Oncology (General Cancer)/Palpable Lymph Nodes in Neck

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QUESTION: Hi,

I am a 26 year old female.

About 3 weeks ago I noticed 3 lymph nodes in my neck- right side only. I guess they are all cervical nodes.

I am not sure what to make of them. I don't feel like they have always been there and I'm just noticing them, because I get massages often and believe I would have felt the therapist roll over them in the past. If I stretch my neck all the way to the left, then I can see 2 (2 are next to eachother) of them under the skin.

The last time I was sick was with a cold about two months ago.

I asked my Chiro about them, he said they were nothing to worry about and I also saw an Internist Friday about them and he didnt think they were anything of concern.

I guess I didn't ask while I was there- But WHY would they just now be palpable if I haven't been sick and am not getting sick?

I have Lymphoma fears. Though I don't have any other symptoms besides a bug crawling sensation on skin and some hip pain, that I thought had correlation with alchohol consumption (maybe coincidence). I described all my concerns to the doctor and he told me he thought I was healthy. He reviewed blood work I had pulled 3 months ago.

ANSWER: Most cases of enlarged nodes are benign in someone your age.  However, if they are increasing in size, get another opinion.  IT doesn't take much to do a fine needle biopsy.  Obviously lymphomas and hodgkin's disease are possibilities, but you shouldn't be concerned if the nodes are small and not changing.  And even if the nodes do turn out to be lymphoma or hodgkins disease we can almost always cure those diseases now.  Keep me posted.  Measure the nodes, wait a week, measure them again.  You won't lose anything by giving it a little time.   

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QUESTION: Thank you very much. Is there an accurate or 'best way' to
Measure them? I feel them often but it's kind of hard for me
To tell if they are changing. At what rate would they enlarge if they were cancerous?

ANSWER: The rate of change for a serious problem would have to be noticeable. For really small nodules, I suggest that you simply feel them, and try to decide whether they are closest to the size of a grain of rice, the eraser on a pencil, or a pea.  Then check it again in two weeks.  If it doubles in size, be concerned.  If it doesn't, check it again in two weeks.  And so forth.  Don't feel them all the time.  If you have a lymphoma it will be obvious, to you and to people who know you.  If I knew I had a lymphoma, I wouldn't worry about it to the extent that I'd run to the doctor.  Unlike cancers of other tissues, whether you can cure a lymphoma or not does not depend on when you find out; it depends on the kind it is.  

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QUESTION: Just a follow-up. I visited an ENT and he said they were too small to be of concern and told me not to worry. Also said they were too small for and FNA and people would think he was insane to do an excisional biopsy on them (which I wouldn't want at this point anyway)

They are pea sized. Have been pea sized. However, they have gotten more prominent. The actual lump they create under my skin (stretching my neck to the side) has become more noticible, NO doubt, since first notice 2 months ago. But when I feel them individually, they feel the same size? Could this be because I am messing with them often? I've had a really hard time following your two week advice- I can't help myself :/

Answer
It's very possible that your "messing with them"  too often.  Sometimes massaging little lumps can actually cause them to get a bit larger.  If you've been to two doctors who have told you not to worry, I would try to stop worrying.  Get a calendar and put "measure lumps" once a week.  measure them, write down the measurements.  Don't touch them otherwise.  My suspicion is that once you see that they aren't really changing you will probably be less anxious.  Good luck.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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