“Enlarged Lymph Node?”
Around the middle of April (13 April 2020 to be exact) I suffered from a diverticulitis attack and went to the ER. CBC was normal and CT Scan of the stomach showed diverticulitis but nothing else. The doctor gave me 2 week prescription of two antibiotics (Flagyl and Ciprofloxacin). With that, I also took some probiotics to help restore my gut flora. No problems noted and I recovered within a day or two.
Then around the first of May, I had a couple of episodes of violent coughing as I was mowing the lawn. I think I actually inhaled some grass into my lungs or throat both times where it got stuck. After that, I had a mild cough off and on and my chest hurt a bit. My throat was a little sore and I had ear pain on the left side.
Around this time I noticed a slightly swollen lymph node in my neck about 1.5 inches above my left collar bone and on the neck. It wasn't very big, it was squishy and moveable. So I went to a doctor (Dr. H) on 19 May 2020 who said I had lymphadenitis and he prescribed Toradol for 5 days to help with the pain and inflammation. He wasn't concerned and said it was my immune system doing its job.
Two weeks later (6 June 2020) I began to think it was a supraclavicular lymph node and got scared so I went to another doctor (Dr. A) to take a look at it. She told me that she did not think it was a supraclavicular lymph node but rather part of the cervical chain. She noticed that my throat was red and gave me 10 days of Amoxycillin and told me to see my regular doctor in about 2 weeks.
I then saw my regular doctor (Dr. M) on 6 July 2020 who disagreed with the other doctor (Dr. A) and said it was a supraclavicular node and recommended that I get it scanned as lymph nodes in that area were extremely problematic--especially since I am in my mid-60's. Needless to say, he scared me to death. Anyway, an appointment was set up for a CT Scan on 17 July. Likewise, another CBC was done which came back completely normal. [My 4th CBC in about 4 months--all normal.)
I then went back to the other doctor (Dr. A) the next day to clarify whether it was a supraclavicular lymph node or a cervical one and she restated that she thought it was a part of the cervical chain as it was on the neck but since it was above the collar bone it was technically supraclavicular. At any rate, she stated that since it was small (about 4mm in her estimation), isolated, moveable, and hadn't grown that it was probably nothing to worry about. Unlike Dr. M she was more reassuring. However, she also made an appointment for me to see an ENT to have my ears and throat examined around the beginning of August. She also made another appointment for me to have an endoscopy in the middle of August (possibly for my diverticulitis?). Along with that, she gave me some Cetirizine for my allergies which have been really acting up. [Note: My entire family suffers from seasonal allergies and this year the weather has been really bad where I live.]
Needless to say, I am not sure who to believe. One doctor says it's supraclavicular while the other doctor thinks otherwise. For the record, the lymph node is still small (in my estimation about 5mm or less), it is now rubbery but still moveable. Although I initially felt pain for the first week or so that has pretty much subsided. It is 1.5 inches above my collar bone on the side of the neck and resting on what I think is a muscle that runs diagonally from the neck over the supraclavicular area to the collar bone. After the antibiotics were used up my throat and ears felt much better. Likewise, my cough has disappeared for the last few days thanks, I believe, due to the Cetirizine.
Anyway, my problem is that the lymph node is still slightly enlarged and I am increasingly concerned as it has been 9 or 10 weeks since my lymph node became palpable. It is not visible and has not grown. Granted, my sore throat and cough have only subsided for a few days and my lungs now feel normal--so I was wondering if that might be a reason why the node has not returned to their regular size. I asked my regular doctor (Dr. M) if my allergies or diverticulitis might have set off the lymph node but he didn't seem to think so.
Anyway, my questions are:
(1) The "book" says that an enlarged supraclavicular lymph node stands a 90% chance of being cancer somewhere in the lungs or abdominal cavity. However, I have also read that "enlarged" often refers to a node that is greater than 1 cm. That said, if mine is less than 1 cm does that lessen the chances for cancer?
