Suspicious growth on lymph node - is removal urgent?

[pb_online]

Hi, my wife is in the Philippines and I am getting her a spouse visa to come to my country in Europe, this process could take two or three months.

She has noticed a growth on her lymph node, like a 'ball', near to her front jawline and been for medical advice. It is not responding to antibiotics after two weeks. She has had an X-ray with no obvious problems visible and an ultrasound scan that came back with:

There is approximately 14.8 x 10.7 x 5.5 mm well-defined complex focus in the submental region. No significant internal vascularity is detected.

Both thyroid lobes are normal in contour, echo pattern and dimensions. No definite focal solid nor cystic nodule is detected.

Isthmus is not thickened.

Trachea is in the midline.

COMMENT

Complex submental structure wherein lymph node is considered.

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She has been advised to have a surgical procedure, I am not sure if this would be to remove the growth or the whole node.

The problem I have is deciding whether it better for her to have this procedure urgently in the Philippines, or waiting to join me in my country and have more extensive investigations and treatment here, where the standard of healthcare is generally far better. I am not sure if the hospital that she has been attending has a CT scanner so there is probably a limit to what they can understand before operating.

I understand that cancers come into a lymph node from elsewhere in the body, but can a cancer spread from a lymph node?

On balance I am taking the view that it is safer for her to have the surgical procedure as a priority in the Philippines, this has the downside that we will probably not learn enough the reasons behind it.

What is your estimation of the risk in this instance? Any advice appreciated.

[Ken_PA]

I'm glad to have been of help. What this new doctor says seems to be the reasonable approach.

But the previous doctor, the one who immediately advised to have the resectional biopsy without much reason? I'd be wary of that doctor.

Good luck.

[Ken_PA]

If it did come up suddenly then plateau, then that's exactly the behavior of a node when it reacts to some infection. The node fills up with rapidly multiplying cells that are employed to fight an infection. Usually a node would later go down - unless there has occurred scarring (fibrosis) inside, which can take a very long time to disappear.

A cancer that is so very aggressive as to grow a large amount suddenly is very unlikely to then just suddenly stop growing.

So there are 2 x 2 possibilties:  being a node or not-node, and being cancer or not-cancer. The most likely at this point seems to be a "reactive" node (which is not-cancer).

Btw, I've never heard of a growth *on* a node - only in a node.

You've probably read that FNAs can be prone to false negatives - the needle can by chance miss any bad spots.

Has she had any problem in the mouth or lower lip or cheek?

[pb_online]

Ken she has never had a problem in the mouth, lower lip or cheek, and no other symptoms to speak of.

Her doctor seems to believe the matter is not urgent and has said that she should only have the surgery if she is uncomfortable with the growth.

We are going to wait and see, perhaps she will need to get it treated later. Of course if it gets bigger in the meantime we will take action.

Thank you for helping us to understand the factors involved.

[Ken_PA]

Hi, you should first ask her if it came up very suddenly and then plateaued in size.

A cancer can enter a lymph node (metastasis from elsewhere, including the thyroid gland) or can originate in a node (lymphoma). But either way, it can spread.

I can say a lot more, but I've learned to first see if the other person actually reads and replies. (Many times, they do not.)

Overall, I'd suggest that you get a radiologist (possibly anywhere in the world) to look at the images from her sonogram and give you an opinion. The size, shape and lack of vascularity so far tends to being not-cancer. It might possibly not even be a lymph node ("Complex submental structure wherein lymph node is *considered*") but some benign mass.

[pb_online]

Thank you so much for your response Ken.

She is not completely sure, but she thinks it came up quickly then stayed the same size, and it seems that way to me.

I am slightly baffled as to why a benign mass would suddenly appear for no apparent reason given that she is otherwise very healthy.

On your advice we're going to ask for the images from the scan, she was not given these but maybe they saved them.

I have read about fine needle aspiration but as far as I am aware her doctor hasn't mentioned or suggested it.