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What are the chances of cancer when having multiple palpable lymph nodes?

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Posted on Sat, 17 Jan 2015
Question: I had a question regarding palpable lymph nodes. I started out with a small but palpable lymph node on the left side of my neck. It started out the size of a pea and is now quarter size - slowly but steadily growing since it appeared 2 years ago. Within the last 4 months, I have developed 2 additional palpable nodes in the neck, one on the left and one on the right, as well as a palpable right supraclavicular node, though it is quite small. Systemically, I have been having sporadic fevers for the last 2-3 months and almost nightly cold sweats. I literally wake up soaked. Multiple courses of antibiotics have not changed anything. Blood work is normal except for anemia, which is chronic. I asked for a biopsy, but my Dr. said she is not worried due to my age and the characteristics of the nodes. I, however, am concerned because:
1. I have Acute Intermittent Porphyria, which I know increases my risk of liver cancer
2. I have smoked for 15 years
3. I have had over 30 CT scans, mostly of my abdomen/pelvis, but a few of my head and chest

I was wondering, given my symptoms and history, if I should listen to my Dr and forget about it or if I should seek a second opinion and try to get a biopsy. Thanks!
doctor
Answered by Dr. Prashant Sharma (3 hours later)
Brief Answer:
Get FNAC.

Detailed Answer:
Hi madam,

Happy new year first of all.

The lymph nodes palpable in neck, specially in lower neck, progressive in size and number should not be ignored. Your doctor's opinion may be based on his/ her experience.

In my opinion we should ideally have a biopsy, because some forms of less aggressive lymphomas behave in this manner. If biopsy can not be done due to any reason, FNAC (fine needle aspiration cytology) is a satisfactory alternative.

In FNAC a pathologist just pricks a small needle in the lymph node, sucks the fluid drop, and will give you the report in the evening. Accordingly we will proceed.

No chances of liver cancer with this history, a USG will clear your doubt.

Hope new year brings you good health.
Feel free to ask.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Follow up: Dr. Prashant Sharma (4 hours later)
Thank you for your quick reaponse. I had a couple of additional questions, if thats okay. I remember one of the reasons the Dr didnt want me to get a biopsy was because she said it is dangerous in the neck due to all the vital structures, and easy to cause permenent damage. Is this true? What kind of damage is likely following an excisional biopsy in the neck?
Also, i was doing some research and it seems like PET scans are pretty good at detecting certain cancers. I noticed they are usually used more for staging after diagnosis. Do you think it would be helpful to request a PET scan first, since it is less invasive?
Finally, you mentioned a FNAC. I have a friend that is a pathologist and i remember her mentioning a while back that FNAC are frequently inconclusive or dont show malignancy even though it is there due to small tissue size. Do you know how likely a FNAC is to give the correct answer? Thank you very much and Happy NewYear to you!
doctor
Answered by Dr. Prashant Sharma (1 hour later)
Brief Answer:
I would still advise an FNAC

Detailed Answer:
Hi. seems you already know much about the things.
Practically no complications after excision biopsy in expert hands.

I have done a lot of such biopsies without any significant complication. usually complications like wound infection, bad scar, painful scar, sensation loss, minor bleeding etc occur in less than 10%. but all these are easily manageable. by God's grace i have not seen any permanent damage till now following just an excision biopsy of a small node like yours.

FNAC of course like any investigation has got false positive and negative results. but in expert hands it has around 90% sensitivity. only 1% chances of false positivity. it can be inconclusive, but can be repeated also with the same ease. no harm in doing FNAC usually.

PET scan- not completely non invasive as they will inject XXXXXXX in your veins. it also has got false positive and false negative rate. its false positivity is more than FNAC, may be upto 25% depending upon the region concerned. also it may no pick the nodes less than 1 cm in size.

Also treatment can not be given based on PET findings. you must have tissue diagnosis in the form of FNAC or biopsy.

In FNAC you have to undergo just a single prick by a small thin needle, nothing is less invasive than this. many pathologists expert in cytology even give final diagnosis on FNAC.


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Answered by
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Dr. Prashant Sharma

Oncologist, Surgical

Practicing since :2003

Answered : 177 Questions

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What are the chances of cancer when having multiple palpable lymph nodes?

Brief Answer: Get FNAC. Detailed Answer: Hi madam, Happy new year first of all. The lymph nodes palpable in neck, specially in lower neck, progressive in size and number should not be ignored. Your doctor's opinion may be based on his/ her experience. In my opinion we should ideally have a biopsy, because some forms of less aggressive lymphomas behave in this manner. If biopsy can not be done due to any reason, FNAC (fine needle aspiration cytology) is a satisfactory alternative. In FNAC a pathologist just pricks a small needle in the lymph node, sucks the fluid drop, and will give you the report in the evening. Accordingly we will proceed. No chances of liver cancer with this history, a USG will clear your doubt. Hope new year brings you good health. Feel free to ask.