, your doctor will ask for a CBC, a chest X-ray, and an HIV test. If these are normal, you might get other tests, perhaps for tuberculosis or syphilis, an antinuclear antibody test (which checks your immune system), or a heterophile test (for the Epstein-Barr virus). The next step is a biopsy of the most abnormal node.

What Does Cancer in a Lymph Node Mean?

Cancer in your lymph nodes may point to lymphoma or another blood cancer, or may be a cancer that has spread from another site.

Based on the source of the cancer cells and how far away that is from the swollen nodes, your doctor will recommend a treatment plan. It could include surgery, radiation, or chemotherapy, or a combination of treatments.

Show Sources

Insight, Dana-Farber Cancer Institute: “If My Lymph Nodes Are Swollen, Do I Have Cancer?”

Cleveland Clinic: “Swollen Lymph Nodes.”

Mayo Clinic: “Swollen lymph nodes.”

JAMA Oncology: “Lymph Nodes and Lymphadenopathy in Cancer.”

American Cancer Society: “Lymph Nodes and Cancer.”

UpToDate: “Evaluation of peripheral lymphadenopathy in adults.”

Leukemia & Lymphoma Society: “Imaging Tests,” “Blood Tests.”

When do swollen lymph nodes mean cancer?

The simplest answer would be – hard to say! While some general indications are there, these are not enough to confirm or rule out cancer. There are some physical markers in which case cancer is suspected. The lymph node could be large in size, irregular in outline, firm or hard, or rubbery or not very mobile. However, these are not enough to confirm cancer. In the same way, absence of such markers does not mean, there is no cancer. That is why more tests are done to confirm or rule out cancer(s).

To know more about this, we need to understand what is the lymphatic system is and how does it work?

What is the lymphatic system?

Among all the body-systems, people have the least awareness about the lymphatic system. Yet it’s one of the most important systems for our overall health and well-being. It’s part of the body’s immune system and is responsible for maintaining a good level of immunity against disease.

The lymphatic system primary consists of thin, tubular, vein-like ‘lymph vessels’, in which a thin, clear fluid called the ‘lymphatic fluid’ flows, and small, kidney-bean shaped, lymph nodes. Clusters of lymph nodes are present throughout the body. They are close to the surface of the skin, behind the ears (auricular lymph nodes), in the neck (cervical), near the collar-bone (supraclavicular), upper chest (subclavian), chest (pectoral), at the armpits (axillary), at the elbow (epitrochlear) and the groin (inguinal). These can be felt to the touch by a doctor. Other than these, there are several clusters deep inside the body which cannot be seen or felt. Overall, there are approximately 600 clusters estimated to be present in a normal, healthy, adult human body.

Why do lymph nodes swell up?

The working of the lymphatic system can be best understood by comparing it with the criminal-policing system. The lymph vessels are like the highway in which white blood cells, that act as patrol police, flow through. Pathogens like viruses and bacteria, cancerous cells and other toxic materials are like criminals that get onto the highway and try to harm the body. That is, invading cells attach themselves or penetrate blood vessels and lymph vessels in an attempt to harm the body.

If white blood cells (patrol police) are not able to destroy the infiltrating pathogens, they are able to get away but eventually arrive at check-points called lymph nodes. Here, more white blood cells (more police) try to attack or stop the invaders, causing a build-up of cops and criminals – white blood cells and invading cells at the lymph node. That is when, or that is why, the lymph node gets swollen up. It’s a clear indication that there are invaders – infections or disease-causing pathogens in the body. (You may remember doctors trying to feel the underside of your throat when you have a fever. They are basically looking for swollen cervical lymph nodes.)

That is why the lymph vessels, lymphatic fluid and lymph nodes are compared to filters as they filter out invading pathogens. They are also compared to sewerage drains as they drain out the waste in the body. This is because the lymph vessels generally drain into blood vessels, from where the waste material is transported by blood to the liver and kidneys (sewage treatment plants) for breakdown and elimination.

The clusters of lymph nodes are distributed throughout the body, in order to filter out invading cells in the vicinity, which makes perfect sense. So if lymph nodes in the throat are swollen, it’s an indication of cold or viral infections, if swollen in the groin area, an indication of sexually transmitted disease, etc. In exactly the same way, cancerous cells in the proximity of a cluster of lymph nodes will cause that cluster to swell up. However, every lymph node swelling is not cancer and there are many conditions that cause this.

Conditions that cause lymph node swelling

Common infections

• Ear infections
• Infected or abscessed tooth
• Measles
• Strep throat
• Skin or wound infections like cellulitis
• Mononucleosis, a condition caused by the Epstein-Barr virus
• Human immunodeficiency virus (HIV) which causes AIDS

Uncommon infections

• Tuberculosis
• Toxoplasmosis: an infection caused by parasites that enter the body subsequent to contact with the feces of an infected cat or from eating undercooked meat
• Sexually transmitted infections like syphilis
• Cat scratch fever: a bacterial infection caused by a cat scratching or biting the person

Immune system disorders

• Lupus: marked by chronic inflammation in the heart, lungs, kidneys, joints, skin and blood cells
• Rheumatoid arthritis: marked by chronic inflammation of the synovium, a tissue that lines our joints

Cancers

• Lymphoma: here the cancer has originated in the lymphatic system itself
• Leukemia: cancer of the tissues that form blood – such as the bone marrow, and lymphatic system
• Metastasized cancers: Cancers that started in other organs or parts of the body and spread to the lymph nodes

Also Read: Chemotherapy and its role in cancer treatment

Diagnosis and Treatment

• Personal medical history: The doctor will try to understand when and how the lymph nodes got swollen, and check other signs and symptoms.
• Family medical history: The doctor will want to know if you or any of your family members have a history of cancer or any of the conditions listed above
• Physical examination: The doctor will look at and feel the size, texture, warmth and tenderness of the lymph nodes near the skin.
• Blood tests. A complete blood count (CBC) and other targeted tests are done to check for specific underlying conditions such as infections or leukemia.
• Imaging tests: An X-ray or CT scan of the affected area is done to identify possible sources of infection, or detect tumors.
• Lymph node biopsy: If none of the above tests are conclusive, the doctor may order for a biopsy of one or more swollen lymph nodes. A small sample of tissue from such nodes are extracted using a fine needle and examined under the microscope.

Treatment options vary depending on the underlying conditions. Common infections are treated by antibiotics, OTC drugs and home-remedies. Uncommon infections and immune disorders are treated by drugs and therapies that are targeted at them. Cancers are treated through multiple options such as radiation, chemotherapy and surgery.

Outlook

If you or any of your dear ones are showing swollen lymph nodes or any other symptoms of disease, do not panic. Rush to a reputed hospital. Here, specialists will conduct the required tests, diagnose the condition precisely and prescribe the right course of treatment for quick recovery and rehabilitation.

Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem and Bengaluru, the hospital also renders adult and pediatric trauma care.

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