Saturday, February 19, 2011

What is Normal? Or Does Size Matter?

A few of you have asked what is the size of a normal lymph node. We have around 500- 700 of them so I guess it would be good to know.

If only we did.

First let me say that there can be cancer in a tiny node less than 5 mm.
Like everything in CLL it is the trends, not a single measurement that matters.

Nodes also swell from many causes including infection, inflammation, and cancer. They can shrink with exercise or castor oil topical treatments.

How they feel gives some imperfect clues as to their origins.

Palpable rock hard nodes makes you worried about metastatic disease, especially if the nodes are fixed to the tissues below or the skin above. Firm rubbery nodes are more typical for lymphomas including CLL. Tender nodes points you towards infection, but not always.

As for size, it depends. Are they growing? Are they more numerous? Nodes can jump from 1 cm to 2 cm to suddenly 6 cm, not because the cancer is taking off, but because a cluster of nodes have grown together and the clinician's hands or the CT scan feels or sees them as one entity.

You must always ask if there another explanation for the size or change besides the CLL.

Depending on whom you read, and where the nodes are, they may be considered abnormal if they are bigger that 5 to 20 mm.

A node of 6 mm at your funny bone is worrisome. but a 12 mm node in the groin may be perfectly normal.

Gut nodes tend to get bigger as they are found lower in the pelvis. Nodes in the groin are a bit larger and stilL OK.

All that said, the rough rule of thumb any nodes that is greater than 1 cm (10 mm) is usually considered abnormal. It is certainly easier to remember than the long lists of what is normal and where.

So I follow the trend, and get worried when my nodes get too big, whatever that means, because treatment is more problematic when nodes are "bulky".

Which is another poorly defined word, but I would say anything over 5 cm is "bulky" but some define the number at 1/2 that.

Clear as mud.

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1 Comments:

Anonymous Anonymous said...

Hi Brian: Hope you are okay! Alison.

March 15, 2011 at 9:28 PM  

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