Just to vent .... and see if a biopsy is warranted

[cris_01]

So I've had right side submandibular lymph node swelling for the past seven months now.  I've had a CBC, MRI, and CT Scan with contrast - all to tell me that I am "fine" and not to worry.  Unfortunately I feel and notice this thing every day, and every appointment has confirmed it is indeed a "palpable lymph node".  Over these past 7 months I've experienced labored swallowing, throat dryness, very mild hoarseness, mild night sweats (not since MAR), finding more petechie on my body (not an alarming amount), 7-8% weight loss, jaw pain on the same side, and a feeling like other lymph nodes in the area are reactive as well.  Also, more recently I notice if I have a glass of wine or any alcohol the lymph node does not like it at all.  It doesn't burn or hurt per say but it certainly becomes uncomfortable. Recently the area has started to itch, and the lymph node feels tight (if that makes sense).  I do not feel a hard mass or immovable mass and whenever I do check it (and I do so very infrequently at this point) but touching it does make it feel more tender.  

At this point I am going back to my GP to request another CBC.  The report on the first was "normal" however there were some parts where I was on the way upper and lower ends of normal (Hb, Hct, Platelets, lymphocytes all low or way low end of normal).  I had a CBC back in 2019 which was truly normal, and in which I was almost perfectly down the middle of normal (except for very very low end of "normal" platelets).  So at this point I am wondering if I am out of bound on asking my GP for a referral for a fine needle biopsy?  Every appointment I'm only seen for about 5 -15 minutes then sent on my way, so it really feels like they don't care or don't have a clue.  If nothing else I am hoping at least for a referral to an ENT.  

This is completely depressing to deal with - which everyone here knows. But I am trying to remember the positive.  Plus there are positive indications as well - I am still very physically active (working out, riding, running 5 days a week), I feel generally okay/healthy, I sleep just find and most of the aforementioned symptoms have not returned lately.  I had a close friend go through this with the same results - being told everything is okay, he doesn't need a FNB only to have his FNB come back and say stage 1 cancer!  Thankfully he was treated and recovered. If he wouldn't have persisted he might have had a different out come.  I can't help but feel like I am in the same situation.

[Ken_PA]

Without seeing the scan reports, I'll have to assume they say that all is normal as far as nodal shape and internal architecture. Therefore, no doc would order an excisional biopsy, though that is the only way to rule out a lymphoma with near certainty. But some docs might be pressed into ordering an FNB because it is such low risk. Even so, FNBs are known for false negatives and there is apparently no suspicious spot to target with a *guided* FNB. A negative FNB is therefore not an end to worrying.

Docs would likely want to see some significant change before investigating further on a blood cancer. Everything seems to point to an immune system reaction at this point. In future, US is better than CT even if w contrast, IMO.


A benign node can be filled with fibrosis and stay enlarged forever.


However, with platelets low and something off with RBCs, you might wonder about possibility of occult (hidden) bleeding somewhere.

'I had a CBC back in 2019 which was truly normal, and in which I was almost perfectly down the middle of normal (except for very very low end of "normal" platelets)'
It would be unlikely for a blood cancer to cause low counts only in platelets. But unfortunately, nothing is simple and almost anything is possible. Still, it's most reasonable for now to look for some other cause of the low-ish platelets, not a cancer in your marrow.


Btw, I see nothing wrong in how your doctors have been doing things.

[cris_01]

I meant ultrasound not MRI.