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Forum Name: Lymphoma

Question: Possible Cancer?


 LEJ1445 - Sun Dec 11, 2005 12:15 pm

I am a 20 year old male, with no immediate family history of cancer. I have always had good health and although slightly overweight, live a healthy lifestyle, IE no smoking, rarely drink. Three days ago I noticed a small lump on my right side, at the base of my neck, right above my collar bone. It seems to me to be an enlarged lymph node that is a bit larger than a Nickel in diameter. I have also over about the past 2 weeks had a slight pain in my neck in that area, that has intensified over the last few days. I sit at a computer for most of my day so before noticing this lump I had just attributed the pain to that. I am wondering if any of the medical professionals on here could provide me with any explanation of what this could be. Thanks!
 LEJ1445 - Sun Dec 11, 2005 5:36 pm

Just wanted to add that the lump seems to be increasing a small amount in size each day. Also, the pain in my neck seems to come and go. If anyone has any ideas on what this might be I'd love to hear from you. Thanks in advance!
 Dr. Tamer Fouad - Sun Dec 11, 2005 5:37 pm

User avatar Hello LEJ1445,
Thank you for using The Doctors Lounge.
According to your description this could be a supraclavicular lymph node enlargement. Generally speaking a lymph node may enlarge either due to an infection or due to cancer. I cannot stress enough how important it is for you to get a doctor to look at it. It is imperative that cancer be ruled out by clinical examination.
Please let us know what your doctor thinks.
Best regards,
 LEJ1445 - Tue Dec 27, 2005 11:45 pm

First of all, thanks so much to Dr. Fouad for replying to all of our posts here on the forum. As you recomended, I visited my ENT Doctor about the lump on my neck. He examined it and told me that he was not concerned about it and that it did not feel like a lymph node. I have also had it examined by my father, who is a dentist, and he also said that it did not feel like a lymph node to him either. However, I am still concerned. The lump is at the base of the right side of my neck, right where the central vein running down the right side of my neck goes into my body. The bump is most clearly shown by depressing the skin on either side of it. It is about the size of a marble but is not firm. Both my father and my ENT Doctor seemed to think that it is something that has maybe been there forever. I however, know that this is not true. I have also had pain, not in the exact area of the bump but in my neck/shoulder area, for about the last 3 weeks. I am wondering if anyone has ever had something like this or could at least tell me what this could possibly be. Thanks!
 dimeless9 - Wed Dec 28, 2005 1:28 am

LEJ1445 wrote:First of all, thanks so much to Dr. Fouad for replying to all of our posts here on the forum. As you recomended, I visited my ENT Doctor about the lump on my neck. He examined it and told me that he was not concerned about it and that it did not feel like a lymph node. I have also had it examined by my father, who is a dentist, and he also said that it did not feel like a lymph node to him either. However, I am still concerned. The lump is at the base of the right side of my neck, right where the central vein running down the right side of my neck goes into my body. The bump is most clearly shown by depressing the skin on either side of it. It is about the size of a marble but is not firm. Both my father and my ENT Doctor seemed to think that it is something that has maybe been there forever. I however, know that this is not true. I have also had pain, not in the exact area of the bump but in my neck/shoulder area, for about the last 3 weeks. I am wondering if anyone has ever had something like this or could at least tell me what this could possibly be. Thanks!
Hello.. I JUST WANTED YOU TO KNOW I HAVE THE SAME THING RIGHT NOW AND I HAVE A DR APT TOMORROW ANDI WILL LET YOU KNOW IF MY DR TELLS ME SOMETHING DIFFRENT.. DO YOU HAVE ANY OTHER PAIN BUT YOUR NECK? I HAVE IN MY JAW AND EAR... SO I AM HOPING IT IS JUST A INFECTION... I WILL KEEP YOU UPDATED...
 Dr. Tamer Fouad - Wed Dec 28, 2005 3:03 am

User avatar Hello LEJ1445,
Thank you for your kind words.
I am glad that you had it looked at. I trust that their evaluation; however, I understand your worry.
Let me address a few points in your second question:
As regards incidence findings from a Dutch study revealed that only 10 percent of patients with unexplained adenopathy required referral to a subspecialist, 3 percent required a biopsy and only 1 percent had a malignancy.[1] This means that cancer is actually a rare cause of lymph node enlargement.

As regards age in primary care settings, patients 40 years of age and older with unexplained lymphadenopathy have about a 4 percent risk of cancer versus a 0.4 percent risk in patients younger than age 40.[1] Meaning that this is an even rarer possibility given your age.

As regards the accuracy of the clinical examination in one study examining the presence of supraclavicular lymph node enlargement in nonsmall cell lung cancer patients - Nodes had to have a diameter of 22.3 mm or greater to be palpated in 50% of cases.[2] CT scans can detect the presence of enlarged lymph nodes in the neck with a short-axis diameter of 5 mm or greater.

The sensitivities of ultrasonography and CT did not differ significantly in detecting the presence of a lymph node enlargement.[2]

I do not think that there is a high possibility of there being cancer in your case; however if you are still worried about the node you can discuss the possibility of getting a CT scan done to confirm the nature of the finding.

References:
=========
1. Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Pract 1988;27: 373-6.
2. Hans van Overhagen, MD, PhD, Koen Brakel, MD, PhD, Mark W. Heijenbrok, MD, Jan H. L. M. van Kasteren, MD, Cees N. F. van de Moosdijk, MD, Albert C. Roldaan, MD, PhD, Ad P. van Gils, MD, PhD and Bettina E. Hansen, MSc. Metastases in Supraclavicular Lymph Nodes in Lung Cancer: Assessment with Palpation, US, and CT. Radiology 2004;232:75-80.
 LEJ1445 - Thu Dec 29, 2005 9:18 pm

Hi Dimeless, to answer your question about pain: I seem to have pain in my neck as well as a small amount in my jaw. How was your Dr. appt? Did you gain any insight into what may be the nature of our problem?

Dr. Fouad, thanks so much for your previous reply. If you could answer just one more question for me. First of all, to recap. My symptoms are a some sort of bump either above or below the vein on my right side at the base of my neck. I also have pain (not severe but a lingering stiffness/pain that has been present for about the last 3 weeks) in my neck area as well as some pain in my jaw area. In your previous reply you stated that the enlarged lump alone was probably not cause for alarm. What I am wondering now is if the combination of the lump/pain in my neck (The pain is not concentrated in the same area as the lump) should be cause for alarm. As I said, I have visited my ENT and he felt of the lump and said that he did not think it was a lymph node, but this left me wondering what else a lump like this could be. Thanks in advance for your reply!
 Dr. Tamer Fouad - Fri Dec 30, 2005 10:22 am

User avatar Hi LEJ1445,
Pain/Tenderness. When a lymph node rapidly increases in size, its capsule stretches and causes pain. Pain is usually the result of an inflammatory process or suppuration, but pain may also result from hemorrhage into the necrotic center of a malignant node. The presence or absence of tenderness does not reliably differentiate benign from malignant nodes.[1]

References:
=========
1. Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Pract 1988;27: 373-6.

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