Medical Edge Newspaper Column

Swollen Lymph Nodes in Abdomen Not Necessarily Cause for Concern

September 18, 2009
Dear Mayo Clinic:
My recent CT scan of the kidneys and bladder showed swollen lymph nodes in the abdomen. What are the possible causes of swollen lymph nodes in this area? I am a 68-year-old healthy woman with minor Sjögren's disease diagnosed last year. The Sjögren's is giving me no problems.

Answer:
Mildly enlarged lymph nodes may not be a serious concern. Infections or underlying inflammatory conditions, such as chronic fungal infections, Sjögren's or lupus among others, can result in enlarged lymph nodes that may not, by themselves, cause any problems.

However, enlarged lymph nodes can be an early sign of some cancers including lymphoma, a malignancy of lymph node tissues. It would be wise to work closely with your doctor to determine if the swollen lymph nodes are due to the Sjogren's, another benign condition or cancer.

In your case, Sjögren's syndrome is a possible cause of the swollen lymph nodes. In this autoimmune disorder, white blood cells attack moisture-producing glands. The most common symptoms are dry eyes and dry mouth. Because Sjögren's is a systemic condition, it can cause symptoms throughout the body. Other symptoms can include dry skin, stomach upset, vaginal dryness, recurrent bronchitis, arthritis and muscle pain.

If you begin to experience troublesome symptoms, revisit your doctor to discuss managing Sjögren's. Strategies might include treatment for specific symptoms or systemic medications.

Sjögren's syndrome slightly increases the risk of lymphomas, which are cancers of the immune system, including Hodgkin's lymphoma and non Hodgkin's lymphoma. One symptom associated with these conditions is enlarged intra-abdominal lymph nodes.

While just a small number of patients with Sjögren's syndrome develop these cancers, it's good to be aware of the risk and typical symptoms associated with lymphoma. They can include: unexplained fever, night sweats, fatigue, unexplained weight loss, itchy skin and red patches on the skin. If you experience any of these symptoms, see your doctor.

Other malignancies in the abdomen and pelvis also can be associated with enlarged lymph nodes. They include colon cancer, cancer of the cervix or ovaries, genitourinary (urinary and male and female genital) system cancers, and other non-colonic gastrointestinal malignancies. Colonoscopy and endoscopy of the upper gastrointestinal tract are two exams that may be of help in eliminating the possibility of these diagnoses.

Depending on the size of the lymph nodes and any other troublesome symptoms you might have, your doctor could recommend a lymph node biopsy to check for a malignancy. This can often be performed as a needle biopsy guided by CT scan images. If you don't have any other symptoms, watchful waiting may be prudent. Your doctor could suggest another CT scan in three to six months to check for any changes.

— Gerardo Colon-Otero, M.D., Hematology/Oncology, Mayo Clinic, Florida; Kevin Moder, M.D., Rheumatology, Mayo Clinic, Rochester, Minn.