Possible Lymphoma?I'm a 58 year old woman, five foot two, sixty four kilos, office job but fairly active. Some years back in the early 1990's I had a thyroid tumour removed, and since then have also had Non Hodgkins lymphoma of the bowel and stomach in 1998. I've suffered arthrtic pain for many years with swollen finger (nodes now clearly visible with some distortion# XXXXX wrist/ankle joints, and recurrent problems with swallowing as my throat was damaged by weeks of tubes and chemo. I am post menopausal and have very dry skin, especially on my face, back and scalp which itches all the time. I've had Reynauds for years. There is genetic history of cancers in my family - my maternal grandparents both died of cancer #breast and throat#, as did my Mum #primary breast, secondary liver# XXXXX Dad #skin cancer#. We don't have pets but have a neighbour's young cat regulalry visit us. I have not been scratched. Our house is very old #16th C# XXXXX we are renovating, and recently uncovered old straw used as insulation - probably in the walls for over 100 yearsTwo weeks ago I developed what appeared to be a bacterial throat infection #slight fever, pus and white spots in throat, swollen and sore# XXXXX was treated with 7 days of broad spectrum antiobiotics as I was due to have a broken tooth filled a few days later. The dentist also scaled and cleaned my teeth. Over the past few days my teeth, lips and gums have become progressively more sore, and I now find that the gland under my chin #submental or submandibular?# XXXXX XXXXX swollen - the size of a large plum, but deep. It is visible, symmetrical, quite firm, and can be moved from side to side on palpation. It's on the midline, and moves slightly up when I stick out my tongue, and to the right when I swallow. It's non-tender, but my throat is still sore, and I'm feeling very tired. Other little glands just under my chin on both sides are slightly swollen and tender. I have no fever, don't use drugs #except anti inflammatories adn paracetamol for pain releif), and dont have heart disease. No evidence of enlarged liver on self examination.With my history I am now quite panicked - thinking that perhaps the lymphoma has come back, though my common sense tells me that it's probably due to infection. My research says that it's normal to wait 3-4 weeks for glands to go down after an infection, but my anxiety levels are high, especially as I nearly died of the lymphoma in 1998 when it was initially mis-diagnosed as a hernia. I think that if I go to my doc she'll just tell me not to panic and come back in 2-3 weeks. I'm think along the lines of:Best case - unresolved infection from the throat bug, new infection from the dental work.Slightly worse case, mono or toxoplasmosis , or even Sjogrens syndrome.Worst case, a recurrence of the cancer. I think I should ask my doctor for referral to ENT for examination, a fine needle biopsy and a CAT scan just to be sure that there is nothing ominous going on. It takes weeks to arrange to see a specialist in UK but I have private healthcare. What would you advise?
Person's Gender: Female
Person's Age: 58
antiobiotics for a week
Hello, I think you are spot-on correct that your swollen lymph node is due to recent throat infection and dental work, which creates local inflammation. You're also correct that it takes weeks for a node to return to normal size. If I were you I'd likely have the same anxiety, and the only way you will get a definitive answer is to see an ENT for exam and possibly get a needle biopsy of the node if by that appointment it has not regressed in size or if you have new symptoms. I am not medically worried from your post that your lymphoma has recurred, but there is only one way to definitively answer that concern. All Best,
Thanks for your reply. I was expecting a more detailed response for £40. Please explain why you are not particularly concerned? Please tell me how quickly should I seek medical advice and request a referral for further investigation (it's now two weeks since the initial infection). Thanks
I was expecting a more detailed response for £40. Please explain why you are not particulalry concerned? Please tell me how quickly shoold I seek referral for further investigation?
I am not medically worried since the location of your swollen nodes corresponds with an area of known infection and inflammation in your system from the recent throat infection and dental work, as I stated. If you have no adenopathy elsewhere then the nodes are reactive until proven otherwise ; also you did not cite systemic symptoms other than some fatigue which is very non-specific. How quickly to seek referral depends upon your level of anxiety. From a strictly medical standpoint, I would advise watchful waiting for 2-4 weeks, and referral if any new symptoms occur or if your lymph nodes do not shrink in size by that time frame.
Ok. makes sense. Thanks for the advice. Last question: What new sysmptoms should I watch out for? last time I had lymphoma I had no symptoms at all except for slight lump in my belly, and some fatigue. By the time I got to see the consultant my red blood cell count was down to 3.3! I had full transfusion within a few hours, and realised immediately I had a malignancy. Dont want to go there again.
I don't blame you. For reasons that are not well understood, recurrences tend to come to medical attention with similar symptoms as the initial diagnosis. I'd watch for unexplained fever, continued fatigue (only you know what is normal or not for you), loss of appetite, sweating at night, paleness, easy bruising. Wish you all the best!
Thanks Louise. I am somewhat reassured. Watchful waiting it is. Many thanks.
You are most welcome! Take care,
Board-Certified in Pediatric Hematology and Oncology