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Is lymph nodes around lower left posterior cervical region malignant?

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General Surgeon
Practicing since : 2002
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General Persistent Lymphadenopathy. Hi there, I am an 18 year old fit and healthy male I am 6"2 and relatively slim. i have had a small 1cm soft rubbery,movable bump(probably lymph node) on my trapezius muscle for at least a few years with no apparent growth so i never really worried about that one. Two months ago I noticed a small bump under my chin and found two very small lymph nodes next to each other largest was about 1 cm, after persistence of about 3 weeks I saw my GP who after a brief 2 min examination ordered a round of antibiotics because he though they were due to the acne on my face. A week passed while taking the antibiotics and I noticed that one of the lymph nodes decreased slightly(2-3mm)on the fourth day in but not again after that. After some research I felt my armpits and other regions of my neck and found another sausage shaped,rubbery,highly movable, lymph node in my left armpit which again was about 1cm in length. So I went and saw my GP and he ordered a blood test which came back fine. A week later I found another 2 easily movable, smooth, and rubbery 1cm lymph nodes in my posterior cervical region on the left side of my neck. This was concerning because from what Ive gathered on the internet lower neck lymph nodes swell usually due to malignancies. So I freaked out and asked my doc for a referral to a surgeon for biopsy. Yesterday was my appointment with the surgeon, he felt the lymph nodes in my neck and armpits and decided he wasnt concerned and that we should wait 3 months to see if they grow before doing a biopsy. However I forgot to tell him about the lymph node on my trapezius muscle and I dont think he felt the largest lymph node in my lower right underarm(2cm, easily movable, and rubbery) so now I am left wondering if he would have been surprised by these lymph nodes and instead done a biopsy. Now the thing is I havent been having any other symptoms and my blood tests have been fine thus far. Most of the nodes are all 1cm or smaller, painless, rubbery, and highly movable and I have no idea how long some of them have been there because Ive never looked for them, I only found them when I searched thoroughly through every inch of these parts. another thing is that my left shoulder has been sore on and off, so I am wondering if that 1cm node on my trapezius(thats been there for at least a year) could have been causing the pain and if so is actually something serious, and if it is due to the fact that my brain is so close if it is lymphoma it could spread to my brain as well. I know I sound a little hypochondriac but this is the first time in my life I've been this worried and anxious about something. I hear about so many misdiagnosis on the web with regards to lymphoma and they really freak me out so I cant help but wonder if I fall into the category or whether I should just trust my doctor and surgeon. On one hand they(doctor and surgeon) know what theyre doing, and none of my lymph nodes are that big or have been growing, blood tests are fine, no symptoms, nor do I know how long alot of these have been around etc. On the other I am worried that this could be an indolant lymphoma that could spread to my brain due to the fact that one lymph node is so close, plus the nodes themselves are painless and rubbery(another sign of lymphoma), an indolant lymphoma would also explain my lack of symptoms as well. Should I get a third opinion from another doctor or am I just worrying unnecessarily?  also, i have also noticed that a chain of 3 lymph nodes all around 1cm or smaller are palpable from my lower left posterior cervical region down to just above my supraclavicular area. i have done research and it says these are usually malignant so now I am very worried. They are all small,painless, rubbery, and movable.
Posted Sat, 25 Jan 2014 in Cancer
 
