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Forum Name: Head and Neck Cancer

Question: Lump in neck - seeing ENT


 LisaLisa627 - Wed Jul 04, 2007 6:47 am

After going through a lymphoma scare earlier in the year, it was discovered by a hygenist that I have a lump in what appears to be the Parotid gland area, more under the ear in between the ear and the jaw. Went to my Primary - he sent me for MRI and the to ENT. Saw ENT on Monday and MRI was normal, but he did not seem to think an MRI would show anything anyway. He can feel the lump, I just think he thought it was the wrong test to do. He is leaning towards a Parotid Gland tumor, but said of course it could be a lymph node as well. He put me on antibiotics, but seeing as I have not been sick he does not think it will help, just protocol. I go back on Monday and he said if it is still there they will do an FNA. He said if it is cancer he thinks we will have caught it very early. Any advice? How would he know if it was a lymph node or tumor? Will he do and FNA even if he does not know which one it is?

Thanks!

Lisa
 Dr. Chan Lowe - Wed Jul 04, 2007 11:34 am

User avatar Great questions. This is a relatively common issue that people deal with. The location you are describing is an area where lymph nodes are commonly found. This, alone, does not rule out a parotid tumor since these also would be found in this area.

The FNA (fine needle aspiration) is used to determine which of these (or some other option) the lump is. Your doctor does not need to know if the lump is a lymph node or tumor since the FNA will give the answer. If he is able to determine which it is, the FNA may not be needed.

A FNA is a relatively simple procedure. A small needle is used to remove a small part of the mass. This part is then analyzed under a microscope to determine what the lump is.

Following up with your ENT doctor is the key. I would certainly not be certain that this is a tumor as the chances are good that it may be a lymph node. However, it is far from 100% so if there is any suspicion that it may be a tumor the FNA is probably a good idea.

Best wishes.
 LisaLisa627 - Wed Jul 04, 2007 3:42 pm

That helps me alot! So, can you tell me how long I can expect to wait before I get the results of the FNA? And I assume if it is cancerous that the FNA should show? If it is a non cancerous tumor - will they know that from the FNA as well? Or will I just get answers as to if we need to remove a tumor or do open biopsy of lymph node? I am sure you understand the waiting is the hardest part!

I had previous DCIS on left side - same side as node or tumor and had radiation to chest wall and breast on that side. So, of course I get a little nervous about these things. Also, he could feel some small lymph nodes on my right side of neck - where I originally earlier in the year had big lymph nodes that were a scare for lymphoma - but, never biopsied.

I go to ENT on Monday so will update you on what I find! Thanks again!

Lisa
 Dr. Chan Lowe - Wed Jul 04, 2007 4:46 pm

User avatar The FNA is likely to be able to answer all the questions as to what the lump is-cancer, non-cancer or normal lymph node. Usually preliminary results come back relatively quickly, 1-3 days or so (even though these days may seem eternally long). If more specialized staining of the tissue is needed or other specialized tests it may take longer to get these results. Generally the answer of cancer or not cancer can be made in the first reviews of the tissue. If, unfortunately, it is cancer the more specialized tests may be needed to help specifically type it and get information about how to treat it.

Having lymph nodes swollen on the other side at the same time actually tends to favor an enlarged lymph node (statistically) although this, too, does not rule out cancer.

Having the previous DCIS does increase the chances of having a recurrent cancer, although it seems a less likely area for breast cancer to spread to. The radiation should have been well focused to minimize exposure of the parotid gland and other structures except those in the direct path of the radiation beam. This makes a secondary tumor in this area less likely but, again, not 100%

I look forward to your update. I completely understand how long the next few days will seem to you. Try not to dwell on it being cancer. Best to stay optimistic and await the answers.

Best wishes.
 LisaLisa627 - Mon Jul 09, 2007 9:35 pm

I went to ENT today and he wants to watch it and wait another month to see what it does before doing a FNA or open biopsy. He thinks we can wait since the MRI did not show anything. He is thinking it is a lymph node and parotid gland thickening. I am hoping it is ok to wait! I always worry because they did not think I had Breast cancer either as it never showed up on mammogram. But, once they did a biopsy 9 months later it was! Any advice is great! Thanks so much!

Lisa
 Dr. Chan Lowe - Tue Jul 10, 2007 8:17 am

User avatar I think waiting is a very reasonable approach. In this case, unlike with the breast cancer, the mass is in an area that is easy to evaluate. If the lump begins to get bigger, let your ENT doctor know and you may need the FNA sooner.

Best wishes.

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