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GPs urged to refer patients with swollen neck glands promptly for cancer investigation

Patients with unexplained, persistent swelling of their neck lymph glands should be referred urgently for investigation of suspected lymphoma, GP researchers have concluded.

Two large, case–control studies reported in the British Journal of General Practice this month found swollen lymph glands – particularly in the neck – were the most important risk markers for both Hodgkin and non-Hodgkin Lymphoma among elderly people.

Unexplained head and neck masses should also prompt urgent referral, the team said.

The studies looked at data from over 680 practices in the Clinical Practice Research Datalink, which included over 4,000 cases of non-Hodgkin Lymphoma and nearly 300 of Hodgkin Lymphoma.

Lymphadenopathy was found in both studies to be associated with the highest risk of lymphoma out of all potential clinical features related to the cancer. The positive predictive value of lymphadenopathy for either form of lymphoma was 18.6%, compared with 4.6% for a head and neck mass, and 1.1% for a mass found elsewhere.

Although blood test abnormalities combined with these factors helped to refine the risk, these and other symptoms would not exclude lymphoma.

The researchers concluded: ‘The default decision should be referral of patients aged 60 years and older with lymphadenopathy or a head and neck mass, unless there is a clear alternative explanation.’

They added: ‘This largely accords with current guidance, although it could be argued that the need to wait six weeks – to allow resolution or an alternative diagnosis to emerge – is unnecessarily long.’

Professor Willie Hamilton, from the University of Exeter Medical School, who oversaw the studies, said: ‘Of course swollen glands are common with throat infections, but in cancer, they are usually larger and painless. It’s been known for a long time that this could represent cancer – this study shows that the risk is higher than previously thought.’

Br J Gen Pr 2015; available online 27 April


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