 
Answered by Dr. Deepak Kishore Kaltari 1 hour later
Brief Answer: No need to worry Detailed Answer: Greetings Good morning I commonly come across many such patients having small lymph node in the out patient department of my hospital. If you would have been my patient I would have manged you in the following way Going by the description of your lymph node they are very small in size and size wise they are insignificant but as you said they are multiple and mobile so it's less likely to be malignant Following will be your work up 1. Complete Blood count including peripheral smear examination: in your case it's normal which is very good indeed 2. Chest X ray: I usually rule out Koch 's lesion and mediastinal and hilar lymph node 3. Ultrasound abdomen: to look for Hepatospleenomegaly and paraortic and mesenteric nodes. If the above results are normal. I would have put you on course of antibiotics for 10 days. Next follow up after 15 days. If the nodes are still persistent and remaining I would have done a open biopsy to rule out remote possibility of lymphoma or Koch. If the histopathology report is negative, then there is no cause f or concern. I hope it helped In case you require any further assistance, will be glad to assist you. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH Consultant Pediatric and General Laparpscopic Surgeon
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 1 hour later
Xray results will be in on Monday. 4 weeks ago I was on a 7 day course of clydamycin and on the 4th day I noticed a very decrease in size maybe 2mm of the submandibular node but it may have been just in my head so I take it with a grain of salt. Also if I had lymphoma according to my aunt, it would be stage 2b because I have no symptoms and its on both sides of the diaphragm in multiple nodal areas. So if it was at that stage wouldn't there be a slight hint in my blood tests? And wouldn't I feel at least a little "off" if you will? Does having so many small mobile nodes that haven't changed noticeably in the past two weeks favour a benign cause or is this quite common in most lymphomas? Also according to my aunt a chain of lymph swollen nodes from the posterior cervical to the supraclavicular area is a general sign of a malignancy and almost always rules out infectious causes. Plus my surgeon never palpatated the supraclavicular node because it is hard to find and quite small although it is located just below the other two nodes in my posterior cervical area. In your practice as a surgeon, when you feel a lymph node can you normally tell if its upon palpatation if its concerning? Thanks so much for your time
 
 
Answered by Dr. Deepak Kishore Kaltari 14 minutes later
Brief Answer: likely to be benign Detailed Answer: Greetings In most cases it's possible to say it's benign or malignant. If it's not adherent to each other and are discrete nodes it's more likely to be benign. Your aunt may be corrected in her interpretation, even if all the lymph node of neck are enlarged it does not rule out possibility of benign disease like Koch ' s which is infective pathology cannot be ruled out. Lymphoma will never regress with antibiotics alone. Your age , long duration of nodes being present are against diagnosis of malignant lesion like lymphoma. In my practice majority of such lymph node turn out to be non specific reactive hyperplasia or some cases turn out to be Koch. Out of 200 to 300 cases I have seen, I have seen only one case presenting as lymphoma. I would request you to discuss the treatment option which I have described earlier with your Surgeon. Rest be assured everything is alright. I would suggest you to be calm and reassured firmly again that based on your description it appears to be benign. Discuss open biopsy with your Surgeon to avoid missing even remote possibility. Do get back if you need any help. Take care Best Regards Dr Deepak
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 9 minutes later
OK so in your examinations, do you frequently see persistent general lmyphadenopathy like mine? Also I have done some research and it says that sausage shaped nodes are benign 97% of the time, is this true or just internet nonsense? I have just palpated the thicker part of my lower armpit and have found several other small movable nodes on both sides along with the larger 2cm movable node on my right armpit they are all very small as well.
 
 
Answered by Dr. Deepak Kishore Kaltari 6 minutes later
Brief Answer: Shape is not the deciding factor Detailed Answer: Greetings I have already mentioned I see such cases very often. I would request you to kindly follow my previous advice on this topic. Shape of nodes has no bearing on its clinical picture. It's always a Clinical dictum to view the whole case in its complete background. Internet is ocean of knowledge and authenticity of all the information given cannot be guaranteed. It's always better to go with the opinion of experts and standard reference. There is no substitute for a detailed clinical examination by an experienced surgeon. Rest be assured everything is alright. Take care Best Regards Dr Deepak
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 7 minutes later
Sorry doctor I know I sound very anxious and worried. In your examinations do you occasionally have palpable supraclavicular nodes in patients I am also told this is abnormal to feel any of these? Sorry again for sounding worried and a little anxious
 