(2) The "book" says that a supraclavicular lymph node is "just above" the clavicle. Well, what does "just above" mean? Is it 1/4 inch, 1/2 inch, 1 inch, 1 1/2 inch? I mean, my ears are above the clavicle but that doesn't mean they encompass the supraclavicular area. So how far up should a lymph node be to fall under the term supraclavicular?
(3) The "book" says that--if caused by infection or inflammation--a lymph node should revert to its regular size within 2 to 4 weeks after the situation has been resolved. So, let's say that my lungs or throat were inflamed by my violent coughing attack at the beginning of May--could my and allergies have prevented a complete resolution of the inflammation and thereby result in my lymph node not reducing in size? Likewise, since I have only really felt better in the last week or so should that be the starting timeline?
In essence, in your experience, what do you think?
Then around the first of May, I had a couple of episodes of violent coughing as I was mowing the lawn. I think I actually inhaled some grass into my lungs or throat both times where it got stuck. After that, I had a mild cough off and on and my chest hurt a bit. My throat was a little sore and I had ear pain on the left side.
Around this time I noticed a slightly swollen lymph node in my neck about 1.5 inches above my left collar bone and on the neck. It wasn't very big, it was squishy and moveable. So I went to a doctor (Dr. H) on 19 May 2020 who said I had lymphadenitis and he prescribed Toradol for 5 days to help with the pain and inflammation. He wasn't concerned and said it was my immune system doing its job.
Two weeks later (6 June 2020) I began to think it was a supraclavicular lymph node and got scared so I went to another doctor (Dr. A) to take a look at it. She told me that she did not think it was a supraclavicular lymph node but rather part of the cervical chain. She noticed that my throat was red and gave me 10 days of Amoxycillin and told me to see my regular doctor in about 2 weeks.
I then saw my regular doctor (Dr. M) on 6 July 2020 who disagreed with the other doctor (Dr. A) and said it was a supraclavicular node and recommended that I get it scanned as lymph nodes in that area were extremely problematic--especially since I am in my mid-60's. Needless to say, he scared me to death. Anyway, an appointment was set up for a CT Scan on 17 July. Likewise, another CBC was done which came back completely normal. [My 4th CBC in about 4 months--all normal.)
I then went back to the other doctor (Dr. A) the next day to clarify whether it was a supraclavicular lymph node or a cervical one and she restated that she thought it was a part of the cervical chain as it was on the neck but since it was above the collar bone it was technically supraclavicular. At any rate, she stated that since it was small (about 4mm in her estimation), isolated, moveable, and hadn't grown that it was probably nothing to worry about. Unlike Dr. M she was more reassuring. However, she also made an appointment for me to see an ENT to have my ears and throat examined around the beginning of August. She also made another appointment for me to have an endoscopy in the middle of August (possibly for my diverticulitis?). Along with that, she gave me some Cetirizine for my allergies which have been really acting up. [Note: My entire family suffers from seasonal allergies and this year the weather has been really bad where I live.]
Needless to say, I am not sure who to believe. One doctor says it's supraclavicular while the other doctor thinks otherwise. For the record, the lymph node is still small (in my estimation about 5mm or less), it is now rubbery but still moveable. Although I initially felt pain for the first week or so that has pretty much subsided. It is 1.5 inches above my collar bone on the side of the neck and resting on what I think is a muscle that runs diagonally from the neck over the supraclavicular area to the collar bone. After the antibiotics were used up my throat and ears felt much better. Likewise, my cough has disappeared for the last few days thanks, I believe, due to the Cetirizine.
Anyway, my problem is that the lymph node is still slightly enlarged and I am increasingly concerned as it has been 9 or 10 weeks since my lymph node became palpable. It is not visible and has not grown. Granted, my sore throat and cough have only subsided for a few days and my lungs now feel normal--so I was wondering if that might be a reason why the node has not returned to their regular size. I asked my regular doctor (Dr. M) if my allergies or diverticulitis might have set off the lymph node but he didn't seem to think so.
