the body has approximately 600 lymph nodes, but only those in the submandibular, axillary or inguinal regions may normally be palpable in healthy people
in most patients, lymphadenopathy has a readily diagnosable infectious cause.
when the cause of the lymphadenopathy remains unexplained, a 3-4 week observation period is appropriate when the clinical setting indicates a high probability of benign disease
localized adenopathy should prompt a search for an adjacent precipitating lesion and an examination of other nodal areas to rule out generalized lymphadenopathy.
nodes are generally considered to be normal if they are up to 1 cm in diameter; however, some authors suggest that epitrochlear nodes larger than 0.5 cm or inguinal nodes larger than 1.5 cm should be considered abnormal
when a lymph node rapidly increases in size, its capsule stretches and causes pain.
the presence or absence of tenderness does not reliably differentiate benign from malignant nodes
stony-hard nodes are typically a sign of cancer, usually metastatic.
very firm, rubbery nodes suggest
lymphomanodes that are matted can be either benign (e.g., tuberculosis, sarcoidosis or lymphogranuloma venereum) or malignant (e.g., metastatic carcinoma or lymphomas)
only 1-2% of patients with unexplained lymphadenopathy presenting to a GP are found to have a malignancy causing it.
1)in primary care settings, patients 40 years of age and older with unexplained lymphadenopathy have about a 4 percent risk of cancer versus a 0.4 percent risk in patients younger than age 40.
biopsy should be avoided in patients with probable viral illness because lymph node pathology in these patients may sometimes simulate lymphoma and lead to a false-positive diagnosis of malignancy.