 
Answered by Dr. Deepak Kishore Kaltari 5 minutes later
Brief Answer: I do see supra clavicle n0des Detailed Answer: I do understand your concern and apprehension. It's perfectly okay for anyone of us Being anxious like this. I do encounter supra clavicular nodes. With these findings like you all were benign. That's the reason I have suggested you to discuss planning of lymph node biopsy from your Surgeon. Take care Best Regards
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 3 minutes later
I already have, I waited two weeks for an appointment and he said come back in 3 months b/c they were not large enough to biopsy and because I am so skinny he feared he would puncture a lung. Why would he say come back in 3 months? Btw I am 6'2 and 170 ibs
 
 
Answered by Dr. Deepak Kishore Kaltari 26 minutes later
Brief Answer: I have no idea about his decision Detailed Answer: Namasthe Greetings I really have no idea why he would have advised you that. It will be ethically not correct to comment about clinical decision of other competent colleague. Suggest you to get in touch with him for further management. Take care Best Regards Dr Deepak
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 18 hours later
OK so today after feeling my lower armpit I have found yet another larger 3cm movable mass that appears to be yet another lymph node. It moves quite easily and is very long and thin. It may have been there before as it takes quite a bit of feeling around to find. Is it normal to find lumps, bumps, and lymph nodes if you press hard enough and search enough in your body? And should it be a concern unless it is easily noticeable or protruding in some way?
 
 
Answered by Dr. Deepak Kishore Kaltari 2 hours later
Brief Answer: Re-consult your Surgeon Detailed Answer: Greetings Its more advisable for an experienced Surgeon to comment and decide about significance of particular lymph node based on good clinical examination and assesment. I would suggest you to re-consult your Surgeon, and give him the privilege of assessment. Its not normal to find lumps and bumps in the body on pressing , so get a complete re-assessment from your Surgeon. Take Care Regards
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 3 hours later
OK doctor now I am very concerned, In the deep area of my armpits and after a lot of feeling around in those areas I have encountered yet another few movable hard masses. The one in my right arm pit is about 3cm by 4cm and has a very odd shape and is very movable. On the left I have found one that is also hard and movable and about 3 or 4 cm with smaller ones nearby. I am now very very concerned, these nodes feel quite odd. Especially since you stated that it is not normal to find these lumps and bumps. What could cause this? if the lymphoma is this widespread wouldn't it have shown indicators in my blood tests by now?
 
 
Answered by Dr. Deepak Kishore Kaltari 5 minutes later
Brief Answer: Re-consult your Surgeon Detailed Answer: Greetings I would request you to have a good clinical assessment by your Surgeon, it will put to rest all your apprehensions. The blood test would have been abnormal if there was widespread lymphoma. Take Care Best regards
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 4 minutes later
Thanks for the timely reply. Because I have so many swollen nodes in my neck and armpits(both sides) and no symptoms would your personal suspicion of lymphoma be quite low due to the fact that my blood tests have been fine thus far? Also if it was a lymphoma in my neck and armpits and presenting in so many swollen nodes wouldn't I be feeling a little bit sick or tired?
 
 
Answered by Dr. Deepak Kishore Kaltari 4 minutes later
Brief Answer: No cause for concern Detailed Answer: Greetings I have already reassured you on previous occasion that there is no cause of concern and it's unlikely to be lymphoma. Rest be assured everything is alright. Take care Best Regards Dr Deepak
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 3 minutes later
So you wouldn't classify widespread persistent lymphadenopathy in my neck and armpits with some masses over 3cm and irregularly shaped as concerning? Is this common in anything besides lymphoma?
 
 
Answered by Dr. Deepak Kishore Kaltari 3 minutes later
Brief Answer: Definitely very much concerning Detailed Answer: Yes its definitely concerning. Suggest you to consult your Surgeon at the earliest. Wishing you happy and healthy life.
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 0 minute later
Well you just said this is not concerning like 2 minutes ago? I don't understand?
 
