Lymphadenopathy

[Jess340]

About 2 months ago, I noticed a slightly swollen lymph node under my arm. I didn't think much of it and then about 2 weeks later I became ill one evening-I was very dizzy, all my muscles had flu like aches, I had a horrible radiating pain from the first lymph nodes, across my breasts and to my other arm. In the morning I felt sore spots all over my chest. Went to the doctor and she found swollen lymph nodes in the neck, armpits, around my breasts, and groin. I also can feel one on my ankle and have sore spots behind my knees which I believe are lymph nodes, but can't actually feel them. She did a CBC, which was normal. Tested for mono, that was negative. Gave me an antibiotic for 10 days, didn't help. Aches and pains got better, but still had swollen lymph nodes. A couple weeks later I developed viral stomatitis in my throat and mouth. That last about 3 weeks, although 2 weeks into it, I had a sore throat for only a day and following that had difficulty swallowing for a week. That has all gotten better. Most of the aches and pains have disappeared, I feel better but my lymph nodes are still swollen. The ones in my armpits and around my breasts are sore, as well as the ones on my legs. The ones in my neck and groin are a little sore sometimes, but usually not. They're all 1 cm or less and haven't grown in size. I'm terrified that this is lymphoma or leukemia or something serious since the lymph nodes are not going away. My doctor is very persistent that this is only some kind of viral infection. She referred me to a infectious diseases specialist, but he can't see me for 2 months and my doctor isn't running any other kinds of tests. I don't have insurance so I'm afraid she's not doing these tests because she thinks it'll be hard for me to pay for them. I need some kind of peace of mind. I'm only 20 years old, i have a 7 month old daughter and am terrified I won't be around for me. Should I be pushing more tests? Does this sound like cancer?

[Fernando Roque, MD]

Hi.  From the information you posted, a viral infection would still be the most probable explanation for all the symptoms you've experienced.  But this would be hard to prove directly, since only a few hospitals have pathology laboratories that are equipped to culture and isolate viruses.  A diagnosis of cancer cannot be totally ruled out at this point.  The question is: should you push for a lymph node biopsy to be done immediately?  It's really up to you, but I would advise waiting it out for a month to see if the swollen nodes are persistent or become bigger. Then that might be the right time to do the biopsy.  If the swelling of the nodes resolve within a month, then it's likely due to a viral infection.

[Jess340]

Since i have lymph nodes all over and they're all about the same size, would it matter which one i had biopsied? If it was cancer would it show up in all of them? Not sure if I should push for a CT Scan as well?

[Fernando Roque, MD]

Hi.  It's usually the largest and most accessible lymph nodes which are chosen for biopsy.  If multiple nodes are involved, sometimes samples from two or more areas may need to be taken.  Even if this were cancer, it may not have spread to all of your nodes, so it may only show up in some of them - most probably the larger ones.  If the biopsy were positive for malignancy, then probably that's the time to go for a CT scan to look for the primary tumor.