Lymph Node Issues: When to See a Specialist

Q: Lymph Node Issues: When to See a Specialist

Hello： First of all, the excision of subcutaneous lymph nodes is a procedure that any general surgeon can perform; you can choose anyone. <br>Those who claim to have special expertise are simply indicating that they are particularly specialized in this area. <br>Lymph node excisi

Lymph node issues?

Hello Doctor, I had a biopsy of the groin lymph nodes last October, which turned out to be benign.
In February, I had a PET scan for a chest nodule, and there were no significant issues.
However, recently I have been feeling more and more lymph nodes, so I went to see a hematologist.
The hematologist didn't even want to examine me and said to come back if they get larger.
I mentioned that I feel they have increased in size, but I was sent home.
Recently, in addition to the swelling of the groin lymph nodes, I have also noticed swelling in the head and neck area (which I have already seen an ENT specialist for), and I even felt similar lymph node swelling in the lower abdomen.
I heard that some doctors say general surgeons can evaluate lymph nodes, but surgery is divided into many specialties, some focusing on liver tumors, liver cancer surgery, biliary cancer, laparoscopic cholecystectomy, pancreatic surgery, and thyroid surgery, while others specialize in breast surgery.
I'm not sure which specialty I should consult.
If I undergo another biopsy of the groin lymph nodes, can it confirm that the lymph nodes in other areas are normal? Thank you.

Xiao Cheng, 20~29 year old female. Ask Date: 2017/05/15

Dr. Chen Yunfang reply Oncology

Hello: First of all, the excision of subcutaneous lymph nodes is a procedure that any general surgeon can perform; you can choose anyone.
Those who claim to have special expertise are simply indicating that they are particularly specialized in this area.
Lymph node excision is something that second-year residents learn, and there is no surgeon who cannot perform it.

Regarding your second question: of course, it is not appropriate to make broad generalizations.
The groin is just the groin; it cannot represent the entire body.
However, it is impossible to excise lymph nodes from the entire body! No one does that.
What I want to emphasize is that lymph nodes that are truly malignant are usually larger than 1 cm, with the vast majority being around 2-3 cm in diameter.
If your lymph nodes are that large, surgical excision is recommended; otherwise, observation is sufficient.
Thank you for your questions.

Reply Date: 2017/05/15

More Info

When it comes to lymph node issues, understanding when to seek specialist care can be crucial for your health and peace of mind. Based on your situation, it seems you have a history of benign lymph nodes and have undergone various imaging studies without significant findings. However, your recent concerns about the increasing number of lymph nodes you can palpate, particularly in the groin, neck, and abdomen, warrant careful consideration.

Firstly, it’s important to recognize that lymph nodes can become enlarged for a variety of reasons, including infections, inflammation, and benign conditions. In your case, since you have previously had a benign lymph node biopsy, it is reassuring but does not entirely eliminate the need for vigilance. The fact that you have noticed more lymph nodes and perceive them to be enlarging is a valid concern, and it’s understandable that you would want to seek further evaluation.

You mentioned that you saw a hematologist who was dismissive of your concerns, suggesting that you return only if the lymph nodes become significantly enlarged. While it is true that many lymph nodes can be benign and may not require immediate intervention, your intuition about changes in your body is important. If you feel that the lymph nodes are changing, it may be worth seeking a second opinion or consulting a different specialist.

Regarding which specialist to see, it can indeed be confusing given the various subspecialties within surgery and hematology. Generally, a general surgeon or an oncologist specializing in lymphatic diseases would be appropriate for evaluating lymph nodes. An oncologist can provide insight into whether further imaging or biopsies are necessary based on your history and current findings. If you are considering another biopsy of the groin lymph node, it is essential to discuss with a surgeon who has experience in lymphatic surgery or a surgical oncologist.

As for your question about whether a biopsy of the groin lymph node can confirm the status of lymph nodes in other areas, the answer is somewhat nuanced. A biopsy can provide information about that specific lymph node, but it cannot guarantee that other lymph nodes are normal. Lymphatic drainage patterns mean that diseases can affect multiple nodes, and a single biopsy may not capture the entire picture. Therefore, if there are concerns about multiple lymph nodes, a comprehensive evaluation, possibly including imaging studies like ultrasound or CT scans, may be warranted.

In summary, given your history and current concerns, it would be prudent to seek a consultation with a surgical oncologist or a general surgeon who has experience with lymphatic issues. They can perform a thorough examination, consider your previous findings, and determine if further investigation or intervention is necessary. Trust your instincts about your health, and don’t hesitate to advocate for yourself in seeking the care you feel you need. Regular follow-ups and monitoring are essential, especially when changes occur. Remember, it’s always better to err on the side of caution when it comes to your health.

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