Oncology (General Cancer)/a bump on occipital area

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QUESTION: Hi,
about a week ago i woke up with a bad neck pain on the left side. I found an enlarged, hot and painful occipital lymph node on left side. it wasn't hard but just above it there is a prominent bony-hard thing on the occiput. there is the same prominent area on the right side but about 1/5 size of this one! this comparing big structure is fix and immobile and is not tender at all. now after a week the enlarged occipital lymph node has become smaller but still a bit large, and it's not tender or hot. but the large bony prominence is still unchanged there. pressing it causes an aching pain in the left side of my face (specially my left ear and behind the eye)

-besides 2months ago i had a tetanus diphtheria vaccination and 3 days after that i experienced left side painful
inguinal lymph node enlargement which became normal in size and non tender after about 4days.

-i am experiencing dandruff right now. i have experienced it many times before but it never caused enlarged occipital lymph node.

-i'm 31, female.

any help would be appreciated,
thanks,

ANSWER: In  general, something that starts out enlarged and painful and then shrinks and loses its pain is probably not cancer, but rather, inflammation, perhaps due to infection or to injury.  The area you are describing is the insertion point of one of the "strap" muscles.  Sometimes you might cause local injury by sleeping the wrong way, or in my case, playing pool too long (:( -- it really happened)  I would give it a little more time before getting too worried.  The other thing is that our skulls are usually a little asymmetrical, but sometimes the only way you notice is if something calls your attention to it.  I think you have inflammation of the periosteum) lining of the bone) caused initially by some sort of trauma, and it is getting better.  Give it a week or so before you worry too much.  Let me know what happens.l  

---------- FOLLOW-UP ----------

QUESTION: Dear DR. Higby,
Hi,
the pain subsided with a little decrease in lymph nodes size, but yesterday after a week, it started again and this time with a posterior cervical lymph node enlargement added. this cervical node unlike the two other enlarged lymph nodes is not hard nor fixed and it's not tender to touch but again the muscles in the area has caused me pain. the pain even goes behind my left eye. and the area is some how warm.
can dandruff be a cause?! i have experienced it before but it didn't cause any lymph node enlargement.

really thank you for your help,
Simin

ANSWER: I don't think you can blame dandruff.  It's also hard for me to see how you can have pain behind the eye as a result of something going on in the back of your head, unless there is something else going on to explain both.  I'm not sure what is going on but I would think it is benign; however, maybe you should see a physican, since diagnosis requires visualization and usually, feeling the questionable place as well.  It wouldn't hurt to wait a little longer, however.  Does the eye pain come and go? Or is it there all the time?  Any blurred vision?  Do you have any numbness under the eye?  

---------- FOLLOW-UP ----------

QUESTION: Dear dr. Higby,
Hi an thank you so much for your response,

the pain behind the eye is not always there, it comes along with the muscle spasm in the area and goes when the spasm becomes less and there is no numbness under the eye. but there is a feeling of warmth and fullness in left half of my face which come and go. sometimes even some tongue movements cause discomfort but it's not always like this.

now that i'm writing this, there is a little decrease in the posterior cervical lymph node size and the muscle spasm has become much more tolerable, it's painful just at the end of neck rotation and extension when muscles compress the nodes. (the nodes themselves are not that much painful but pressing them causes pain in the area around them)

I was worried about it, so i visited a specialist in infectious diseases. she told me the all three prominences are lymph nodes and the posterior cervical node is soft and mobile and the other too are not that much soft because they are located on the bone. she told me that it's probably toxoplasmosis. and she asked me to do a series of tests including;
-CBC, ESR, CRP
-toxo IFA (IgG, IgM)
-SGOT, SGPT, ALKp
-LDH, wright, wembs wright (i can't read the last one completely)
-P.P.D

i'm going to do the tests as soon as possible but the thing that i'm worry about is cancer or malignancy. do you think i should see an oncologist? I'm really worry about it,

besides about 13 months ago i experience a demyelinating attack in C4 level, they told me that they can't tell if it is MS or not at this time but, it should be follow up by MRIs every 6 months. and at this point they didn't prescribed me any drugs (I do not use any drugs now). my third follow-up MRI will be next week and it will be an MRI for Brain and Cervical spine. Do you think it can help in diagnosis of my recent problem? (to rule-out cancer r any malignancy?)

thank you so much again for your helpful responses,

Answer
From everything you are saying, I don't think it's lymphoma.  Toxoplasmosis is a possibility and by all means get the tests.  As for the sensations you are experiencing, perhaps that might be due to some aspect of your demylenating disease.  An MRI may help, and if it is negative, you've done about all you can right now from the standpoint of imaging.  If the toxo tests are negative, you might want to see a surgeon to consider a lymph node biopsy. That's the only way you can be certain about what it is, but again, if the nodes are soft, not tender, and don't change, you aren't in any trouble.  Hope this helps.  

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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