Would lymphoma in a cervical lymph node shrink without treatment, should I worry?

[ant1126]

   Back in early July I noticed a lump/knot in my neck cervical lymph node region the size of a nickle. The lump was rubbery, not very movable,and painless. I then started googling,and my research indicated possible lymphoma. So,not to jump to conclusions I took a wait,and watch approach for a few weeks. After 4 weeks I scheduled a appointment with my GP who scheduled me a appointment 4 weeks out Sept.11,because he is a busy doctor. I didn't wish to wait ,so I seen the APNP in same clinic. She noticed the lump ,and said it felt like a bean,and was somewhat fixed. She ordered blood tests including CRP,and ESR,and a neck ultrasound. The ultrasound was scheduled a week later. All blood work came back normal with the exception that the C reactive was 2.2 mg/dL. The ESR was 21 mm/hr. Doc was more concerned with the C reactive. So I waited,and the lymph node felt like it decreased in size slightly before the ultrasound.
      The ultrasound finding where:At the palpable abnormality site hyperechoic 1.8 x 1.2 x 0.6 cm lymph nodes noted with normal flow. No posterior acoustic shadowing is seen. No other abnormalities are seen.  Impression: Most probable reactive lymph node in the right neck. The APNP I seen said we will wait two weeks,then see what another C reactive test will show. That test showed 1.6 mg/dL. This is her message to me:

Your lab test is better, but still slightly elevated. I would suggest just having ENT take a look at that lymph node as well as your lab results and see if they feel it is benign or if it should be biopsied. I believe because it is getting smaller that it is nothing to be concerned about, but in light of the length of time you have had the enlarged lymph node and with the elevated lab value, I think it would be best just to have another opinion.

So I scheduled a appointment with a ENT for September 28th. The node is about the size of a pea,or small jelly bean,and seems fixed still.No pain. I also noticed another rubbery very tiny lump,or lymph node the size of a small shotgun pellet on my left side.That has been around same length of time,or longer,and hasn't grown either,and is not painful,but very fixed. The ultrasound did not detect that node even tho I mentioned it,and showed the radiologist its exact location. I haven't shown any of the B symptoms of lymphoma,or itchiness,or fatigue.I'm still wondering if I should worry about theses nodes. Any help would be appreciated.

[ant1126]

"Also the ENT appt will probably be pointless. "
I'm back with a  update on the  ENT. He  checked the node I had ultrasound on,which has reduced in size tremendously,and he checked the new one I found. He said all those nodes are normal. The new one is most likely "shotty"(he didn't like the term),but he said it feels normal. Their not growing or super big ,so you will live he says. I have a  skinny neck that's why he says I can feel them better than most people. Another ultrasound on new one would be a waste,and their not concerning to him so why waste money. If they wax ,and wane,or grow larger I can come back. =)

[Ken_PA]

Yes, I'd said that the ENT visit would be pointless because of exactly what happened: it was practically inevitable that the ENT would say that everything is benign. Everything had pointed to that beforehand.

At the same time, nothing was added toward solving the real underlying problems.

[Ken_PA]

Maybe see a hematologost instead of a rheumy etc since we are zeroing in on MCAS/MCAD (which is not the malignant mastocytosis).

But I'd want a hema with actual experience in MCAS/MCAD.

[Ken_PA]

...and with the traits comparison from the psychiatrist, just leave anxiety out completely and see what group you otherwise match. Anxiety is just a confounder here.

[Ken_PA]

Btw, you're doing great with rapidly absorbing knowledge.

Make a note for not-now but for later reading: MTHFR

Also you should take niacin as a test one day. Look on youtube for "niacin flush" examples. If you flush LOTS more than average, that's a big clue pointing to mast cells.

[Ken_PA]

The new node is probably reacting to whatever caused the first node to react. Not lymphoma. For lymphoma metastasis you'd also mainly want to check axillary and inguinal. Lymphoma spreads less locally than other cancers.

For being an overmethylator, let's go off the mainline path a litte to here (she's still an MD):
http://www.judytsafrirmd.com/histamine-methylation-and-mthfr/
then scroll do to "Some symptoms and traits of..." and just let me know simply which group you fit more. There won't be a perfect match.

"I do get weird adrenaline rush feelings with no increase in heart rate on occasion..."
Make a note of what you consumed before that. Maybe it's a dopamine effect, if it includes elation.

"...he kind of brushed off. Maybe he thought I was crazy! "
Yes, this is in your future, too. Most docs don't know about these things and woud scoff. (Example: many people get diagnosed with the immune caused chronic fatigue syndrome only after 3-4 years of seeing and paying for various specialists.)

