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Could lymph nodes in armpit,posterior cervical,submandibular, and supraclavicular areas be Lymphoma?

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General & Family Physician
Practicing since : 2005
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palpable lymph nodes in armpit,posterior cervical, submandibular, and supraclavicular areas. 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 under 1cm 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. Read more: concerned over swollen lymph nodes in neck and armpits - Lymphoma Forum - eHealthForum WWW.WWWW.WW Follow us: @ehealthforums on Twitter
Posted Thu, 23 Jan 2014 in Cancer
Answered by Dr. T Shobha Deepak 56 minutes later
Brief Answer: There is no cause for concern Detailed Answer: Hi, Welcome to Healthcare-Magic Greetings of the day. I would like to reassure that it appears to be benign and unlikely to be malignant. There is no substitute for good clinical examination by an experienced surgeon, even a cursory glance by an experienced surgeon is sufficient to pick up gross abnormality. There is definitely always a factor of human error associated. To err is being human. Following are points which are against the diagnosis of malignancy like lymphoma 1.Long duration of presence of nodes especially the Trapezius 2. Response to antibiotics, obvious by initial response to antibiotic by decrease in size. 3. Very small <2cm and freely mobile 4. No significant increase in size(almost static) 5. No other constitutional symptoms like fever, weight loss, loss of appetite 6. Presence of foci of infection like acne 7. Young age Location does not decide upon chances of malignancy. Its the clinical behaviour and clinical examination and assessment by experienced surgeon. I would agree with the management of your physician. Fine needle aspiration cytology is also difficult due to small size. If there is any change in size, the swelling persists after couple of months then i would suggest to go for open biopsy. Rest be assured everything is alright In case you need any further assistance, will be glad to assist you. Take Care Best Regards Dr T Shobha Deepak MBBS,MD
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Follow-up: Could lymph nodes in armpit,posterior cervical,submandibular, and supraclavicular areas be Lymphoma? 1 hour later
Thanks for your reply. A few more things 1. The surgeon did not palpatate my left supraclavicular node because I have just found it today and is quite small although less movable than the others. Its along the same chain of swollen nodes in my lower left posterior cervical area which he felt and said don't concern him due to shape, size, and movability. If the others are of no concern should this one be any different? 2. A 2cm sausage/bean shaped node was also not picked up by the surgeon and is located in my lower right armpit and to me it feels the strangest of the bunch also the largest although it is movable. If the majority of my other nodes don't display anything strange to the surgeon should this one be of concern either? 3. My blood tests have come back fine and I haven't been experiencing any other aymptoms . If it was lymphoma I would technically be stage three right? because it is on my left and right sides of the diaphragm and in more than two areas. So wouldn't my blood tests be abnormal if I was at stage 3? 4. You mentioned that if it persists for more than a couple months I should pursue an open biopsy, although I only found the axillary and other cervical nodes within the last month or couple of weeks and they haven't noticeably changed, but my node under the chin has been there for a few months and I thought it decreased slightly I am now wondering if it was just in my head? And really has just stayed the same size since then. Another thing I forgot to mention is that although the nodes under my chin are less than a cm they don't really move altogether, it feels like the top of the node moves and the bottom stays fixed. However they are very small so the surgeon says he's not too concerned about them.
Answered by Dr. T Shobha Deepak 12 minutes later
Brief Answer: No cause for concern Detailed Answer: Greetings 1. every lymph node has its own mobility, which can be accurately judged by experienced surgeon. As you mentioned there is left supraclavicular node and its small so it could be clinically insignificant. Lymph nodes are very much prominent in thin individuals and with long neck even though they might not be enlarged. 2. 2cm node may also be insignificant which is in the arm pit. 3. Your blood tests would have been definitely abnormal in case it would have been long standing lymphoma, there would have been lymphocytosis and other markers which i am sure you would have definitely come across while searching online. 3. Lymphoma node will never spontaneously decrease in size, they are known for progressive increase with sudden spurt. soits unlikely your chin node could be pathological. I would once again reassure that there seems to be no cause for concern. Get a reassesement with your Surgeon on the date of appointment. Take Care Regards
Above answer was peer-reviewed by
Follow-up: Could lymph nodes in armpit,posterior cervical,submandibular, and supraclavicular areas be Lymphoma? 1 hour later
So because there are so many lymph nodes enlarged on 3 parts of my upper body which indicate that if it was lymphoma it would be stage 2 or higher lymphoma ,and because my blood tests are still normal without symptoms would that alone be enough to rule out lymphoma? Also is it true that oblong or sausage shape nodes are benign generally ? Lastly I am a thin individual 6'2 160 ibs with a fairly long neck etc. Wouldn't I be able to feel lymph nodes on both sides Rather than just one if they were normal? And my naturopath practicioner said that supraclavicular nodes in a chain like mine no matter how small are most likely not from my thin body type but rather from an immune disorder or more likely cancer, and because they are a chain it rules out infection although she is not a qualified MD like yourself or others I have seen about this, so I tried not to panic when I was told that. Thanks again though, I am very worried but youve helped to make me feel better.
Answered by Dr. T Shobha Deepak 10 minutes later
Brief Answer: No cause for concern Detailed Answer: Greetings I would once agin reassure that there is no cause for concern. It would be really helpful if you could attach clinical photograph for further advise. from the clinical description of the lesion and features as described by you its unlikely to be lymphoma, confirmatory test for diagnosis is biopsy, which at present is not indicated as the nodes are small and other features discussed. The shape of the lymph node is not the criteria for deciding its malignant potential. Its the complete clinical profile taken as a whole including thorough history, physical examination and investigation which decide it I would again suggest you to leave the onus of diagnosis on the Physician/Surgeon. Having trust and maintaining a good rapport and openly discussing with your clinician is very important. I do understand your concern and apprehension based on the thorough online search done by you. I Appreciate it In case you need any further help, get back to me. Regards Dr T Shobha
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Follow-up: Could lymph nodes in armpit,posterior cervical,submandibular, and supraclavicular areas be Lymphoma? 1 hour later
So, when would you consider a lymph node in someone like me concerning? And do lymphomas most frequently present as larger than 2cm? In your examinations is it normal to feel nodes in slim young adults like myself or am I in the minority? I keep palpating my body for lymph nodes and finding small ones all over is this normal if you search hard enough?, every time I find one I get nervous and anxious. So would it be beneficial if I just left them for a few months until my next exam? Or should I keep checking for increase in size in them and wait until they become noticeable without palpating or having to look hard?
Answered by Dr. T Shobha Deepak 4 minutes later
Brief Answer: No need for worrying Detailed Answer: Greetings It's quite normal to see many thin individual have palpable lymph node even if they are not pathological. At present I would suggest you to leave them alone. Any significant increase in size will automatically draw your attention toward it. Lymphoma usually present significantly larger than 2 cm. Rest be assured everything is fine. Be relaxed till your next visit to doctor. Take care best regards
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