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Thread: Swollen lymph node: how to proceed?

  1. #1
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    Swollen lymph node: how to proceed?

    I have an appointment tomorrow with my general practitioner, initially for other stuff, but apparently, this too.

    Based on some research I've done through looking at past threads and articles online, a lot of people are saying that it's very likely to just be an infection, but at the same time, I read a lot of stories about people having to push for biopsies because they were being met with resistance, but then it ultimately turning out to be cancer.

    This is the first time I'm seeing my general practitioner, as I haven't established a relationship with a PCP yet. So I want to get some opinions here on whether this looks worrisome, and is this something I should be pushing to get biopsied or if that would be overkill.
    I believe in "better safe than sorry", so I do prefer to get tests to make sure even if it's unlikely, but would it be necessary in this case?

    Age: 21 Sex: Male Height: 5'4 Weight: ~133 Race: Indian Duration of complaint: first noticed several days ago (length of presence unknown). Location: Orlando Metro, Florida / On Neck

  2. #2
    Moderator Top User IndyLou's Avatar
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    Hello, Silver-

    You're doing the right thing here, in having an appointment with your PCP doctor. You're young, but it's always good to have a relationship with your doctor--hopefully at your age, you won't need to see them much.

    As for your swollen gland, I think it's WAY too early in the process to start asking for biopsies. Lymph nodes react to infections, and one of those reactions is to swell. Your body is doing exactly what it should be doing.

    As to your doctor visit, here's what will likely happen: Your PCP doctor (or a nurse on their staff), will ask you a lot of questions about your medical history, and then the doctor will make a recommendation on a course of action. It might include an antibiotic drug, or it may just be that the doctor will tell you to wait for a few weeks. If the swelling doesn't go down, then the doctor might consider other options. The doctor might also refer you to an ENT (Ears, Nose & Throat specialist.) An ENT is very experienced, and will consider further treatments. Doctors tend to favor more conservative approaches first, and that would mean that they would not consider a biopsy as the first option. Be prepared for this, and don't let your impatience and anxiety get the best of you.

    In my non-medical opinion, I would follow the advice of your doctor. You're young, and cancer should not be the first thing that pops into your head when you get a swollen lymph node.
    Age 54 Male
    early Feb, 2013 - Noticed almond-sized lump in shaving area, right side of neck. No other "classic" cancer symptoms
    late Feb, 2013 - Visited PCP for check-up, PCP advised as lymphoma. Did blood work, orders for CT-scan, referred to ENT
    3/7/13 - CT-scan inconclusive, endoscopy negative
    3/9/13 - FNA of neck mass
    3/14/13 - Received dx of squamous-cell carcinoma, unknown primary
    3/25/13 - CT-PET scan reveals no other active tumors
    3/26/13 - work/up for IMRT
    4/1/13 - W1, D1 of weekly cetuximab
    4/8/13 - W1, D1 of IMRT
    5/20/13 - complete 8 week regimen of weekly cetuximab
    5/24/13 - Complete 35-day regimen of daily IMRT
    mid-July 2013 - CT-PET scan reveals no active tumors, but shows necrotic tissue at site of original tumor
    early Sept 2013 - partial neck dissection to remove necrotic tissue. Assay shows no cancer present.
    Spring 2014 - No signs of cancer
    Spring 2015 - NED
    Spring 2016 - NED
    Spring 2017 - NED
    Spring 2018 - NED
    Spring 2019 - NED

  3. #3
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    Hi,
    Sorry your worry has brought you to a cancer patient forum.
    If we recapitulate the current situation, you have had a swollen cervical lymph node for a few days and are wondering whether you should walk into a first appointment with a demand for a biopsy… Doesn't that look a little like you're rushing things?
    As you have noted, lymph nodes can swell for a number of reasons - and generally, a swollen lymph node is due to an infection. That is much, much more likely than cancer.
    Based on your description of yourself, you are rather slim, and therefore a slightly swollen lymph node can be easily detected.
    Doctors are trained to assess patients' lymph nodes and are the most competent to determine the probable cause. Let the doctor you will see tomorrow do what s/he deems appropriate for your case after having examined you and heard your medical history. This may involve waiting a bit longer to see if it reduces in size all by itself, or trying a course of antibiotics to see if it helps. Very likely not jumping the scalpel as a first move.
    I suggest you discuss your worry with that doctor and ask what s/he thinks about your current medical situation.
    I hope you find the reassurance you are seeking.
    Do keep us posted on the results of your appointment, as this is a way to contribute in helping others with similar complaints and worries.
    Needless to say, in the unlikely event you are diagnosed with cancer, this is a great place for support.
    PBL

  4. #4
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    Alright, I suppose if that’s the case, then just going with whatever they recommend should be sufficient since it might go down on its own.

