Posterior Cervical Lymph Nodes

[martonius]

A little over a year ago, I discovered three small lumps in my neck.  I started to get anxious about them, so I decided to go to the doctors.  He said that I had a few slightly enlarged posterior cervical lymph nodes and they were probably due to a recent cold or virus.  A few months later they were still around the same size so I went back.  He told me they were around 1cm (though they felt larger to me) and that I should keep an eye on them to see if they get larger, and that sometimes they can become permanently enlarged.  Well, it's been over a year and as far as I can tell, they haven't gotten any larger, but I can still easily feel them.

The thing that bothers me is that I read about this particular lymph node group, and almost every site I look at says that if the Posterior Lymph Nodes become enlarged, it is commonly due to malignancies, leukemia, or lymphoma.

I am a 25 year old male.  I've had no fever, night sweats, or any other symptom besides the lymph nodes.  I've had blood work done on two separate occasions, which have both been fine.  I've also had a monospot, HIV test, and TB test, also OK.  

I've just had a bit of anxiety lately, and have grown a little concerned over this.

Any advice would be helpful.

Thanks!

[Caliber2005]

Hi,
I think persistent posterior cervical group of lymph nodes without increase in size suggest benign nature of swelling, but to confirm and alleviate your anxiety permanently, it is best to do a Fine Needle Aspiration Cytology and know whether swelling is benign or malignant.

[rooster1969]

I have the same problem.  I have one lymph node that is swollen in the posterior triangle region also called the cervical chain.  The lymph node as described by my ent is 11mmx8mmx3.5mm and is firm, rubbery and moveable.  It has been there since August or July, and I have not had any colds and such.  The ent said that it was fine and that I should come back only if it changes.  I have had intermittent fevers that last for 4-5 hours ranging from 99.9 to 100.3 that never result in any illness.  I do not have night sweats, but have broken out with some sort of rash that itches intensely.  About a year ago I began to get intense pain after one swallow of alcohol.  Hopefully my ent knows what he is talking about, but I am keeping a watchiful eye on it.  Good luck to you.
Rachel
37 years old

[Forst42]

Intense pain after swallowing alcohol along with the itching (pruritis) is a sign associated with a condition called Hodgkins lymphoma- If you haven't already PLEASE, PLEASE go and see your doctor- I'm a medical student and our consultant said this is the only time you get pain in the lymph nodes on swallowing alcohol.

[Drmikechicago]

I highly doubt this is hodgkins and why are you worrying this person. Why don't you wait till you get your degree before you start diagnosing. A lymph node under 10mm, is almost never malignant!

[rooster1969]

thank you for your information on Hodgkins, I was actually told this by a pathologist in December, and have been getting tests.  The Dr. even gave me medical articles to support this.  I do have a question for you however, you stated that your consultant said that this is the only disease (condition) that causes this, but what if they find any evidence  of a specific node that they deem large enough to biopsy?  And how long do people have this symptom until nodes appear?  By the way Drmikechicago should pay close attention to the use of the word (almost).  That would imply that it does on occasion happen.  Better a person have information like this and get checked, than for a doctor to automatically assume that because a condition is rare, and they doubt it is what they have, that they don't share the possible causes for it!!!

[CSI007]

Do not, I REPEAT do NOT get a needle biopsy.  With Hodgkins the chances are very high that you will get a false negative.  I had one done and it came back negative, two weeks later and an excisional biopsy I had a diagnosis of Hodgkins NS stage 2b.

[Fishben]

My 12-year-old son has large lymph nodes in the right side of his neck.  I have had him to the doctor twice and she has treated him with Keflex then Augmentin.  He also had some sort of strange inflammation on his scalp.  The second time she did blood work which she said was normal - and sent him for an ultrasound which showed many large lymph nodes, but two that were 1 cm or larger which the radiologist called "suspicious."  The radiologist suggested a follow up ultrasound after the antibiotic is finished, but the doctor said the ultrasound was not concerning to her (I guess because the blood work was normal).  In the meantime the antibiotic is finished and he still has the large nodes.  He also has been complaining occasionally of intense itching which I have to give him Benadryl for.  I did not connect this because he has had problems with his skin since he was little (ezcema, hives, etc).  He has also complained of a sore throat in the morning.  Should I be concerned or should I wait it out?

[cam580]

I'm a 16 year old girl and have the same symptoms as your son, Fishben.
The ultra sound report said that I have large "lesions" on both the left and right posterior cervical lymph nodes. They are not tender in the slightest and i have no other symptoms to suggest a viral or bacterial infection. The doctor has also prescribed keflex and ran a blood test which came back clear of infection. After reading many grave internet diagnosis' i have become increasingly worried. These all seem to state that due to the non tender nature, the size of the nodes (which are 4 times the healthy size), no infection and the position (level 5) of the nodes, cancer of some sort may be the cause.
I do not have any itching nor fever and only occasionally do i get night sweats, if you would call them that, as they are not extremely intense. The ultrasound report also states these could be 'reactive' in nature although I'm not sure what that means.
If anyone could help it would be greatly appreciated as I'm very worried.
Thank you

[jennm33]

I have two swollen lymph nodes in this area, that I have had since July. I have had two cycles of antibiotics and no change. Still swollen, no pain though. The doctors are sending me to an ENT this week. Any suggestions?

