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What Causes Painful Lump In Groin And Swelling In Scrotum?
Question: Hello, my father has had a bladder removed including prostate some 8 years ago. He is 88 and now has a painful lump appear in his groin and his scrotum has swollen to the size of a large orange over a period of time some 12 months . He has had tests and the results are that yes he has substantial cancer cells in his right lymph node evidenced by a US guided biopsy. His doctor has indicated that he has an infection which is causing the scrotum to swell caused by a blockage due to the infection to the drainage to the lymph node (?) (at the moment he is having antibiotic injections but the treatment does not seem to be working as he has not experienced any improvement in the symptons, the antibiotics, oral and injection have been administed over 2 weeks.) This the doctor says is causing pressure to the femoral artery and pressure to the main nerve in his right leg causing severe pain (?). His doctor also said that the infection needs to be treated to relieve the pain he is experiencing before he has the radiation treatment for the lymph node. The radiation treatment I find odd as I always thought that the treatment of the primary or secondary cancer with radiation etc would be more effective than treating the 'indicator' of cancer ie the lymph node. I have been informed that less than 5% of cancers originate in lymph nodes. After speaking to a radiation oncologist friend he said that in some instances a hernia can develop ie 'inguinal hernia' which can cause severe pain and swelling of the scrotum etc. However he is not ruling out the obvious and that is that the cancer from the bladder has spread even though the bladder cancer was in-situ. He also recommended we look into having a PET scan to diagnose if it is cancer from a primary or secondary site. Dad has had a CT scan and blood tests but his GP said that the results were not 100% conclusive. However because of dads age and the fact that he has had previous cancer it appears to me that they are going down this road. At one stage they recommended radiation treatment on the lymph node before they had even received the results from the biopsy. My concern is that he is being misdiagnosed due to past cancer history and that he needs a PET scan to show whether the bladder cancer has metastasised.
Brief Answer:
Its Metastasis to lymph node,Radiotherapy required
Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the day
I do understand your concern and apprehensions regarding the treatment of your father.
As stated by you if the lymph node biopsy has been done and it shows cancerous cells, its more likely to be secondary cancer of lymph nodes (metastasis) primary being some where else, for the following reasons:
1. Metastatic involvement of lymph node usually causes enlargement of the area drained by it specifically penis and scrotum
2. Primary tumour of lymph node ( inguinal region) i.e. lymphoma is rare. Oedema and swelling are less likely seen in case of primary tumor of the the lymph node
3. Previous Bladder cancer could have caused spread of cancer cells into Internal/External illiac lymph nodes and through which retrograde spread to inguinal lymph node would have been possible causing secondary tumor of inguinal lymph node.
If the biopsy has confirmed tumour cells, and the diagnosis is malignancy of lymph node, finding out whether the lymph node enlargement is primary or secondary will not alter the management as currently lymph node is being involved and has already caused blockage of lymphatic drainage. The eminent danger is erosion of femoral artery causing bleeding. So it will require reduction in size of lymph node. Radiotherapy is the preferred therapy for reducing the size of lymph node and reducing risk of bleeding. Getting Immunohistochemistry of biopsy can reveal the origin of tumor whether its primary and secondary.
I hope it was helpful.
Do write to me if you need any further assistance, will be glad to assist you.
Wish your father good health.
Take Care
Best Regards
Dr T Shobha Deepak
MBBS,MD
Its Metastasis to lymph node,Radiotherapy required
Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the day
I do understand your concern and apprehensions regarding the treatment of your father.
As stated by you if the lymph node biopsy has been done and it shows cancerous cells, its more likely to be secondary cancer of lymph nodes (metastasis) primary being some where else, for the following reasons:
1. Metastatic involvement of lymph node usually causes enlargement of the area drained by it specifically penis and scrotum
2. Primary tumour of lymph node ( inguinal region) i.e. lymphoma is rare. Oedema and swelling are less likely seen in case of primary tumor of the the lymph node
3. Previous Bladder cancer could have caused spread of cancer cells into Internal/External illiac lymph nodes and through which retrograde spread to inguinal lymph node would have been possible causing secondary tumor of inguinal lymph node.
If the biopsy has confirmed tumour cells, and the diagnosis is malignancy of lymph node, finding out whether the lymph node enlargement is primary or secondary will not alter the management as currently lymph node is being involved and has already caused blockage of lymphatic drainage. The eminent danger is erosion of femoral artery causing bleeding. So it will require reduction in size of lymph node. Radiotherapy is the preferred therapy for reducing the size of lymph node and reducing risk of bleeding. Getting Immunohistochemistry of biopsy can reveal the origin of tumor whether its primary and secondary.
I hope it was helpful.
Do write to me if you need any further assistance, will be glad to assist you.
Wish your father good health.
Take Care
Best Regards
Dr T Shobha Deepak
MBBS,MD
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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