 
Answered by Dr. Deepak Kishore Kaltari 5 minutes later
Brief Answer: reassessment by your surgeon Detailed Answer: That is because it's concerning you very much. So the best reassurance in your case will be thorough evaluation by clinical examination. It's always better to get clinical assessment in real when you are very much concerned about malignancy. It was not of much concern to your Surgeon too who preferred putting you on followup without any intervention. Do get back if you need any further assistance. Will be glad to help you. Take care
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 5 minutes later
Ok we both know it concerns me, the thing is my surgeon didn't find these nodes upon exam, if he would have found them and said they were benign I wouldn't be concerned either. But he didnt , and my question for you is if this was lymphoma in all these nodes in both armpits and neck wouldnt something have indicated it in my blood test? Also would these nodes show up in a chest xray?
 
 
Answered by Dr. Deepak Kishore Kaltari 7 minutes later
Brief Answer: It would have indicated in blood tests Detailed Answer: Widespread abnormality will definitely show abnormality in blood test(go through my response 30 minutes ago) In my first reply I have given you a very much detailed work up for persistent lymph node including Chest X ray. If it is seen or not can only be confirmed and said after getting chest X ray I do request you to thoroughly go through my previous replies in detail. It sufficiently and clearly answers all your queries and rest to all your apprehension. Take care Wishing you a very happy and healthy life. God bless you. Take care Best Regards Dr Deepak
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 14 minutes later
I'm sorry as you know I am very concerned. You are a very patient and helpful doctor. In lymphomas do all nodes present as abnormal or concerning if it is widespread or can some appear benign and some malignant? I also occasionally pluck my armpit hairs because I am a swimmer, sometimes this causes ingrown hairs that I've had to pull out, could this cause such lymphadenopathy in my armpit? Or would it likely go away with time?
 
 
Answered by Dr. Deepak Kishore Kaltari 4 minutes later
Brief Answer: Same pathology same manifestation n behaviour Detailed Answer: It is difficult to comment without examination. When the pathology is same all lymph node behave the same. Suggest you to send clinical photograph.
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 10 minutes later
Thanks again doctor 1. surgeon has dismissed me for 3 months after exam 2. Widespread persistent lymphadenopathy with no other symptoms 3. Normal blood tests 4. All nodes are movable and don't appear to be growing larger 5. Largest nodes are in armpit and are hard to find generally(not found in exam by surgeon) over 3cm, most other nodes are 1 cm or less If you were my doctor and I presented you with this info what would your level of concern be on a scale of 1 to 10?
 
 
Answered by Dr. Deepak Kishore Kaltari 1 hour later
Brief Answer: level of care and concern is 100%to all my patient Detailed Answer: Greetings My level of concern and care is 100% to all my patients. 10/10. Take care
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Follow-up: Is lymph nodes around lower left posterior cervical region malignant? 5 hours later
I understand that and appreciate that but I think you are missing what I am asking. If you were my doctor and I presented you with 1. surgeon has dismissed me for 3 months after exam 2. Widespread persistent lymphadenopathy with no other symptoms 3. Normal blood tests  4. All nodes are movable and don't appear to be growing larger  5. Largest nodes are in armpit and are hard to find generally(not found in exam by surgeon) over 3cm, most other nodes are 1 cm or less Would you suspect a lymphoma? Or something else based on that info?
 
 
Answered by Dr. Deepak Kishore Kaltari 17 minutes later
Brief Answer: Reassessment for confirmation of size by surgeon Detailed Answer: Greetings I had initially told you , there is absolutely no cause for concern, untill you told me the axillary lymph node is 3 cm. Accurate assessment is only by an experienced Surgeon who frequently handles such patients. Its already been mentioned in the previous conversation that its unlikely to be lymphoma based on all above features. I would only do a biopsy on routine basis , just to be sure not to miss anything or some rare diagnosis if the nodes persists. Trust and faith form integral part of doctor and patient relationship. I hope it helped relieving you of all the anxiety and undue stress you have been going through. Take Care Bye Regards
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