A lump in the neck can be a concerning finding, as it may indicate an underlying medical condition like lymphoma. Lymphoma is a type of blood cancer that develops in the lymphatic system, which is part of the body’s immune system. The most common symptoms of lymphoma include painless swelling of lymph nodes in the neck, underarm, or groin area. A lymphoma lump in the neck often feels rubbery, smooth, firm, and painless. The lump is usually non-tender and may grow over time as lymphoma cells multiply. Identifying the characteristics of a lymphoma lump can help differentiate it from other causes of neck lumps, like infections or benign growths. Early diagnosis and treatment of lymphoma are crucial, so being aware of the signs is important.
What is lymphoma?
Lymphoma refers to cancers that arise from lymphocytes, a type of white blood cell. Lymphocytes circulate in the lymphatic system, which includes the lymph nodes, spleen, thymus, bone marrow, and other lymphatic tissue. There are two main forms of lymphoma – Hodgkin lymphoma and non-Hodgkin lymphoma. Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells, while non-Hodgkin lymphoma consists of all other lymphomas without these cells. The most common locations for lymphoma development include lymph nodes in the neck, armpit, groin, chest, and abdomen. Enlargement of these lymph nodes leads to noticeable lumps under the skin. Lymphoma may also involve other organs like the liver, bone marrow, GI tract, or brain in later stages. While lymphoma can occur at any age, it is most commonly diagnosed in people aged 20-40 years old or over age 55. The causes of lymphoma are not fully understood but may be related to infections, autoimmune disorders, family history, and environmental exposures. With treatment, many types of lymphoma are curable.
What does a lymphoma lump feel like?
A lymphoma lump typically has the following distinguishing features:
Location
Lymphoma lumps most often arise in lymph nodes in the neck, armpit, or groin region. However, lumps may develop anywhere lymph nodes are present. Common locations include:
– Neck – Lymph nodes in the neck, often along the front and sides under the jawbone and muscle. A neck lump is one of the most common presentations of lymphoma.
– Armpit (axilla) – Lymph nodes under the arm near the underarm hair region.
– Groin – Lymph nodes found where the leg joins the torso near the groin crease.
– Above the collarbone (supraclavicular) – Lymph nodes above the collarbones.
– Abdomen – Lymph nodes or organs like the spleen or liver if lymphoma spreads internally.
Size
– A lymphoma lump is typically larger than 1 centimeter (cm) or about 0.4 inches across.
– The lump may start small and grow larger over time as cancerous cells accumulate.
– Lymph nodes affected by lymphoma often grow to over 2-3 cm in size if left untreated.
Shape
– Lymphoma lumps are oval or round in shape as they fill an enlarged lymph node.
Texture
– The lump tends to feel smooth, firm, and rubbery upon palpation.
– Lymphoma nodes feel denser than normal lymph nodes.
– The lump does not feel cystic, filled with fluid, or spongy.
Mobility
– Lymphoma lumps are generally movable under the skin and not fixed to underlying tissues.
– Later on, a lymphoma lump may become attached to skin, muscle, or other structures.
Number
– There may be a single enlarged lymph node due to lymphoma.
– However, lymphoma often causes swelling in multiple lymph nodes in the same region.
– Having numerous swollen nodes in one area raises suspicion for lymphoma.
Growth
– The lump may slowly and painlessly grow larger over days to weeks as cancer cells multiply.
– A lump that continues to enlarge warrants medical evaluation.
Pain
– Lymphoma lumps are typically painless and non-tender to the touch.
– Pain is not a common feature in the early stages.
Skin changes
– The overlying skin usually appears normal without redness or signs of infection.
– Later, skin may become inflamed, ulcerated, or fixed to a lymphoma lump.
How is a lymphoma lump diagnosed?
If lymphoma is suspected based on a neck lump or other nodes, doctors will perform exams and tests to make a diagnosis including:
Physical exam
Doctors will closely inspect and palpate all lymph node regions to check for enlargement. They will note the size, texture, mobility, and tenderness of any lumps or swollen nodes.
Imaging tests
– Ultrasound – This uses sound waves to create images of lymph nodes and help distinguish solid lumps from fluid-filled cysts.
– CT scan – A CT scanner takes cross-sectional x-rays giving detailed views of swollen nodes and internal organs. Oral and IV contrast dye may be used to enhance images.
– PET scan – A PET scan involves injecting a radioactive tracer that accumulates in cancer cells. It identifies areas of increased metabolic activity typical of lymphoma.
– MRI scan – MRI uses magnetic fields to produce 3D images. It provides excellent soft tissue detail for assessing lymph nodes and organs.
Biopsy
A lymph node biopsy is needed to confirm a lymphoma diagnosis and determine the subtype. This involves surgically removing part or all of the suspicious node to examine under a microscope. Samples may be obtained by:
– Fine needle aspiration – Inserting a thin needle into a lump to withdraw a sample of cells. Local anesthesia is given.