[fury6]

I have small palpable lymph nodes in this area as well. I've had blood work and ct scan which showed 4 enlarged nodes one being the largest 1.5 x 1.9. I had it biopsied fna but due to the inacuracy they added the core needle ultrasound guided and put it through flow cytometry. I went to a doctor who was rated number 1 hematologist/ encologist in the tristate area by 12,000 doctors and he explained this " many people can feel their lymph nodes when they are normal there is a cervical chain that runs in the posterior triangle all the way to the supraclavicular area. He explained past infections can cause permanently enlarged lymph nodes. He explained its very easy to detect a metastisized cancer and even though lymphoma is more difficult to diagnose flow cytometry usually always picks it up. You might not know what kind of lymphoma etc but something suspicious would prompt excisional biopsy. People do have palpable normal nodes with practice most people can feel theirs.

[ambi816]

hi, i have a question and if anyone has this please give me some info on it. i have a pea sized knot on the back of my neck, its small and at times hard to find. it doesn't hurt and its been there a while and still the same size. it never moves and its not getting any bigger. its on the side of my neck right under the hair line just before you get to the back of neck. nothing unusual just there. any info or any past experience with this?
thanks.

[Ken_PA]

Hi, it could be a lymph node that got internally scarred (fibrotic) from an infection. Or it might be a cyst. You are right to keep an eye on it, but it doesn't seem to be a cause for worry at this time.

[kristina961]

Hi,
I have two sowllen lymph in the back of my head and nick, one is bean size in the back of my neck left side just within the hear line at the left corner. The other is in the back of my head behind my left ear.
I went to Dermatologist and she started one week Keflex treatment. Should I check ENT doctor or just wait for the one week treatment.

[Ken_PA]

Ahlan. I'd wait to see if the antibiotic handles it. Sometimes, it might take two courses of antibiotic. There are lymph nodes in those locations which might be "reactive" to an infection.

It's also somewhat possible to have lipomas or cysts, but two together like that makes such a diagnosis less likely.

Did they both pop up closely together in time? That tends toward infection. Did you have an earache or scalp problem?

To be prudent, you can also check underarms and groin for other enlarged nodes.

[Ken_PA]

I'd also take yogurt or something similar while on antibiotics.

[KahnKan]

There is no single test that can accurately diagnose if a lymphnode is malign or benign in nature, except excisional biopsy. Even if it is made, the experience of the pathologist and the prediagnose of the clinican takes importance for the pathologist to prepare the materials for specific diseases. For example burkitt lymphoma requires additional procedures the pathologists didn't make in routine.

There are specific points clinicans take for consideration for diagnosis :

If a node is most likely benign in nature;

- It will be enlarged after an infection (Appeared after inf in max 2 weeks)
- Most likely bilateral (Infection most of the time spreads fast)
- In ultrasound it is ovoid in shape (Length-short axis ratio is under 0.5)
- Not supraclavicular (And may be not posterior cervical)
- Respond to antibiotics theraphy in 2 weeks (Most nodes are not affected because EBV and atypial mycobacterium infections are not responsive to classic ab theraphy. They require specific agents to be cured.)
- Has fluctuation (infection causes necrosis)
- Is movable (Metastasis invade and don't move)
- Does not change size in follow-up (Infections regresses or stabilizes)
- Is painful (Because of enflamation)

If it is malign in nature;

- Axis ratio is bigger then 0.5
- Long size is over 2 cm
- Supraclavicular (Atypical location for enlarged nodes)
- Does not respond to antiobiotics theraphy
- Increase in size or change shape in follow up (Shows progress)
- Is fixated (Invaded adjent soft tissue - metastasis) and hard (Hypercellular - lymphoma)
- Stayed enlarged over 2 months

Risk increases if malign characteristics be together or decreases benign characteristics group together.

FNAB has high risk of being psudonegative (Meaning it is malignant but pathology reports as indecisive or as reactive which renders it uneffective. About 4 of 10 patients which had cancer will be pseudonegative in FNAB before undergoing excisional biopsy.).

My 1.5 years old child also had a posterior cervical lymphnode for 6 months, the doctor couldn't even able to find the node (My child was being really uncooperative), he dismissed us. Over the six months, the node didn't get any larger or got minimally enlarged but I'm thinking of excisional biopsy to be just sure after ultrasound followup.

Excisional biopsy seems like the best option in any case for every one.

[cuckfancer27]

did you get the results to this biopsy?

[nyla123]

I am a 28 year old female. from age 22 until recently I suffered from chronic lyme disease.
I have a node in my posterior cervical chain. it is said to be 1.2 cm according to ultrasound tech. (done friday, discovered node earlier in week on tuesday)
doesn't hurt. i suppose it feels rubbery.
What should I do? Should I be concerned?
Doctor put me on antibiotics, so far doesn't seem smaller. Also waiting for chest X-ray to come back.
I am worried sick. I can't function until I know that I am okay!
PLEASE HELP?
Do you think I am okay?

