I'm sure that most of us had, at some point in their life, swollen lymph nodes (be it because of a flu or some other kind of not-too-serious illness) and there is generally no reason to panic if one finds a swollen lymph node on their body. Now, even if the swelling is often associated with something harmless in certain cases it can be dangerous and needs further checking by doctors. If you google when you should see your doctor, one often finds lists like these.

if your swollen lymph nodes:

  • Have appeared for no apparent reason
  • Continue to enlarge or have been present for two to four weeks
  • Feel hard or rubbery, or don't move when you push on them
  • Are accompanied by persistent fever, night sweats or unexplained weight loss

(Source)

The first and last point seem quite intuitive to me, or at least, I as a non-medic can check that. But the two middle points are somewhat confusing to me.

For example, have been present for two to four weeks, so does this mean, that if it isn't something serious, they should disappear in two to four weeks, and if it is something serious than they wouldn't disappear at all? Or would it take them longer than that to disappear and therefore the doctor couldn't determine what the problem is? The third point is something that seems completely indefinable for a non-medic. I'm mean, what exactly is hard/rubbery (any reference, like f.e. a rock, or more like a eraser). The same goes for the comment don't move when you push on them. What exactly should I expect when I push them? How far should I be able to push them? Does pushing inwards, not to the side, also count? What to do if they don't really hurt?

Of course, all of these questions are simply answered by calling your doctor and going, if something like this arises. But nevertheless it would be nice if someone could maybe clarify a bit what the two middle points in the quote from above exactly mean.

  • I really do like your question, and maybe someone is able to answer this extensively. As a starting point (maybe you want to research further): In the capillaries, some 10% of the blood enter the lymphatic vessels and are transported to a lymph node before they re-enter into the bloodstream in the superior vena cava. The presence of antigenes within the filtered blood in a lymph node activates the multiplication of B and T-lymphocytes as a reaction of the immune system to the infection, the lymph nodes begins to swell. However, there also exists a tumeral swelling of lymph nodes – Narusan Dec 2 at 16:20
  • [cont'd] in which cancer cells permanently enter the lymph nodes. Those can be a lot bigger than normally enlarged lymph nodes, they swell slower and don't hurt as much. The location of the swollen lymph node can give a hint towards which type of tumour/cancer is present. However, there are other diseases that directly affect the swelling of lymph nodes. Wikipedia is a good starting point. // Obviously, the above is a huge oversimplification and not referenced at all, hence it's not an answer, but a starting point for OP and other users. – Narusan Dec 2 at 16:23
  • @Narusan thank you very much for the comment. The explanation why lymph nodes swell when you have the flue, etc. is certainly useful. The list int the Wikipedia article that you provided is quite long (and to me seems also really broad) but quite an interesting read, so thanks for that! – Marius Jaeger Dec 2 at 17:22

I get swollen lymph nodes all the time when I have a cold. If I push them, they kind of move back, and it hurts a little. When the cold clears up, they go back to normal.

In contrast, when the melanoma nobody knew I had metastasized to under my chin, the lump was entirely different from my swollen lymph nodes. Various medical people said "it might just be a swollen node" but I knew it was not. It was larger, didn't move when I pressed it, and for the first few months it didn't hurt, either. It took a long time to establish what it was, and during that time I was well aware that this was not your typical "swollen nodes" situation. If you can't feel any difference between a lump under your chin that you have now and one you had 6 months ago when you had a cold, that's because there probably is no difference.

You can learn more about this at cancer.org but that doesn't really cover "how can I tell if my swollen nodes are ok or not?" because basically, swollen nodes are almost always ok. That's really what point 1 and 2 are about. If they've appeared when you know you have an infection, they are caused by the infection. If they go away within a week or so of the infection clearing up, they were caused by the infection. Nothing to worry about at all. Point 3 speaks to the physical differences, which to be fair you probably won't recognize until you've met a tumour, so isn't super useful in a consumer-focused list, and point 4 speaks to other cancer symptoms (nobody told me sweating was a symptom, I wish I had known that.)

If I were giving medical advice around this it would be: ignore them until you feel you can't ignore them any longer. That's basically what I did. I think it's what most of us did. Don't be poking at your neck or armpits regularly to evaluate your lymph nodes. Most places no longer recommend monthly lump checks for breast cancer. This article mentions recommendations from Canadian sources, and I think much of that applies to trying to learn things from your own lymph nodes too.

