Lymph Node Questions

[gibson64]

I am a 29 year old thin male in good health. About 11 years ago I discovered "lymph nodes" all over my body.  For example, I found my inguinal nodes (a few on each side from a small pea to 1.3 cm), my submandibular nodes (two on each side up to 1.3 cm and <1 cm), my preauricular nodes (< 1 cm), and my axillary nodes (discussed further below).  I also believe I have one on my right shoulder blade (<1 cm) if there is such a thing.  I'd have to consider them all to be kind of "rubbery" although they are definetely "flat" (i.e., I wouldn't consider them round or filled with fluid).  They have not really changed over the last 11 years with the exception of a couple new small ones on my left inguinal region popping up. This whole time (11 years) I have feared and indolent lymphoma and was always too scared to go to the doctor.  But, recently I finally did (in fact I went to my GP, a dermatogolist [for other reasons but he felt my nodes nonetheless], and a thoracic surgeon [friends dad] who's been practicing for 30 years).  They all said they could feel them but none felt "pathological".  The problem is, this seems contrary to what is on the internet which states you should not be able to feel your lymph nodes.  Also, I feel like I have big "lumps" in my armpits (I can feel smaller nodes up to 1.3 cm but feel bigger lumps very very deep) so I am still concerned.  Questions are:

1)  How easy is it for a doctor to "find" axillary lymph nodes?  Meaning, I know exactly where to look for my lumps and bumps because I've looked the last 11 years and I'm feeling things they can't.  Should I trust that they would have been able to feel irregular axillary lymph nodes and perhaps I'm not even feeling lymph nodes (muscles/tendons)?

2)  Can you normally palpate all lymph nodes in healthy adults if you really tried?  I was told because I am thin and "in shape" that they are easier to find.

3)  I may just bite the bullet and go get a CT scan or ultrasound on my own nickel [since the doc's won't give me a presciption] to put my mind at ease.  Ultrasound is much cheaper, but is it "accurate enough" to detect abdominal and/or axillary lymph nodes.  Note that I have also been having general upper right and left abdominal pain for the past 6 months...

4)  Finally, I'm sure 90 percent of this is in my head (other than the axillary area which I know there are large "things" but who knows if they are lymph nodes)...I also know "lymph nodes" are a common hypochondria for people.  After three doctor's and 11 years, is it pretty safe to say that it's all in my head?  

Thanks for any opinions.

[Kevin Pho, MD]

To answer your questions:
1) Larger nodes can be felt during a physical exam.  Smaller nodes may require imaging studies - like an ultrasound or CT scan.

2) A thinner body habitus would make it easier to palpate lymph nodes.  However, some of the smaller nodes may escape detection by palpation.

3) There is no test that can detect nodes with 100% sensitivity.  In general a CT is more sensitive than ultrasound.  The ultrasound is more sensitive than a physical exam.

4) I can't comment about that over the internet.  However, going to 3 physician opinions would make problems with the lymph nodes less likely.  You can consider obtaining a blood count - which can be abnormal if there is lymph node disease.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[mike1105]

kevin--- i am a dentist, not an MD, but I have experience with patients and, of course, their psyches and their phobias. It certianly sounds to me like you are a hypochondriac. you've been palpating your nodes for years....???  Why??? Because of something you, as a non-doctor, read somewhere? My advice would be to go to the doctor and get a complete exam and bloodwork. If the lymph nodes "all over your body" are diseased/ pathological, it will most likely show up in your bloodwork, or be apparent to your doctor. If you are told your lymphatic system is fine, listen to your doctor-- don't go for a cat scan because you think he's wrong or maybe missed something.  go to the movies instead and have a coke and some popcorn. Some people are guilty of living in the past-- their lives suffer for it. You are guilty of living in the future as evidenced by your "what if" thinking. hey kevin, guess what?? you're not only gonna die some day but you're going to die FROM SOMETHING. Are you going to spend your days worrying about it and trying to discover now, at your young age, what that might be????? And then what???? If your lymph nodes are fine are you going to start counting your heart beats all day because you think you may have an arythmia??? I'm just trying to show you the ill effects of your thinking process. Get a check up. If your fine, get on with your life. If something is wrong, pursue the best treatment and still...... get on with your life.

[borninquisitive]

>My advice would be to go to the doctor and get a complete exam and bloodwork. If the lymph nodes "all over your body" are diseased/ pathological, it will most likely show up in your bloodwork<

I agree. Further, constantly messing with your lymph nodes will keep them aggitated. I know, I've done it and stopped once I learned that "bugging" them will irritate them. Checking when you are ill isn't unreasonable but all the time...no.

Bloodwork should reveal lymphoma.

[gibson64]

Thanks for your comments and I agree 100-percent.  I am way to young to be thinking like this which is why I want to resolve it once and for all and move on with my life.  I do recognize that this is most likely in my head (and am seeing a counselor about it). I do have to add that this whole thing started after someone in my family just got colorectal cancer and two of the three doctor's were incorrect(although everything turned out fine).  I feel much better after going to the doc(s) that there is nothing wrong with the easily palpable areas.  My only outstanding issue is my axillary region where I know I can feel deep lumps on each side (up to 2 cm in size) but the doc's say they can't feel anything (they are tough for me to find too).  They may not even be lymph nodes but if I can put it to bed with a an imaging test than I will really be able to move on.  

I do get a good blood work up every year for my work physical.  They have all been fine.  Only problem is, I know that the "indolent lymphoma's" rarely show up in blood work.

[mike1105]

at your age, and considering you ARE NOT AN MD, you should not even know what "indolent lymphoma" is. nor should you know tha names and exact sizes of all the diffeent lymph nodes in the body. these things, not your lymph nodes, are what jump off the screen for me. i'm not saying you don't have cancer. (relax, that does not mean you do either) All i'm telling you is that you have to trust somebody eventually, or you'll go crazy. For all you know, an imaging test may not be a reliable way at all to diagnose any kind of lymphoma.

[Duchess47]

Because I had an MRI reveal "bone marrow infiltrating disease such as lymphoma, leukemia, myeloma or other" I will be having a bone marrow biopsy next week.  My own family doctor can perform it and says he is doing so that we can both sleep at night.  Lymphoma is one of the rarest cancers. Symptoms are not just swollen lymph nodes, but blood tests, age, symptoms. If after 11 years this is all you have wrong, then it's time to move on.

[mbui]

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