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- Tue Jan 06, 2009 10:18 pm
Hello, I am a 36 year old female who has been suffering with an intermittent lump just below or on the bottom edge of my left armpit. It is sort of toward my back but is still in the armpit area. In the past 5 years I have had a diagnostic mammogram, 2 ultrasounds which showed an englarged node of 1.3 cm which reduced to 1.1 cm over 6 months. This node would become inflamed on and off for the next 3 years or so, until now. Most recently, about 5 months ago my dr ordered a CT scan of the left chest with contrast and an MRI of the same area without. Nothing was found. I am happy about that, but I still get this swelling and as of 2 weeks ago I got some kind of infection (a red warm tender circle area developed just above the swollen node). A dermatologist prescribed antibiotics which took care of it I guess (they think it could be a very deep cyst or infected node) however, now the original node is big and swollen again. Is there any test that will be able to rule out cancer or tell exactly what this is?
I have a family history of metastatic breast cancer and want to get this resolved as well b/c we want to have another baby soon. Not to mention I had a night sweat the other night which freaked me out a bit, but then I had my period so it is probably related to hormones.
Any help or input would be appreciated. Thanks.
| Dr. Tamer Fouad
- Thu Jan 15, 2009 1:34 pm
An ultrasound can usually differentiate an inflamed lymph node from a malignant one quite easily. Certain criteria such as preservation of the lymph node hilum as well as the size, border appearance can hint at whether the lymph node is 'risky' or not.
A small lymph node 1-2cm is usually not suggestive of malignancy. After inflammation many times a lymph node may remain palpable. This is what they call a shotty lymph gland. This may enlarge again whenever there is a new infection / inflammation of course.
The gold standard for ruling out malignancy is of course an excisional biopsy. That is probably not necessary in your case. You should report to your physician anything that concerns you. You can also discuss your risk with him. Risk of breast cancer can be assessed using several methods including the Gail model. Depending on your risk score there are certain prophylactic interventions such as Tamoxifen.
In patients with familial genetic mutations more aggressive options include intensive screening (MRI), prophylactic mastectomies.