Enlarged lymph nodes may warn of cancer

By Lynda Williams, Senior medwireNews Reporter

Enlarged lymph nodes are a marker for both occult cancer and a long-term risk for malignancy, confirms research published in the British Journal of Haematology.

"Our risk estimates for specific cancers at different time points may help clinicians choose an appropriate diagnostic strategy for patients diagnosed with enlarged lymph nodes in the inpatient or outpatient hospital setting," say Henrik Frederiksen (Aarhus University Hospital, Denmark) and co-authors.

Over a median of 4.7 years of follow up, 1750 cancers were detected among 11,284 patients attending hospital for the first time with an enlarged lymph node between 1994 and 2008, compared with the expected incidence of 389 cases.

In all, 11.5% of patients were diagnosed with cancer in the first year, 14.7% within 5 years, and 18.0% after 10 years. The risk was significantly greater in men than women after 1 (13.6 vs 9.6%), 5 (16.2 vs 13.3%), and 10 (19.2 vs 16.9%) years.

The age- and gender-standardized incidence ratio (SIR) for cancer was 21.1 within the first year. As expected, the increased risk was particularly high for cancers of the head and neck, such as the pharynx (SIR=365.3), tonsils (SIR=331.1), and salivary glands (SIR=262.3), and for lymphomas, including non-Hodgkin (SIR=315.8) and Hodgkin (SIR=834.2) types.

But the increased risk for cancer persisted after 1 year, with an overall 1.4-fold greater cancer diagnosis and a 6-10-fold increased risk for lymphoma, with a modest increase in SIRs noted for most subgroups except for HIV-positive patients (SIR=84.9).

The increased risk for lymphoma may be due to difficulties with diagnosis or "reflect the slow proliferation of some lymphoma subtypes," Frederiksen et al suggest.

Patients with enlarged lymph nodes due to other disorders were also at increased risk for cancer diagnosis after 1 year, with the highest risks including patients with sarcoidosis (SIR=4.4), tuberculosis (SIR=3.10), infectious mononucleosis (SIR=1.2), other infections (SIR=115.6), rheumatoid arthritis (SIR=6.2), and other rheumatic conditions (SIR=6.9).

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