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Forum Name: Head and Neck Cancer

Question: inflamed bilateral occipital nodes, positive SCC blood test


 Vonwebster - Mon Nov 17, 2008 7:36 am

Hi, I'm a 27 year old cauasian male with no family history of cancer.

About 3 weeks I noticed that the left occipital node on the back of my neck was swollen, it was around 1.5cm in diameter and coincided with a really nasty bout of itchy scalp (I am an eczema sufferer). A few days later I noticed the node to the right of my spine had flared up also. Neither lypmh node was painful, they are firm and movable under the surface of the skin (to a cm or so either way you push them)


Shortly after I had a routine blood test to check for Squamous cell carcinoma. And here's where it gets complicated. My SCC blood test came in real high at 7.6ng/ml above the bench mark of 1.5ng/ml. At this point I should mention, I live in Japan where the SCC tumour marker test is regularly used. I realise it isn't used in the West for a number of reasons, one including the raised level in skin disease sufferers (such as me).

My scalp itch died down about a week ago, the left lymph node could possibly be getting smaller, it's difficult to tell. The right one seems roughly the same size, but I am a little concerned about the shape, it's not perfectly round (like the left) but more of an odd bean shape that is fatter at the top than the bottom (maybe 1 - 1.5cm in length). A camera in the nasal and oral cavity detected no obvious tumour


I've taken an FNA and am 5 days away from the results, I'm wondering if there is anything else I should be concerned about? It seems that SCC occuring at first in the occipital nodes isn't the norm but is entirely possible in lymphoma. Also, are infected lymph nodes always painful? Or is that a case by case affair?

Any help or advice is greatly appreciated.
 Dr. Safaa Mahmoud - Mon Nov 17, 2008 4:25 pm

User avatar Hello,

Enlargement of lymph nodes can be due to many causes like infections, inflammatory conditions, and malignant diseases.
Lymph nodes generally enlarge in reaction to inflammations or infections in the area drained by them. Since you have skin problem that involves inflammatory changes in the involved part, it is expected to see enlargement in the drained lymph nodes, the occipital group in your case.

When the inflammation or the infection occurs in the drained area in a more or less a chronic course (like yours), the enlarged nodes may enlarge without typical signs of inflammation like being painful, or this phase may pass unnoticed. Nodes generally regress in size with recovery but never disappear. They then from recurrent attacks of inflammation may become enlarged enough to be easily felt.

However, they may become painful if an acute inflammatory changes or infection occurs on top. Direct clinical examination is essential to identify the character of these swellings. If they are benign looking like any non specific nodes (smaller than 1cm, mobile, painless, and soft to firm) your doctor may recommend a follow up. The whole different characters rather than the shape itself are important.

Serial clinical examination is essential, since nodes that continue to grow, or increases in number, as well as the appearance of other involved groups are signs that warrant further investigations.

To my knowledge studies regarding the use of SCC marker in the diagnosis of different malignancies were not conclusive enough to adopt its recommendation in the clinical practice.

If malignancy is suspected, the best way is to do a histopathologic examination by a biopsy.

Other causes of skin lump like skin cysts and lipomas are also possible. One of them is Sebaceous cyst, an oil secreting glands when blocked they form swellings that are mobile, painless, smooth and roll under the skin when touched.


I would advise you to follow up with your doctor and please keep us updated.
Best regards.
 Vonwebster - Mon Nov 17, 2008 7:50 pm

Thankyou very much for your insight. It is very reassuring. My dermatologist gave me a 5 day course of anti-biotics in the mean time to fight any remaining bacterial or fungal infection of the scalp (still occaisionally itchy) and I hope the nodes shrink in size following that. My FNA results will come in on Saturday, my ENT is suggesting a PET scan regardless of the results due to frequent appearance of "false negatives" with FNA.

I will keep this thread updated, many thanks

G
 Vonwebster - Sat Nov 22, 2008 8:14 pm

Hi, thanks for all the advice so far.

My FNA results came back from the lab, both tests came back as "Class II Lymph node" which the doctor explained means that it is just a normal lymph node. Something I forgot to ask at the time is: "Does this mean it came back negative for all testable cancers or just SCC?"

The doctor (a different one from the first one I met) mentioned that we could probably safely end the investigation here, stating that SCC blood test results are always higher in patients suffering from skin inflamatory disorders like eczema.

However, the doctor the previous week said that, if the results come back negative then we should perform a PET scan or open biopsy anyway, as FNA has a relatively high false negative rate. I'm a little confused about what to do. I have a PET scan booked for next week, but my insurance will only cover 70% as it's not classified as "treatment". I'm wondering if it's worth taking or not as it'll cost me somewhere in the $400 range after insurance.

Either way, it seems like good news so far *fingers crossed*
 Dr.M.Aroon kamath - Sat Oct 10, 2009 10:07 am

User avatar Hi Vonwebster,
Serum SCC antigen (Squamous cell carcinoma antigen) is one of many epithelial tumor markers.
Serum SCC antigen testing is not widely used in clinical practice because it has been found to be elevated in many conditions (such as oral squamous cell carcinomas,some lung cancers, carcinomas of uterine cervix and others) and its sensitivity and specificity (statistical terms which indicate the ability of a test to correctly identify people who have the disease and those who don't) have not been found to be satisfactory.
Therefore one needs to be wary of over-diagnosing cancers (such as oral SCC) based on this test alone (sensitivity and specificity has been shown to improve when interpreted in combination with other tumor markers).
Wish you luck!
 Dr.M.jagesh kamath - Sat Oct 10, 2009 10:34 am

User avatar Hello,A common, but many a times missed cause of lympadenopthy of the occipital area is pediculosis capitis.A history of other members in the family having scalp pruritus can be elicited.Treatment with external application of permethin is good enough treatment.

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