    May I ask though why doctors tend to prefer conservative treatment first? One of my fears in general isn’t so much about what happens regarding what’s out of my control, but rather something that happens that I could have prevented with certain measures. I try to be diligent with preventive maintenance and resolving issues in their earliest stages as possible. I’m not referring to this specifically, but I’m just speaking for in general. I just hate seeing situations where a circumstance becomes much worse where it could have been prevented or much less severe with due diligence, and I’ve heard about other cases where a symptom was brushed off until it was too late so I try my best to avoid that.

    But with this situation, I would agree since there’s a high chance that it is caused by other stuff and subsides accordingly.

    The other thing I would like to ask, is I’ve been noticing a lot of these little issues pop up lately in the last two years. Impetigo, minor pilonidal sinus, a little cellulitis, etc. It seems like recently I’ve been having more frequent little nuisances that suggest infection. They’re not serious or difficult to deal with, but it’s questionable because I never had stuff like this especially during my teenage years. I’ve never had a swollen lymph node before (at least that I know of). I understand that’s what lymph nodes are supposed to do, but none of them have ever done that before. It may not be cancer, but it raises the question as to why these little annoying symptoms that suggest some sort of infection have started coming up on average every few months. And their lack of prior history is what sometimes makes them concerning. I will say that I moved from Connecticut to Florida two years ago, so I wonder if it’s environmental.

    I’ve seen a couple people on various forums suggest it comes with the territory of being in your early 20s because your immune system is still developing, but that didn’t make sense to me, as I thought that happened ages ago (I haven’t actually been getting *sick* abnormally often). And if so, then why haven’t these sorts of things cropped up for many years before?

  5. #5
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    A pilonidal sinus is often linked to sitting on your bottom for long periods of time. Impetigo can be prevented with proper hygiene: daily change of underwear, weekly change of bed sheets and towels, frequent hand washing, refraining from nose-picking or wiping your nose with the back of your hand… All those annoying parental injunctions that are kicked off as a teenager moves out and into student life may not be the silly constraints they seem to be. Since you seek to prevent everything you can, you may follow basic, common-sense and proven tips such as eating a mostly home-cooked plant-based diet, walking and exercising daily, sleeping eight hours every night, refraining from smoking (anything) or drinking... Airing your room daily can do a lot for your general well-being too.

    Here is the answer to your question about doctors preferring the most conservative approach: At the end of their studies, new doctors are sworn in. The Hippocratic Oath begins with "First, do no harm".

    Even the smallest bit of flesh in your body is there for a reason - it has a function. It is not redundant. Each and every lymph node in your body is part of a complex network and plays its own part in the proper functioning of your immune system. Unless it is duly justified, no doctor in their right mind will simply cut one out to take a look at it. Think of it as a mutilation; a seemingly minor one, perhaps, but still. Imagine going back to the doctor's every few months to have another lymph node removed just for the sake of alleviating your health anxiety: after a few of those surgical procedures, you might begin to experience serious issues.
    Again, the doctor you will see tomorrow will write down your medical history and examine you. You may want to prepare for that appointment by making a list of those "little annoying symptoms" you mentioned above - you may even print out your thread on this forum. If s/he sees a pattern or cause for alarm, then s/he knows what to do in your best interests.
    I hope this helps.
    PBL

  6. #6
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    I've actually been putting in effort to lead a reasonably maximally healthy lifestyle, especially recently. My hygiene has always been good. I do wash my clothes and my bed sheets often, and at least daily change my underwear. I also wash my hands quite frequently, probably more often than average, but not to a germaphobic extent. Mostly, I do wash them before eating, especially if they're dirty. The one instance of impetigo that I had happened to be on the back of my neck (it never happened on my face), and it was thought to be caught in the gym.

