many symptoms, lymph disease or breast cancer???

[chrispysmom]

Over the past several months, I have been developing many troubling symptoms. 1. Serious fatigue that makes it hard for me to do what I need to do. I become easily winded and get through many days through sheer force of will. 2. Swollen lymph nodes, most notably under my arms (2.2 cm on right, 1.0 cm on left). These have remained more than a month. Sometimes they feel tender, and sometimes I feel shooting pain in and around them. (No recent infections to my knowledge.)  3. A small itchy patch on the back of my right forearm that has persisted for four months. Sometimes there is major swelling under it, and other times, just minor swelling. Sometimes, there is one raised reddish lump, other times it has a few tiny red lumps surrounding it. 4. Swollen ankles. Some days it is really bad, others it is mild. 5. Swollen and tender abdomen that sometimes feels achy. I have a long history of IBS, but this feels different. 6. Frequently feeling warm/overheated and fairly frequent night sweats for over a month. I took my termperature confirmed that I have an off-and-on low-grade fever. Normally, my temperature is 97.9, and I usually get cold easily, even though I live in Florida. I am 43, but I have no other signs of perimenopause and don't think that is what's going on. Some important background info: I have had fibrocystic breasts and adenomas for many years. In 2004, I had an ultrasound-guided core biopsy of a suspicious solid nodule in my right breast. It came back negative. The nodule has not significantly grown. I just had my annual mammogram/ultrasound and received recommendation that I get another core biopsy on the nodule. The most recent ultrasound also noted the swollen lymph nodes under my arms. I am awaiting results on basic blood and urine tests. Is there anything else I can do or any other tests I should request so that I can get info to start addressing my problem(s)? Thank you very much!

[Kevin Pho, MD]

I agree that you need to exclude breast cancer, and it seems that this is being done with both the past biopsy as well as the recommendation for another one.

A breast MRI can be considered if the mammogram continues to be negative, and there is still concern about cancer.  

Infection can also lead to the swollen lymph nodes, so finding and appropriate treating this is important.  But if the lymph nodes continue to be enlarged, and the tests remain negative, a referral to a surgeon for a lymph node biopsy can be considered to exclude lymphoma.

This option can be discussed with your personal physician.

Regarding the itchy patch, seeing a dermatologist for consideration of a skin biopsy can be considered.

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.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[chrispysmom]

Thank you very much, Dr. Pho.

[chrispysmom]

My blood test results came back, and everything was normal except for my thyroid. My T4 was 13.3, which is higher than usual for me and out of the normal range. My blood counts were normal, and there was no sign of infection. I have now made an appointment with an endocrinologist, who can't see me for three weeks.

I still have a constant temperature (99-100), am getting much more tired/out-of-breath since I last wrote. I need to rest all the time. My blood pressure, which is normally 110/80, was 12-/90 a week ago, and 146/90 the other day.

I still have not had my appointment for the breast/lymph node biopsy. I am still going to ask to have the nodule taken out and to have the largest lymph node biopsied.

Does this new information (no signs of infection in lab work/high thyroid) lead to any more questions I should ask the surgeon and doctors I will be seeing? I'm not sure if the thyroid explains everything, or if several things are happening to me.

Thank you.