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How are swollen lymph nodes behind the neck treated ?

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Female, age 32, 130lbs, 5'7". Sort of long background, but the specific questions are at the end. In April I was referred to a neuro-ophthalmologist for benign intracranial hypertension. During the exam she noted swollen lymph nodes in the back of my neck and told me to have it checked when I got back home with my GP (I had to travel out of state to see her). She determined that the IIH was mostly resolved since my pregnancy, no problems there. At home, my neurologist put me on verapamil and ordered an EKG to be performed at my G.P.'s office (he is known for being rather “thorough). At the G.P.’s office the G.P. made it clear that he thought the test was a waste of time. He did a lot of eye rolling about doing an EKG on a 32 year old with no heart problems. When I mentioned the lymph nodes, he poked me in the front of the neck and said "you're fine, why they send people who don't need unnecessary tests is beyond me". So, it's now 4 months later. When I went for a follow up with my neurologist he stopped during the exam and asked if I had my nodes checked. I explained the visit at the G.P.'s office. He had his nurse make a new appointment for me and I went the next day. The appointment was not with the same G.P., it was with the head of the practice. They did a CBC and it came back fine and told me that in two weeks if they don't go away they would like to do a biopsy. He did not give me any reason they might be swollen that made any sense. (e.g, he said "they can swell from a scalp infection" I asked "you just went over my scalp with a fine tooth comb, is there an infection?" he said "no, but something like that can cause them to swell”). There were several questions that went like that. So here is where I am now: When the neuro-op had me feel them so I would know where they were located and could point them out to my G.P. I could not identify them. Now, they are so large I can actually SEE them. I have not been sick in years. I have had no infections of any kind. I live an extremely healthy lifestyle. I don’t have a sore throat. I do not have any STD’s. So my questions are: 1. Can a person have an infection for 4 months and not know it? And if it is possible, would the nodes continue to grow? 2. If that seems unlikely, what else can cause swelling over the course of 4 months besides cancer (again, I have not had infections/STD’s/illness’).
Posted Thu, 19 Apr 2012 in Infections
Answered by Dr. Rakhi Tayal 2 hours later
Thanks for writing to us.
It is not possible that a person has an infection for 4 months and there are no symptoms. But sometimes it happens that the nodes swell due to an infection, the infection gets resolved and the nodes resolve later in next 6-8 weeks and even longer in some cases.
Lymph nodes that are less than 1 cm in diameter are usually not a problem, even if they stay for longer than 3 months. The lymph node swelling can be caused by a viral or bacterial infection. Other causes include allergic reactions, metabolic disorders or some malignancy.
To find out the cause of lymphadenopathy, a FNAB (fine needle aspiration biopsy) of the lymph nodes and swollen glands is the best test. FNAB is aspiration of the material of the glands which is done by a fine gauge needle (22 or 25 gauge) and a syringe. This will confirm the diagnosis as swollen neck glands are often caused by an infection, allergic reactions, cancer or metabolic diseases.
Lymph nodes swelling associated with cancer is usually associated with an acute weight loss. You are not giving any such history. So, malignancy does not seem likely.
I hope my answer and recommendations are adequate and helpful. Waiting for your further follow up queries if any.

Above answer was peer-reviewed by
Follow-up: How are swollen lymph nodes behind the neck treated ? 1 hour later
The nodes are quite large, certainly larger than 1cm. They are at least the size of a large grape. I didn't have any infections in April that would have caused them to swell and then not go back down, back in April when the first doctor pointed them out, I couldn't even feel what she was talking about and now I can see them. Also, I probably should have mentioned (and the GP knows this) I have lost 35 pounds since January, which I had blamed on stress. So, based on that would you recommend waiting the two weeks? Not sure if the biopsy (they said they would remove the entire node) is so hard to recover from that it isn't worth the peace of mind. Would you wait two weeks?
Answered by Dr. Rakhi Tayal 1 hour later

Thanks for writing again.

If you have a history of weight loss associated with it then it is best to get the biopsy done as soon as possible so that we can know for sure what are we dealing with. Excision biopsy is best in your circumstances.

Earlier the diagnosis, better will be the treatment.

Wishing you an early recovery.


Above answer was peer-reviewed by
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