    Generally, I do try to stay active, though there have been some hiccups and pauses. I try to do both strength and cardio. But even if I'm not, whenever I'm in the office for the day for my internship, I utilize the standing desks and alternate between standing and sitting every 30 minutes to an hour, and go for a stroll during lunch hour.

    With regard to the pilonidal sinus, the only thing is I do drive a lot because it's a hobby of mine and I enjoy it, but whenever I go for a long drive, I always take care to take breaks every 50 miles or so and get out of the car and stretch. The overwhelming risk factor is probably the fact that I have a lot of hair in the area, so I'm looking at getting that area treated with laser hair removal, as that's been shown to bring down the risk a lot, and frequently cleaning the area. But sometimes you just draw the short stick with these things.

    I used to eat a lot of sugar (and this was true for my whole life until a couple months ago), and did almost go into the overweight BMI at one point, but for a while, I've been eating very little added sugar, especially on the weekdays (and just modestly more lenient on the weekends). I try to eat mostly whole foods, and stick to complex carbs instead of simple carbs. I eat fruits, vegetables, and nuts. And that's what the vast majority of my diet consists of. I don't smoke, and rarely (and when I do, moderately - no more than 2-3 at the very most) drink. I do 16/8 intermittent fasting, and I am nowhere near overweight. I keep my window open for all of Orlando's summer (March/April to October) months because I like bringing in the fresh air and I like the climate here. I get out of the house a lot too.

    The main things that need work for me are sleep and stress management. That's where I struggle. PBL, while I appreciate your recommendation and I don't want to sound like I'm defending myself, but I am just writing to let you know that I do put quite a bit of effort and diligence into various aspects of my well-being. One of those things is also that I generally don't wait too long to see a doctor when symptoms crop up, as preventive measure, which has been beneficial in stopping things before they became more serious (i.e. with the pilonidal sinus). I actually put the same effort towards maintaining my car: I get it serviced regularly and do all the recommended maintenance in the owner's manual at the suggested intervals. So I mean in life in general, I try to be diligent about prevention with diligent upkeep, maintenance, check-ups, and planning. But I realize that none of this will give 100% protection, but I do it majorly so I can have the satisfaction of knowing that I tried my reasonable best, even if a bad outcome does occur.

    So I mean I don't know. The few things that cropped up in the past couple of years - I can't really point to anything specific that would have caused them. And they're not that serious, but I was just curious about why they did just because I've never had those issues before.

    Anyway, I went to the doctor today, and he took a look at the lump, and said that it needs to have an ultrasound done on it, but no biopsy. So we'll go with that and see what happens, and I'll update this thread accordingly. He said the same thing - that most often it's a response to something that was going on.
    Last edited by Silveresque; 06-04-2019 at 05:26 PM.

  7. #7
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    Well then, it looks like you're doing everything reasonably right - which I am sure your doctor has taken into consideration before deciding on ordering an ultrasound.

    I hope it shows all is normal and that it is just a case of a reactive node - maybe (depending on how long ago that was) in relation to that bout of impetigo on your nape?

    Do let us know what the ultrasound says.

    Be well,

    PBL

  8. #8
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    Thank you. I will definitely keep this thread updated, as I understand it can provide many future people who will search and encounter this thread with possible reassurance and an informative reference.

    I forgot to ask what an ultrasound does or detect. Can you explain exactly what sort of evaluation it is used for?

  9. #9
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    The ultrasound will show the structure of the enlarged lymph node, which will provide your doctor some clearer notion of what is going on in there. Contrary to a biopsy, it is a non-invasive, non-destructive means of looking inside an organ.

    A biopsy is only warranted when there is sufficient evidence of something "sinister", as a sample is then required to precisely identify the nature of the "culprit" - and decide on the most appropriate course of treatment.

  10. #10
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    A quick question: does the fact that it’s painless increase the chance that it’s cancer? I’m kind of freaking out as online sources were saying that typically due to infection it’s tender where as a result of tuberculosis or cancer, they are typically completely painless.

    Although at the same time, it seems to be shrinking which, I don’t know, is that in my favor? I read that in some types of lymphoma, the lymph node can shrink and enlarge alternately, so that may not necessarily put me in the clear.

 

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