dysplasia and enlarged lymph node

I would very much like your opinion on  a few things....I have Barrett's esophagus with dysplasia....At last biopsies there was some conflict (read at two labs) as to what grade I am at..One came back with some areas of high-grade, we decided to wait three months and I will have a new set taken later this month....I will also be evaluated later this summer at a large hospital....I have also been having a high white cell count for more than 15 months...(17,000-20,000 range)...Several months ago my PCP noticed an enlarged lymph node directly in front of my L ear....He was concerned and sent me to an ENT who offered no advise except to return in 6 months if it was still there....I was also sent to a hemotologist oncologist because of the high white cell count...I have seen him a total of 7 times in 13 months and he has not done one thing.....He only asks me how I am feeling and says "I will check you again in 2 months"....It is obvious that they are watching and waiting on SOMETHING....I have decided not to continue seeing him.......This is what I need advise on figuring out...I'am also a past invasive cancer survivor with node involvment...My 5 years was up in 2000 and my REAL cancer Dr., that was in charge of all my treatmens and surgeries has since retired, there is no going back to him.....I realize what I will be facing if high-grade dysplasia is involved, what I would like to know, is if this enlarged lymph node "could" be connected to the esophageal dysplasia?....When I think about most people with high-grade, already have EC, then my anxiety seems to start playing alot of tricks with me....This node is not close enough to be considered invasive, so I hope you understand how nerve wrecking this is becoming....It does not hurt but at times it seems to put pressure on my ear. My reflux has not been under control since GB removal in March, in fact, it is much worse.....We had hoped that with the removal of the diseased GB that my WCC would come down, it did not.....We also thought that once the ulcers in the esophagus had healed the WCC might come down, again, it didnt......I take Miralax 17gm twice a day for a paralyzed bowel that was an expected complication from the previous cancer surgery, Im on 100mg nexium daily, and Zelnorm 6mg twice a day, I also have lidocaine and bentyl for the spasms....My barretts segment (at last EGD had went from 6.5cm to 7.5cm).....I want to ask for a biopsy of the lymph node, but since I am going to be going to a lg hosp. I dont know if I should wait and discuss it with the drs. I will be seeing there and have everything at the same clinic or if I should just go get a biopsy some place else before then......My GI Spec. says I have "short esophagus" and a Lg hernia, with a stricture that wont stay dialated.....If I get "lucky" and am still only at low-grade does "short esophagus" make fundoplication not an option? If so, what other options would there be?.....Thank-you for your time and suggestions.....Tessa

[Kevin Pho, MD]

Hi Tessa,
Without examining you or your studies it is impossible for me to say that there is a definite connection or not between your dysplasia and the lymph node.  However, I understand your anxiety about the lymph node.  

With a past history of cancer and the elevated white count, I would defintely pursue biopsy of the node.  I would continue to obtain ENT opinions until one would be a agreeable to a biopsy.  

Fundoplication is still an option with a short esophagus.  A short esophagus would make it technically more challenging and esophageal mobilization would be more difficult.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[tessa0825]

I forgot to add that initally my Dr. treated the enlarged node as though it were an infection and had me use cipro ear drops and oral dynabac antibiotics,Did nothing for it....

[tessa0825]

Thank-you for your suggestions and the information about fundoplication, Tessa

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