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Swollen lymph nodes occur as a symptom of leukaemia in approximately 20% of patients prior to their diagnosis. Also referred to as “swollen glands”, lymph nodes are pea-sized lumps of tissue that contain white blood cells. When enlarged they can be felt or seen as raised lumps underneath the skin, most commonly in the neck, the armpits, or in the groin area.
For the vast majority of cases, swollen lymph nodes indicate nothing more than the fact that your body is fighting off an infection such as tonsillitis or even a common cold. However, because of this, swollen lymph nodes can easily be mistaken as harmless when in fact they could be a warning sign of something more serious, such as blood cancer.
“I made an appointment to go see my GP after work. He thought it was tonsillitis, so gave me antibiotics. However, at the end of the week, I was no better. I went back and was signed off again with a different antibiotic.”
Certain characteristics such as the size of the lymph nodes, the way they feel or how long they last can help to differentiate swelling caused by infection from that caused by leukaemia or another type of blood cancer. Spotting the difference between harmless and harmful lymph nodes may be crucial in diagnosing leukaemia early.
Spotting the difference
Although swollen lymph nodes are nearly always caused by infection or reaction to an allergy, there are a few things you can look out for to help spot the difference between leukaemia and infection:
- They last for longer than two weeks – Swollen glands caused by an infection will normally go down within two or three weeks (i.e until the infection has been naturally dealt with). Make sure you visit your GP if your lymph nodes don’t seem to be improving within this time or aren’t getting better with antibiotics.
“I noticed a swollen gland near my collar bone. After a couple of weeks of it not going down, I made an appointment to see the doctor.”
“I was told I had a bad case of tonsillitis and was given two weeks’ worth of antibiotics. I carried on going to work but I didn’t seem to be getting any better.”
- They are painless – Rather surprisingly, tenderness, redness or warmth of the nodes is actually a good sign as it is more likely to indicate infection of the node. It is important to get painless lumps checked out by a GP to determine the cause of the enlargement. This being said, leukaemia or lymphoma (another type of blood cancer) can cause painful lymph nodes on occasion. This is because they can grow big enough to press down on surrounding nerves or other organs, causing pain.
“I noticed a lump that appeared on my jaw line. I didn’t think much about it as I presumed it was just a lump of fat that was natural with age. It wasn’t painful at all, but it was a bit of a nuisance.”
- They continue to grow in size – In their swollen state during an infection, lymph nodes can enlarge to a size of half an inch in diameter. Lymph nodes that are around 1 or 2 inches or bigger are not normal and should be carefully inspected by a GP. Because the swollen lymph nodes are often painless, they can sometimes grow in size before a person even notices them.
“I had a sort of lump on the side of my neck. I was at work one day and the chap on the desk next to me said it like it was getting bigger, so I went along to my doctor.”
- You can’t work out what has caused them to enlarge – Normally you will have a fairly good idea as to why your lymph node is swollen, for example, you might have a cold or a tooth infection. You should make an appointment with your GP if you have a swollen gland and no other signs of illness or infection.
- They are hard or unmovable – Unfortunately, apart from being painless and abnormally large, swollen lymph nodes in leukaemia or lymphoma tend to feel quite similar to infected lymph nodes. However, occasionally they can feel very hard and cannot be moved when pushed. Healthy lymph nodes are more rubbery than the surrounding tissue but are not solid like stone. Any lumps on the neck, groin or armpits that are hard, very enlarged, and do not move when pushed may indicate lymphoma or another type of cancer and should be investigated by your GP.
- You are also experiencing other symptoms of leukaemia – Leukaemia symptoms normally occur in clusters. If you notice any other symptoms such as night sweats, persistent fever (more than 3-4 days), or unexplained weight loss, visit your doctor immediately.
“I felt really rough, very fatigued, and faint. I also lost weight, I had enlarged lymph nodes and I was very emotional.”
What are lymph nodes, and why do they become enlarged?
Lymph nodes are small, kidney bean-shaped structures that are found in grape-like clusters throughout the entire body. They are a part of the lymphatic system, which carries fluid (called lymph) around the body. Lymph fluid absorbs any waste materials from the blood as well as any viruses and bacteria that are trying to infect the body.
Lymph nodes “sample” the lymph for any harmful intruders and “alert” the immune system if any viruses or bacteria are detected. When the immune system is alerted, the lymph nodes in the area closest to the infection can grow in size due to inflammation. Therefore, usually, swollen lymph nodes are just a sign that they are working hard to get rid of an infection.
In leukaemia, swollen lymph nodes are caused by a build-up of large numbers of cancerous cells which have travelled from the bone marrow. Sometimes in leukemia or lymphoma, the disease is in an ‘active’ state and is producing lots of dysfunctional white blood cells. However, at times the disease can also ‘slow down’ and some of the cells can die. This can mean that the swollen lymph nodes can fluctuate in size, growing and shrinking over time.
“I was very aware of the lumps and bumps, but I’d had them for a while and they always popped up if I was run down. My doctor asked if I had enlarged lymph nodes under my armpits or groin. I said no but he then said he could feel something and asked if I could stay for blood tests.”
When should I be concerned?
It is important not to self-diagnose. Not every person with swollen lymph nodes requires immediate evaluation by a doctor and, if you have swollen lymph nodes, you shouldn’t immediately expect cancer, as this is unlikely to be the cause.
However, make sure to visit your doctor if you feel that the lymph nodes in your neck or armpits are protruding more than usual, are painless or have lasted longer than you would expect. Sometimes infections such as tonsillitis, ear or throat infections do require a visit to the GP if they are particularly bad. You might be prescribed antibiotics, however, make sure to return to the GP if your symptoms do not get better.
Knowing what other symptoms are typical of leukaemia is crucial for helping you make the decision to visit your GP sooner for a blood test. Connect the dots between the symptoms of leukaemia and spot leukaemia sooner.
For information on the other symptoms of leukaemia, click here.