"...area is sensitive to pain"
Probably bradykinin and Substance-P, and histamine, due to mast cells going off like land mines (degranulating). So we can look here to mainline medecine:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171343/

Since that is an authoritatibe source, you can print and take that to the ENT (but *not* the more fringe methyation and personality one cited just previously). The majority of docs would probably just scoff anyway even at the PNC cite - they haven't walked in your shoes.

"fibromyalgia"
Except what you have is not musculoskeletal, but is skin. Mast cells are stationed as sentinels in skin and gut and mucous membranes - anything world-facing.

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Be very wary of any prescriptions given. There are better ways to try first.

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I urge you to get a histamine blood test, since that serves as a (relatively inexpensive) proxy tests for many underlying conditions. You could also just order that yourself online, no Rx required.



IMPORTANT: Do you ever flush and/or sweat randomly?

[Ken_PA]

Related to the serotonin: maybe you are what's known as an 'overmethylator'.

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As you can see, I'm throwing out signposts for you to look into. This can save you an enormous amount of time, yet also requires absorbing an awful lot of info. When you feel that your head might explode from too much new information, you know you're on the right track :)

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Also the ENT appt will probably be pointless. Maybe better with a rheumy or immunologist.

[ant1126]

I noticed another lymph node today, it could be normal,or just another reactive node. I  have been checking myself for any abnormal nodes since discovering enlarged one back in late July. Out of nowhere I noticed this one size of pea,and very rubbery. It is located on the left side 2 inches above the collarbone, maybe a inch,and half from Adam's apple. From lymph node diagrams i am guessing this is a lower anterior cervical lymph node because a supraclavicular would be right by the collar bone. Kind of bugged me at first,but I will just have to monitor it to see if it grows,and bring it up to ENT.


I read into overmethylator ,and it is a  interesting possibility.

"Have you looked into pheochromocytoma"
Interesting as well,but my blood pressure is always normal,or borderline. Never is it a concern to the docs, albeit I do get weird adrenaline rush feelings with no increase in heart rate on occasion. I have just thought that's anxiety related. Doctors all tell me same,and ask me if I want a Rx of Ativan,or Xanax which I have no issues with these addictive drugs accept sleepiness.

Not to be too off subject I also have another symptom that is weird I have had for years that I have brought up to my doc, and he kind of brushed off. Maybe he thought I was crazy! lol  My body especially around chest,and back area is sensitive to pain. I have been tickled around ribs,and it hurts like bruises. Then subsides. My cat (light weight) jumped on my ribs ,and the same feeling occurred where his little paws landed. My back gets same feelings with little bumps,and dings. Occasionally my legs,and  arms have same feeling. Its strange! Ithought this symptom was related to fibromyalgia,but PA I seen said fibro would be worse(more intense). So, I've learned to deal with the symptom its not debilitating.

"Also the ENT appt will probably be pointless. Maybe better with a rheumy or immunologist."
I will push the ENT for a referral to rheumy,or immunologist after he's done with  poking,prodding,asking his  51 questions,and taking my hard earned cash.

[Ken_PA]

"I have some very intense panic attacks"
Have you looked into pheochromocytoma?  Very rare, but that moves somewhat up in possibilty if the attacks are completely indepedent of psychological/emotional triggering.

[Ken_PA]

Okay, we're making good progress here.

"I guess I have had usual amount of colds when I was a child."
So we can rule out the class of genetic autoinflammatory cond Also, without early onset, probably rule our genetic immune deficiency syndromes.

"I have been having reoccurring bouts of laryngitis in the last few months that I haven't mentioned either..."
My guess at this moment is histamine raspiness aggravated by the cold and loud talking.

"Then when I return to work after a few days the symptoms happen."
Very good observing skills. That's exactly what you need to do.

"Photodermatitis"
Let's hope it doesn't progress to lupus. Ever get the butterfly rash?

"I have often wondered if all my symptoms,or conditions are part of autoimmune disorder."
Or some as yet general unnamed autoinflammatory condition (which is somewhat different, but not too much).

"but  I dont like to self diagnose"
I think that is exactly what you have to do, because e.g. these things are often dismissed as just 'in your head' or 'not important'.

"...or feel like a hypochondriac."
That's only if you automatically jump to the worst case scenario, rather than if you become committed to finding the real story.

"This  could all be anxiety related."
I think that's another symptom, not the overall cause.

"I cant take Zoloft..."
I'll mull that one, it rings some bell. Very interesting clue.

"My mom had triple bypass 2 years ago,and is still among the living. =) "
Glad to hear it. But I don't think that's related, since it's so common.

React very badly to bee stings?

Ever try niacin?

[Ken_PA]

The "bell" btw is an big alarm bell. That's because you likely had Serotonin Syndrome and that can be fatal in very severe cases. I'm surprised the doc just brushed it off.