– Core needle biopsy – Using a larger hollow needle to remove a cylindrical piece of a lymph node. Done under local anesthesia.
– Surgical biopsy – An incisional or excisional biopsy of an affected node, done with sedation or general anesthesia.
Blood tests
– Complete blood count (CBC) – Assesses for cytopenias from bone marrow involvement.
– Lactate dehydrogenase (LDH) – An enzyme marker of lymphoma burden that is often elevated.
– Erythrocyte sedimentation rate (ESR) – A nonspecific marker of inflammation that may be increased in lymphoma.
Bone marrow biopsy
May be performed to check for lymphoma in the bone marrow, particularly in aggressive or advanced stage lymphomas. This is done by inserting a needle into the back of the hip bone to withdraw a sample of marrow.
Immunophenotyping
The biopsy tissue is analyzed to identify specific antigens on the lymphoma cells surface. This helps classify B cell or T cell lineage and subtype.
Molecular testing
Specific genetic mutations may be identified that can influence treatment options and prognosis.
How is lymphoma treated?
Treatment is tailored to the individual lymphoma type, stage, and prognostic factors. Common treatments include:
Chemotherapy
Using anti-cancer drugs to kill lymphoma cells. Chemotherapy may be given alone or combined with other treatments.
Radiation
High energy x-rays are focused on involved lymph nodes and other sites to destroy cancerous cells. This spares unaffected tissues.
Targeted therapy
Medications that specifically target and interrupt pathways promoting lymphoma growth and survival. Examples are rituximab and ibrutinib.
Immunotherapy
Drugs like checkpoint inhibitors that stimulate and enhance the body’s own immune responses against lymphoma.
Stem cell transplant
Allows high dose chemotherapy by replacing blood-forming stem cells. Used in some lymphomas when initial treatment fails.
Surgery
Rarely, surgery may be done to remove an isolated lymphoma lump in early stage disease.
Watchful waiting
Some indolent lymphomas may be monitored without immediate treatment until they cause symptoms or change significantly.
What is the prognosis with lymphoma treatment?
The prognosis of lymphoma depends on several factors:
Type of lymphoma
– Hodgkin lymphoma – Often curable with modern therapy, with 5-year survival over 80%.
– Aggressive NHL – Diffuse large B cell lymphoma has a 5-year survival around 60-70% with standard chemoimmunotherapy.
– Indolent NHL – Follicular, small lymphocytic, and marginal zone lymphomas have median survivals over 10 years. However, they are not considered curable.
Stage at diagnosis
Lymphoma found early at stage I or II has a better prognosis than stage III or IV disease that has advanced.
Age and overall health
Younger patients in good health tend to have better outcomes. The prognosis is worse in older adults with other medical problems.
Genetic markers
Certain lymphoma subtypes have genetic features that predict better or worse prognosis.
Initial treatment response
Patients who achieve complete remission have higher cure rates than partial or no remission. Relapsed or refractory disease has poorer outcomes.
With continuing advances in lymphoma treatments, prognosis is improving overall. Regular follow up visits and monitoring after treatment are important to detect and manage any recurrence.
Can a lymphoma lump disappear on its own?
A lymphoma neck lump or nodes in other regions will not typically disappear without treatment. The enlarged lymph nodes are filled with accumulating cancerous lymphocytes. Without directed lymphoma therapy, the lump will continue to expand as the tumor progresses. Rarely, the body’s immune system may temporarily cause a slight decrease in lymphoma lump size, but the effect is transient. Waiting and observing without biopsy and staging studies delays definitive diagnosis and therapy. Starting appropriate chemotherapy, immunotherapy, or radiation appropriate for the lymphoma subtype provides the only chance for significant shrinkage and disappearance of the lump in most cases. With modern treatments, many lymphomas can achieve complete remission where the lump and other disease become undetectable on scans. The lymphoma may be considered cured if it remains in remission over years. Some indolent lymphoma may wax and wane in size on its own throughout its course, but it will never fully resolve without treatment. Any neck lump or nodes that persist and do not disappear within a couple weeks need medical evaluation.
Conclusion
A lymphoma lump in the neck has distinctive features that differ from other causes of neck masses. Lymphoma nodes are typically rubbery, smooth, firm, and non-tender. The lump tends to be oval-shaped, over 1 cm large, and may grow steadily bigger over time. Multiple enlarged nodes in the same area is even more suspicious for lymphoma. Diagnosis is made by biopsy and specialized testing provides details to select appropriate treatment. While lymphomas were historically fatal cancers, modern combined chemoimmunotherapy and other novel therapies result in cure for many patients. A lymphoma neck lump will not disappear on its own however, making timely diagnosis and treatment essential for the best outcome.