Anyway, my questions are:
(1) The "book" says that an enlarged supraclavicular lymph node stands a 90% chance of being cancer somewhere in the lungs or abdominal cavity. However, I have also read that "enlarged" often refers to a node that is greater than 1 cm. That said, if mine is less than 1 cm does that lessen the chances for cancer?
(2) The "book" says that a supraclavicular lymph node is "just above" the clavicle. Well, what does "just above" mean? Is it 1/4 inch, 1/2 inch, 1 inch, 1 1/2 inch? I mean, my ears are above the clavicle but that doesn't mean they encompass the supraclavicular area. So how far up should a lymph node be to fall under the term supraclavicular?
(3) The "book" says that--if caused by infection or inflammation--a lymph node should revert to its regular size within 2 to 4 weeks after the situation has been resolved. So, let's say that my lungs or throat were inflamed by my violent coughing attack at the beginning of May--could my and allergies have prevented a complete resolution of the inflammation and thereby result in my lymph node not reducing in size? Likewise, since I have only really felt better in the last week or so should that be the starting timeline?
In essence, in your experience, what do you think?
Male | 64 years old
Complaint duration: 10 Weeks
Medications: Cetirizine
Conditions: Lymphadenophy
2 Answers
Oncologist|MedicalOncologyOncologist
All your doctors are correct, but I understand that is no assurance to you. What to do with an enlarged lymph node is a fairly common problem that oncologists see. The only way to know for sure is to biopsy the node.
The fact that it has not changed in size in 2 months is reassuring.
The fact that it has not changed in size in 2 months is reassuring.
Hello,
I have read your history. You seem to have a stable lymph node enlargement and are likely responding to antibiotics. Your questions seem to be primarily that your concern is with the possibility of cancer that might have spread from the area where it arose and is growing in a lymph node.
With your concerns the best way to settle this is to do a biopsy. I believe that the possibility of cancer is very low. Lymph nodes can swell for a large number of reasons including inflammations from infections, cancerous growths, or lymphomas. It sounds like your doctors are feeling that your lymph node is due to non-malignant causes, but the best way to know is to do a biopsy which is usually a very benign procedure. Answers to your questions are as follows:
1. A malignant enlarged lymph node should be increasing in size. Your node is small. The chance of a malignancy is also very small. But a biopsy is the best way to know for sure.
2. The exact location of the node does not define how it should be evaluated. Whether it is supraclavicular or cervical does not matter as the nodal groups overlap in this part of the body. The enlarged description leads me to recommend a biopsy.
3. The nodes should decrease in size with time if swollen for non-malignant causes.
Ask your doctor if you can see a surgeon for a biopsy.
I have read your history. You seem to have a stable lymph node enlargement and are likely responding to antibiotics. Your questions seem to be primarily that your concern is with the possibility of cancer that might have spread from the area where it arose and is growing in a lymph node.
With your concerns the best way to settle this is to do a biopsy. I believe that the possibility of cancer is very low. Lymph nodes can swell for a large number of reasons including inflammations from infections, cancerous growths, or lymphomas. It sounds like your doctors are feeling that your lymph node is due to non-malignant causes, but the best way to know is to do a biopsy which is usually a very benign procedure. Answers to your questions are as follows:
1. A malignant enlarged lymph node should be increasing in size. Your node is small. The chance of a malignancy is also very small. But a biopsy is the best way to know for sure.
2. The exact location of the node does not define how it should be evaluated. Whether it is supraclavicular or cervical does not matter as the nodal groups overlap in this part of the body. The enlarged description leads me to recommend a biopsy.
3. The nodes should decrease in size with time if swollen for non-malignant causes.
Ask your doctor if you can see a surgeon for a biopsy.