I'm thinking that something besides pharmaceuticals can also set if off - like maybe some food. Maybe a herb. That'd be importanr for you to know so you can avoid.

[ant1126]

     I have only had one fainting spell in my life back many many years ago,and it was alcohol related. I had issues with disequilibrium months after that incident,and it continued for many many  years. Many doctors,and specialist couldn't figure me out,and handed out the anxiety diagnosis. I do have issues with anxiety/panic disorder I have some very intense panic attacks. I have ups,and downs with my anxiety. Meditation helps. Worrying about my health doesn't help. Googling lymphoma didn't help. I have learned a great respect for the strength people show that  battle,or have battled cancer,and I learned much by googling the subject. I also have a history of PVC's diagnosed through many holter monitors. I have been suffering with ectopic beats since I was 23,and Im 37 now. I know much about the heart because of my PVC's.

On the subject of the lymph node it feels like it has shrank in size since my first discovery,and if before I had the ultrasound. I monitor it daily,and I try not to go OCD with feeling it over  their on my neck. I'm thinking the ENT might FNA biopsy it ,and send me for another ultrasound down the road if the biopsy comes back negative. I have wondered if their is some scarring within the node. I catch a lot of colds from my two toddlers,and even a bad bout of RSV from my boys months back. I also have chronic scalp acne ,that has been terrible lately. If the acne matters. The APNP I seen seemed concerned about the elevated CRP, but if I have a undiagnosed condition maybe autoimmune,this could elevate the CRP. I do appreciate your medical input Ken_PA. =)

[Ken_PA]

Yes, shrinking on its own would be a sign against lymphoma. But then again, repeatedly pressing on it can create some irritation that makes it swell, and that can go down on its own.

Logically, the 1st step is to rule out the worst possibility. I'd say that was accomplished by the sono. I'd be surprised if insurance would pay for an FNA and the associated pathology.

So next, the OCD can actually be put to good use by plunging in to learn about the immune system. That will take a long time, especially since it is not yet well understood. So not all evidence will be high grade, though we can avoid any flighty things.

I'd look for a unifying theory for all of your symptoms that is immune based. E.g., you can find references to histamine and anxiety. Histamine is a primary immune chemical, but also a neurotransmitter. Sominex is the same drug as Benadryl. After Benadryl/diphenhydramine was created, researchers changed the molecule a little bit and created Prozac.

There are skin conditions lie eczema that are immune caused. There is even an immune created acne involved in PAPA.

Macrophages can initiate fibrosis/scarring. I suppose it's even possible that your PVCs could have been caused by scarring from that source.
"Heart disease or scarring that interferes with the heart’s normal electrical impulses can cause PVCs."
http://healthblog.uofmhealth.org/heart-health/premature-ventricular-contractions-could-lead-to-a-more-serious-heart-condition

Elevated CRP could be from very many things, I don't see that as a useful marker for cancer. It's general inflammation.

Did you get many colds since your own childhood? Any family history of odd immune conditions?

[ant1126]

I guess I have had usual amount of colds when I was a child. I have had more colds in my adult life. About a year ago I had influenza type A for 2 weeks solid.

I have been having reoccurring bouts of laryngitis in the last few months that I haven't mentioned either (which I will discuss with the ENT). Raspy voice, cracks often,dry throat,and throat clearing.  I work in at a cold foods factory, its very noisy, and cold. My job requires me to talk over the noise,and talk often.So, I am guessing this is causing the laryngeal issues. This has to be work related,because I work a rotating schedule where I end up with five days off a week,and the issue resolves during my off time. Then when I return to work after a few days the symptoms happen.

The eczema is interesting to because my doctor diagnosed me with Photodermatitis ,which my googling for years with this condition turned up PMLE. Which are pretty much same thing,and immune related.

I have often wondered if all my symptoms,or conditions are part of autoimmune disorder. Researching a few years back I came across Dysautonomia, but  I dont like to self diagnose, or feel like a hypochondriac. This  could all be anxiety related. I cant take Zoloft (not a cope out),but when I took one pill which my doc said was low dose I felt like I was coming out of my skin,anxious all day,and severe panic attacks with heart racing the whole day after. I also couldn't sleep. Weird is all my doc said,and your body is sensitive to things. I try stress relief,and meditation instead.

I don't know my biological fathers medical history. I've never met him or his family. No immune issues in my moms family. Just heart. My mom had triple bypass 2 years ago,and is still among the living. =)

[Ken_PA]

Hi, I wouldn't worry about lymphoma unless the big node gets bigger. It's at the limit of being reactive now, and has a non-malignant shape and internal architecture (as seen with sono). Being somewhat fixed isn't critical.

I'd instead look into fibrosis in nodes, and how that relates to immune cells -- and even how immune cells can relate to anxiety.

Do you still have fainting?