Lymph Nodes

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Harmless and Concerning Findings

If a lymph node does not shrink for more than four weeks, feels hard when palpated, cannot be moved, and is usually not painful, a doctor should investigate the possible cause. If lymph nodes in the abdominal area swell, symptoms such as abdominal pain, digestive problems, nausea, and vomiting may occur. Sometimes, however, an affected lymph node may only appear as a small, hard lump.

Cancer cells—either originating directly in the lymph node from degenerated lymphocytes (lymphoma) or spreading to the lymph nodes from a primary tumor—multiply, displace healthy cells, and can form metastases. As a result, the lymph node swells and hardens.

If a lymph node is immobile, hard, painless, and possibly larger than 1.5 centimeters on ultrasound and has an altered shape, a biopsy may be used to determine the cause. This procedure carries risks: malignant cells may enter the bloodstream during the biopsy, and the tissue sample taken may not contain cancer cells by chance even though they are present elsewhere in the lymph node. Therefore, patients should always discuss carefully with their doctor whether this measure will be medically beneficial in their specific case. 

This becomes necessary whenever there is a strong suspicion of a tumor or when a lymph node does not shrink, even after antibiotic therapy, and no cause such as a dental infection can be identified. A strong suspicion of cancer is also supported by the presence of so-called B symptoms, such as weight loss, night sweats, possible fever, and/or loss of appetite.

The absence of a single lymph node does not impair the body’s immune defense. However, if several lymph nodes must be removed, immune function may be affected. To minimize surgical risks and consequences such as lymphedema, nerve damage, and restricted mobility, doctors remove only the so-called sentinel lymph node whenever possible. This is the lymph node closest to the primary tumor.

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