Why Doctors Advise Against Lymph Node Removal: Risks and Concerns

Q: Why Doctors Advise Against Lymph Node Removal: Risks and Concerns

Hello： Since you have seen so many specialists, it's best to follow their advice and just observe. <br>Clinically, lymph nodes that are recognized to have malignant changes typically have a diameter greater than 1 cm, and most cancers are around 2-3 cm in size. <br>So, is your ly

Why do doctors generally not recommend surgery? Is it because there may be potential complications?

Hello Doctor, in early December 2016, I felt pain inside my right lower jaw.
I thought about massaging it and found a lymph node.
After taking medication at a nearby ENT clinic, it shrank but remained about the same size.
I was still concerned, so in December of the same year, I went to Chang Gung Memorial Hospital's ENT department for an examination.
Dr.
Kang examined me and said there was nothing serious, that this area is common, and advised me to relax and go home without medication.
However, I still felt uneasy and thought I needed a second opinion.
In mid-February 2017, I visited Cathay General Hospital.
This time, the doctor performed an ultrasound and said it was about one centimeter, identified it as a benign node, and mentioned that it is normal for this area in the lower jaw, advising me not to worry.
He also checked my thyroid and both sides of my neck and clavicle, finding no abnormalities.
I still felt uneasy, and in March, I had a full-body health check-up.
My red blood cells, white blood cells, eosinophils, and other infection and inflammation markers were all normal.
The abdominal ultrasound, gynecological ultrasound, Pap smear, and chest X-ray were all fine.
The only abnormal finding was in the mammogram, which was classified as BIRADS 2, and the technician recommended regular check-ups every six months to a year.
Later, in mid-April, I became anxious again and went to National Taiwan University Hospital, where Dr.
Wang Cheng-Ping examined me for nasopharyngeal cancer.
After performing an ultrasound, he also determined it was a normal lymph node and informed me that it might not disappear.
He advised me to maintain a regular lifestyle and exercise, suggesting I return in three months if I was still worried.
It has now been nearly six months since I first noticed it, and its size remains about the same.
I have no discomfort, fever, or weight loss.
I have seen many doctors, and they all told me that it won't disappear as long as it doesn't continue to grow.
I often search for cancer information online, and now I'm not sure what to look for anymore.
I once asked a doctor if it could be surgically removed, but two doctors advised against it.
What should I do, doctor?

Chuang, 20~29 year old female. Ask Date: 2017/05/16

Dr. Chen Yunfang reply Oncology

Hello: Since you have seen so many specialists, it's best to follow their advice and just observe.
Clinically, lymph nodes that are recognized to have malignant changes typically have a diameter greater than 1 cm, and most cancers are around 2-3 cm in size.
So, is your lymph node that large? If not, there's no need to worry too much; just keep monitoring it.
Thank you for your understanding.

Reply Date: 2017/05/16

More Info

When it comes to lymph nodes, particularly those that are small and stable in size, the decision to remove them is often approached with caution. There are several reasons why doctors may advise against lymph node removal, and understanding these can help alleviate concerns and guide you in your decision-making process.

Understanding Lymph Nodes
Lymph nodes are small, bean-shaped structures that are part of the lymphatic system, which plays a crucial role in the body’s immune response. They filter lymph fluid and trap pathogens, such as bacteria and viruses, as well as cancer cells. The presence of a lymph node that is palpable or enlarged can understandably cause concern, especially if there is a history of cancer or other health issues.

Reasons Against Lymph Node Removal
1. Risk of Complications: Surgical procedures, including lymph node removal, carry inherent risks such as infection, bleeding, and complications related to anesthesia. The potential for these risks often outweighs the benefits, especially if the lymph node is not suspected to be malignant.

2. Diagnostic Challenges: Removing a lymph node does not always provide clear answers. If the lymph node is benign, the surgery may not change the management of the patient’s health. Furthermore, if the lymph node is cancerous, the presence of cancer in one lymph node does not necessarily indicate that the cancer has spread throughout the body.

3. Functional Importance: Lymph nodes play a vital role in the immune system. Removing them can disrupt the lymphatic drainage of the area, potentially leading to complications such as lymphedema, which is the swelling that occurs when lymph fluid does not adequately drain.

4. Observation and Monitoring: In many cases, doctors prefer a "watchful waiting" approach. If the lymph node is stable in size and there are no accompanying symptoms (such as fever, weight loss, or night sweats), regular monitoring may be sufficient. This approach minimizes unnecessary surgical interventions while ensuring that any changes are promptly addressed.

5. Psychological Impact: The anxiety associated with the possibility of cancer can lead to a desire for immediate action, such as surgery. However, it is essential to consider the psychological impact of surgery and the potential for increased anxiety if the surgery does not resolve the underlying fears.

Recommendations for Your Situation
Given your history of consultations and the consistent reassurance from multiple healthcare professionals regarding the benign nature of your lymph node, it may be beneficial to follow their advice and continue with regular monitoring rather than pursuing surgical removal. Here are some steps you can take:
- Follow-Up Appointments: Schedule regular follow-up appointments with your healthcare provider to monitor the lymph node. This can help provide peace of mind and ensure that any changes are addressed promptly.

- Focus on Overall Health: Engage in healthy lifestyle practices, such as regular exercise, a balanced diet, and stress management techniques. This can help improve your overall well-being and may alleviate some of the anxiety associated with health concerns.

- Limit Internet Research: While it’s natural to seek information, excessive research can lead to increased anxiety. Consider limiting your online searches and instead focus on discussions with your healthcare provider.

- Mental Health Support: If anxiety continues to be a significant concern, consider seeking support from a mental health professional. They can provide strategies to manage anxiety and help you cope with health-related fears.

In conclusion, while the presence of a lymph node can be concerning, the advice against removal is often based on a careful consideration of risks, benefits, and the overall health context. Regular monitoring and maintaining a healthy lifestyle can be effective strategies in managing your health and alleviating anxiety. Always feel empowered to discuss your concerns with your healthcare provider, as they can provide personalized guidance based on your specific situation.

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