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Thread: Several enlarged cervical nodes

  1. #1
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    Several enlarged cervical nodes

    Hello,
    My 27yr old daughter has several larger swollen lymph nodes in her neck. They are not visible per say but are palatable. Her chiropractor found it in her neck and advised getting it checked. After her exam on Aug 30 with her PCP, the doc said it felt 'cyst-like' and movable. The issue is its been there for months, not any smaller, not any larger. Bloodwork was completed to include WBC, differential and CRP and sed rate. All normal values. She now reports several more nodes enlarged and not painful. Both sides of her neck. She has no other symptoms; no fever, night sweats, weight loss, etc. On a recent chiropractor appt he palpated her underarms and felt nothing unusual. PCP ordered an ultrasound which was completed last Friday. The only thing it reports is sizing and that they are slightly enlarged. The largest one measuring 1.7cm X 0.7cm X 2.0cm. I am not sure if they should have or will report more on the condition of the nodes. I thought an ultra sound could show more than just size. Like what they looked like, shape, density, etc.

    My daughter is a veterinarian and knows medicine. In fact, she just told me how she diagnosed lymphoma a dog recently by blood test and fine needle biopsy. She is not too concerned. I am freaking out. I recommended she follow up with her PCP to request a biopsy. I was thinking she is exposed to more stuff then the general population by her occupation and that maybe she has picked up something zoonotic.

    Any advice to calm my nerves and not get ahead of the data?

  2. #2
    Super Moderator Top User po18guy's Avatar
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    Sorry to hear this. What does her doctor think? And - this can be crucial for peace of mind - even if the doctor is "concerned" or "worried" it does not mean something sinister is occurring. It simply means that more checking is needed to identify the problem. And, bear in mind that some causes of reactive lymph nodes are never identified. Aside from that, there are millions of reasons for lymph nodes to react. Viruses. Millions of them. And this is discounting bacteria and fungi. Of those millions, only about 5,000 have been identified and described. The rest remain unknown types. I am fighting my 4th or 5th virus this year. 2019 has been an unusual year for unknown, unidentified viruses.

    Doctor will probably refer her to a hematologist - a specialist in blood diseases. Perhaps an oncologist - but this still does not mean that it is panic time. Actually, in my experience, "never" is the time to panic. She will progress through diagnostics one step at a time until the problem is identified and then a treatment plan - if any - will be formulated. This all takes time, which is tperhaps the most difficult and frustrating aspect.