[Ken_PA]

Hi, the odds are that it is not lymphoma. Most enlarged nodes are from infection, by far. A node that is only 1.2 cm can certainly be merely from infection.

Sometimes a node just doesn't go down, usually because it has built up scar tissue inside.

Lyme and its co-infections can do many strange things, as you probably know.

I think you can look forward to your doctor telling you that it is not lymphoma. Merry Christmas.

[nyla123]

Thank you.

Thank you so much for your swift response!
What is your experience with stuff like this?
I forgot to mention that I've have no sign of illness or infection. Lyme sure does do MANY strange things to the body.
I have been sweating at night - but I also live in LA and am visiting my parents in NY, so i sleep with a sweatshirt and a lot of blankets, sometimes electric blanket. I worry about itchy skin (I'm not super itchy, just a little, like dryness) but, it could very well be from the dry environment and lack of lotion with the forced hot air.
Then I wonder if i am short of breath or if I'm just so worked up that i feel that way. The whole situation stinks. What should I be doing to confirm? a biopsy or... another ultra sound to see if it grows. I'm sure I'm fine, it'd be really terrible luck if I'm not.
I just wanted to relax over the holidays- I have had the worst year. 2014 has been pretty awful to me, just one thing after another. I was really in need of a good break... and now this. I am so tense.
I feel better after your response... but as you cAn see, I am losing my mind with worry. It is all consuming. I knew a kid back when I was 21 that found a lump on his neck and next thing I knew he was fighting for his life. So, obviously that must have scared me on some level. Thats the only reason I even knew there was cause for concern. If it's nothing- what causes them to be "shotty nodes"? Is this common to have never noticed anything like this my entire life and then have this? I hope so.
Thanks in advance (to anyone).
:)
Nyla

[Ken_PA]

Stress can stir up the immune system also.

Have you seen your sonogram report? The presence of a "fatty hilum" almost always means it is not lymphoma. The word "reactive" means that it is most likely swollen only because of an immune response - not from lymphoma. If you don't have your sono report then get a copy and you will probably feel reassured..

If it popped up suddenly, that is much more like an immune reaction than lymphoma.

The symptoms you are thinking of - sweating, itching, SOB -- are typically in later stages and not in the beginning, Besides, 'night sweats' means that you get *drenched* and have to change clothes.

You don't seem to have "shotty nodes", which are a group of small ones - like buckshot.

It's a shame that this had to happen to you over the Christmas season. But I hope that next year will be the good one for you, Nyla.

I doubt that any doctor would think that a biopsy is warranted from what we know at this point. I hope you can relax a little.

[nyla123]

Haven't seen it yet. Drs will get it tomorrow. Praying that it looks good and that the chest X-ray is clear. Please keep me in your thoughts for that!

The sweats HAVE been drenching, I don't wake up from slumber enough to change clothes but my chest is pretty drenched. I don't really know if thats an issue though b/c like i said I've been sleeping with a lot of blankets and a sweatshirt and its not like it has been every night for weeks or months.

I'm concerned about what kind of Dr I should be seeking the opinion of, because I don't trust GP's. I have seen way too many who have no clue what they are talking about (for example... the Lyme. I saw 30 docs before I was diagnosed. They just wanted to give me antidepressants) What type of doctor would be most familiar with the situation? Ears, Nose Throat? Oncologist?

Hopefully I have that fatty hilum. The other thing is I have NO clue when it popped up. I had an itch right where it is and when I scratched it I felt the bump. I checked it later that evening and it was still  there and seemed to be concerning. If I never had to scratch that itch, who knows if I would have noticed or when. Its only visable when looking for it and when I turn my head a certain way.


When would a biopsy be warranted? Isn't it sensible to want assurance if it doesn't go down anytime soon? I hate waiting.

You are right, the timing is a shame. I feel bad for being so on edge and probably worrying my parents.
This whole thing stinks and I am just ready for a definitive answer from someone so I can relax.

Thanks again for your knowledge

[nyla123]

Also, at what cm size would you stop being calm and start really worrying?
Like I said, the tech told me the sze so I will get the info from Dr.'s interpretation tomorrow.

[Ken_PA]

Lyme etc can create night sweats. I assume you also know there are "Lyme Literate" docs.

For lymphoma worry? The radiologist's report is most important right now. Hopefully, your report is not one that only gives the size. We want to know about the internal structure as well. 2nd opinions can be obtained for the scan images, without needing a whole new scan.

If a sono report says that the internal architecture is effaced, or if it gets even bigger, then it's time for a surgeon. Biopsy is the one sure way of diagnosis.

Your 1.2cm is probably getting near to max. There is not a one-number fits all for it. It makes sense that for infection a node goes quickly to max size.

Surgical biopsies have risks, so are not done willy nilly. Different docs are more or less prone to order a biopsy.

The problem with looking online for lists of symptoms is that it doesn't give a correct view of probability of the cause. Lymphoma is the least likely at this point.

Good luck with your doc visit today.