  • I would upvote, if I could... So thank you for the answer! You say If they've appeared when you know you have an infection, they are caused by the infection. but is that true for all lymph nodes (f.e. if I have a cold, can the lymph nodes in my groin swell on). A source states that this is impossible (sadly in German, so not sure if this is useful here). And do you know anything about swollen lymph nodes on only one side? This is also mentioned quite often and seems to be a sign that you should go directly to your doctor... – Marius Jaeger Dec 2 at 17:31
  • I don't know much about the locations -- if you had an ear infection, for example, it wouldn't be surprising if only the neck nodes on that side were swollen. Your groin isn't near the places that get colds, so I would guess they don't, but if they normally do for you, then that's you and that's fine. The key is really something that feels different and unexplained. You will probably recognize it if it happens. Writing descriptions of what to look for is not only difficult, but probably unhelpful. – Kate Gregory Dec 2 at 18:03
  • Alright, thank you for the comment. I guess the basically, swollen nodes are almost always ok [...] ignore them until you feel you can't ignore them any longer is going to stick with me and seems more useful than the usual bullet points you get from these list... – Marius Jaeger Dec 2 at 19:38
  • @KateGregory Your guess about localisation appears to be partly correct: Vor allem einseitige Lymphknotenvergrößerungen ohne adäquate Entzündungsreaktionen im Zuflussgebiet oder ohne nachweisbaren Allgemeininfekt sollten eine bioptische Abklärung nach sich ziehen. (Especially a unilateral enlargement of a lymph node without a corresponding inflammation in the corresponding capillary area or a proven infection should be biopsied) [Source: Krams M, Frahm S, Kellner U et al., Hrsg. 2. Auflage. Stuttgart: Thieme; 2013. doi:10.1055/b-002-33677] To me this seems like inflammation is localised, – Narusan Dec 2 at 22:48
  • 1
    [cont'd] while a general infect might cause enlargement of lymph nodes in the whole body. @MariusJaeger: If you feel them and they cause pain, it usually is nothing to worry about. If you feel them and they don't cause pain, this might be a hint to see a doctor (Enlargement due to tumour takes longer, so the lymph node has time to stretch and it isn't painful). – Narusan Dec 2 at 22:50

Quick answers:

  • The duration of node swelling >4 weeks is not already a sign of cancer or other dangerous disease. But, the duration of the node swelling tends to increase with the severity of the underlying disease.
  • On palpation, hard nodes feel like a stone or hard rubber and soft ones like a balloon.
  • You can move "movable" nodes 1-2 cm "left to right," and you cannot move "fixed" nodes.
  • In localized diseases, the swelling is typically limited to the nearby nodes (e.g. throat infection > the neck; leg infection > the groin).
  • In localized disease, the node enlargement will be more likely unilateral, and in generalized ones bilateral. The node swelling being uni- or bilateral is not already a sign of severity of the disease. For example, in both common old or lymphoma, the swelling can be uni- or bilateral.

DURATION of lymph node swelling

Swollen lymph nodes that last from few days to about 4 weeks are usually caused by acute infections or insect/snake bites.

Swollen lymph nodes that persist for more than a month can be due to chronic infections, such as tuberculosis (BMJ), HIV/AIDS, atypical mycobacteria ("walking pneumonia"), cat-scratch disease, toxoplasmosis, and chronic inflammatory conditions, such as sarcoidosis, Kikuchi's lymphadenitis, sarcoidosis and Kawasaki's syndrome, medications (phenytoin, antibiotics) (AAFP here and here), autoimmune diseases, such as systemic lupus erythematosus (PubMed), cancers, such as lymphoma (NHS Inform), or metastases of other cancers (e.g. gastric or breast cancer) into the lymph nodes (ISPUB).

In chronic infections/inflammations, the lymph node swelling can persist for many years and have a waxing and waning course. In cancers, the swelling usually persists (and slowly increases) until the cancer is cured.

TENDERNESS and CONSISTENCY

Typically (but with exceptions):

  • In acute infections, lymph nodes tend to be painful/tender, soft and movable under the skin
  • In chronic infections/inflammations, nodes tend to be painless/non-tender and movable
  • In cancers, nodes tend to be painless/non-tender, hard and "fixed" (not movable at all).

LOCATION

Examples of localized (usually unilateral) node swelling:

  • Front of the neck: common cold, metastasis of gastric cancer
  • One armpit: a spread of the infection from the hand/arm, breast cancer
  • Groin: an infection in the leg or genitalia

Examples of generalized (usually bilateral) node swelling:

  • Neck and armpits (and sometimes groin): infectious mononucleosis, HIV/AIDS, sarcoidosis, lymphoma, leukemia.

Even a doctor is often not able to make a final diagnosis just from the characteristics of enlarged lymph nodes. More details about specific conditions and swollen lymph node locations: Lymphadenopathy: Differential Diagnosis and Evaluation (American Family Physician)

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