    We have a motto here: "You do not have cancer until a pathology report says you have cancer." Keep us advised of what comes to pass and in the unlikely chance it is something serious, we are here for support.
    05/08-07/08 Tumor appears behind left ear. Followed by serial medical incompetence on the parts of PCP, veteran oncologist and pathologist (misdiagnosis via non-diagnosis). Providential guidance to proper care at an NCI designated comprehensive cancer center.
    07/08 Age 56 DX 1) Peripheral T-Cell Lymphoma-Not Otherwise Specified. Stage IV-B, >50 ("innumerable") tumors, bone marrow involvement.
    08/08-12/08 Four cycles CHOEP14 + four cycles GND (Cyclofosfamide, Doxorubicin, Vincristine, Etoposide, Prednisone & Gemcitabine, Navelbine, Doxil)
    02/09 2) Relapse.
    03/09-06/13 Clinical trial of Romidepsin > long-term study. NED for 64 twenty-eight day cycles, dose tapered.
    07/13 3) Relapse, 4) Suspected Mutation.
    08/13-02/14 Romidepsin increased, stopped for lack of response. Watch & Wait.
    09/14 Relapse/Progression. Visible cervical nodes appear within 4 days of being checked clear.
    10/06/14 One cycle Belinostat. Discontinued to enter second clinical trial.
    10/25/14 Clinical trial of Alisertib/Failed - Progression.
    01/12/15 Belinostat resumed/Failed - Progression. 02/23/15
    02/24/15 Pralatrexate/Failed - Progression. 04/17/15
    04/15 Genomic profiling reveals mutation into PTCL-NOS + AngioImmunoblastic T-Cell Lymphoma. Stage IV-B a second time. Two dozen tumors + small intestine (Ileum) involvement.
    04/22/15 TEC (Bendamustine, Etoposide, Carboplatin). Full response in two cycles. PET/CT both clear. Third cycle followed.
    06/15-07/15 Transplant preparation (X-rays, spinal taps, BMB, blood test, MUGA scan, lung function, CMV screening, C-Diff testing etc. etc. etc.) Intrathecal Methotrexate during spinal tap.
    BMB reveals 5) 26% blast cells of 20q Deletion Myelodysplastic Syndrome MDS), a bone marrow cancer and precursor to Acute Myeloid Leukemia.
    07/11-12/15 Cyclofosfamide + Fludarabine conditioning regimen.
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    07/17/15 Moderate intensity Haploidentical Allogeneic Stem Cell Transplant receiving my son's peripheral blood stem cells.
    07/21-22/15 Triple dose Cyclofosfamide + Mesna, followed by immunosuppressants Tacrolimus and Mycophenolate Mofetil.
    07/23-08/03/15 Marrow producing zero blood cells. Fever. Hospitalized two weeks.
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    DEXA scan reveals Osteoporosis.
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    05/2016 Tacrolimus stopped. Prednisone from 30-90mg daily tried. Sirolimus begun. Narrow-band UV-B therapy started, but discontinued for lack of response. One treatment of P-UVAreceived, but halted due to medication reaction.
    09/16/16 Three skin punch biopsies.
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    12/16 Type II Diabetes, Hypertension - both treatment-related.
    05/17 Extracorporeal Photopheresis (ECP) begun in attempt to control chronic Graft-versus-Host-Disease (cGvHD. 8 year old Power Port removed and replaced with Vortex (Smart) Port for ECP.
    05/2017 Chronic anemia (low hematocrit). Chronic kidney disease. Cataracts from radiation and steroids.
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    12/17 Bone marrow biopsy reveals no abnormalities in the marrow - MDS eradicated. The steroid taper continues.
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    03/18 Began 400mg daily of KD025, a rho-Associated Coiled-coil Kinase 2 Inhibitor (ROCK2).
    09/18 Due to refractory GvHD, Extracorporeal Photopheresis halted after 15 months ue to lack of additional benefit.
    10/18 I was withdrawn from the Kadmon KD025 clinical trial due to increasing fatigue/lack of benefit.
    11/18 Began therapy with Ruxolitinib (Jakafi), a JAK 1&2 inhibitor class drug. Started at half-dose due to concerns with drug interactions.

    To date: 1 cancer, relapse, second relapse/mutation into 2 cancers, then 3 cancers simultaneously, 20 chemotherapy/GVHD drugs in 11 regimens (4 of them at least twice), 5 salvage regimens, 4 clinical trials, 5 post-transplant immuno-suppressant/modulatory drugs, the equivalent of 1,000 years of background radiation from 40+ CT series scans and about 24 PET scans.
    Both lymphoid and myeloid malignancies lend a certain symmetry to the hematological journey.

    Believing in the redemptive value of suffering makes all the difference.

  3. #3
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    Many thanks.
    She told me her PCP called and said that she has several options. 1. Do nothing and wait. 2. start on antibiotics. 3. Biopsy would not be unusual at this time. She left it up to her. I guess that means the PCP is not overall concerned. I recommended she start on a broad based antibiotic and get the biopsy scheduled. It can't hurt. I also told her to see if there are any other antibody tests that can test for unusual stuff like cat scratch fever, other things that can transfer from animal to human based on her occupation.

  4. #4
    Super Moderator Top User po18guy's Avatar
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    Antibiotics is almost always a waste of time and money, and may provide false hope, since most infections are viral. As well, bacterial infection would "probably" result in a measurable fever. About a month ago, my hematologist palpated my nodes. "You have several that are 1-1.5 CM, but I'm not worried"

    So, although I have had probably 100 nodes that were actual tumors, neither am I worried. Still far too many viruses going around. Weird year in that regard.

 

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