Hodgkin lymphoma often develops in people between the ages of 16 and 34. These younger patients are usually otherwise healthy. Because of this, their bodies can withstand the disease without showing any symptoms for a long period of time. Although these symptoms are common for people who have Hodgkin lymphoma, most people who have these symptoms do not have Hodgkin lymphoma. They often have another reason for the symptoms.
Other times, the only symptom will be painless swelling of the lymph nodes usually in the neck or under the arm, as well as in the upper chest, abdomen and groin. Patients often visit a physician because of this swelling, which eventually leads to a diagnosis.
Other symptoms vary from person to person and may include:
- Pain in the swollen lymph nodes after drinking alcohol.
- Heavy night sweats, with or without a fever.
- Fever or chills at night or during the day.
- Unexplained weight loss.
- Loss of appetite.
- Fatigue or lack of energy.
- Dry, itchy skin.
- A widespread, red rash.
- Cough and shortness of breath or chest discomfort caused by a large lymph node mass in the chest.
- An enlarged liver or spleen.
These symptoms do not always mean you have Hodgkin lymphoma. However, it is important to discuss any signs with your doctor, since they may signal other health problems.
Almost everyone will experience a swollen lymph node at some point. That’s because these structures are designed to filter germs and other impurities from the body.
Lymph nodes become swollen as they trap viruses, harmful bacteria and damaged cells, then attempt to destroy them with lymphocytes, the white blood cells that fight off infection.
But swollen lymph nodes can also be a sign of cancer, including a type of blood cancer called lymphoma. So, when are swollen lymph nodes just a sign of infection, as opposed to a symptom of lymphoma? We checked in with lymphoma and myeloma specialist Felipe Samaniego, M.D.
How often do swollen lymph nodes appear as the first sign of lymphoma in undiagnosed patients?
That’s kind of hard to say. By the time we see most patients here at MD Anderson, they’ve already been diagnosed elsewhere or been told there’s a strong possibility that whatever it is that they have is cancer.
That being said, in the greater community, swollen lymph nodes among undiagnosed patients tend to fall into one of two categories:
- Lymph nodes that patients notice or that a doctor sees or feels during a physical exam
- Lymph nodes that are found during an MRI or a CT scan because the patient is complaining of something else, such as chest pain or a lump in their breast
What are the most common places in the body where swollen lymph nodes occur as a sign of lymphoma?
Most will be in the neck, because the mouth and throat — or oropharyngeal tract — are the main gateway for things to get inside our bodies. So, we need to have a good defense system there.
But patients can find swollen lymph nodes in other places, too — especially where they lie close to the skin’s surface, like the groin area (where the leg meets the trunk) and the axilla, or armpit.
Lymphoma is actually detected pretty frequently during mammograms, because the field of view also covers the armpit, so it reveals swollen lymph nodes in that area.
Occasionally, patients may develop swollen lymph nodes all over their bodies, but this is relatively rare.
Is there a way to tell the difference between cancerous swollen lymph nodes and non-cancerous ones?
Anyone who’s really concerned about a swollen lymph node should go see their doctor. But here are some general guidelines:
- Size: Lymph nodes are made to change in size because they’re doing a job. They grow larger as the number of cells caught inside of them increases and shrink back down to normal as that number drops. But the normal size of an average lymph node is under 1.5 centimeters, or about ¾ of an inch or smaller. So, if something is larger than that or growing continuously, it needs to be checked out.
- Age: Infections are a frequent cause of swollen lymph nodes among young people. So, if you’re a teen or a college student, my first thought would be something like strep throat or mononucleosis. Cancer is more likely in older people, though I’d still want to rule out an infection first. Even among older groups, probably less than half the people who have swollen lymph nodes will have them because of cancer.
- Consistency: Press the tip of your nose with your finger and you’ll have a pretty good idea of what a typical lymph node should feel like. Tumors tend to be harder and more solid, like what you’ll feel if you push on your chin with your finger.
- Sensitivity: Some people think cancer always hurts, but that’s not true. Tenderness tends to be a sign of an infectious process, because the immune system has been challenged. But lymph nodes that are swollen due to lymphoma are usually not painful.
What are other common symptoms of lymphoma?
In lymphoma’s earliest stages, patients often report itchy, inflamed skin or unexplained rashes. In more advanced cases, where patients have large tumors, we start seeing weight loss, fevers, night sweats, and fatigue. Some experience painful muscle aches after drinking alcohol, too, though that is fairly unusual.
When should someone see their doctor about a swollen lymph node?
Swollen lymph nodes usually just mean your body is working the way it’s supposed to. But if a swollen lymph node keeps getting bigger or doesn’t resolve on its own within two weeks, get it checked out.
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