Enlarged Left Axillary Lymph Nodes: Causes and Treatment Options

Left axillary lymphadenopathy?

Hello Dr.
Lai! My boyfriend discovered a large lump under his left armpit in August 2017.
Prior to this, he had experienced an influenza infection, and we are unsure if that was a triggering factor.
In August, he visited the oncology department at Mackay Memorial Hospital in Taipei, where the doctor decided to perform a biopsy for precautionary reasons.
A week later, during the follow-up appointment, the report indicated lymphadenopathy with a diameter of 3 cm.
The pathology report showed no signs of cancer cells, indicating a simple hyperplastic phenomenon.
At that time, my boyfriend also experienced symptoms of a stiff neck on the left side, and subsequently, his left shoulder became swollen.
He has been suffering from persistent pain in the left side of his back every day, to the point that it wakes him up at night.
On November 1, he returned for a follow-up, and the lump had decreased slightly to 2.5 cm.
The doctor mentioned that the pain might be due to pressure and that no medication was necessary.
If the pain becomes unbearable, he could consider surgery in the fall or winter, as sweating could lead to wound infection.
Post-surgery, he would need to rest for two weeks and avoid heavy lifting.
However, I have heard from other patients online that after lymph node removal, there can be many side effects, including swelling in the arm, weakness, and even an inability to work normally.
Despite daily heat therapy and massage on the painful area, there has been little improvement.
I would like to consult Dr.
Lai on whether he should proceed with surgery or not.
I feel worried seeing him take pain and anti-inflammatory medication every day, and I am concerned about potential side effects on his left arm after surgery.
The doctor at Mackay said he could return for follow-up on his own after six months.
Could you please advise us on how to handle this situation? The patient is a 44-year-old male, weighing 90 kg, with a height of 172 cm, who smokes and is classified as obese.
Would weight loss and exercise help improve his condition? He has no family history of disease.
Thank you, Dr.
Lai, for taking the time to respond.
We appreciate it!

Gu Xiaojie, 30~39 year old female. Ask Date: 2017/11/21

Dr. Lai Yicheng reply Oncology

Hello, Miss Gu.
The physician cannot provide treatment without a personal examination.
Please refer to similar questions in this field and consult your attending physician regarding lymph node surgery.
Since edema is related to the number of lymph nodes removed, it is advisable to engage in more shoulder and hand exercises to promote blood circulation.
Maintaining regular full-body exercise is recommended for the best outcome.
Radiation Oncology, Dr.
Lai, November 24, 2017.

Reply Date: 2017/11/21

More Info

Understanding enlarged lymph nodes, particularly in the axillary region, can be a complex process that involves evaluating various factors, including the patient's medical history, physical examination findings, and diagnostic tests. In your boyfriend's case, the discovery of a large lymph node in the left axilla, which was initially 3 cm in diameter and later reduced to 2.5 cm, raises several important considerations.

Causes of Enlarged Axillary Lymph Nodes
1. Infection: The onset of the enlarged lymph node following an influenza-like illness suggests that it could be a reactive lymphadenopathy due to an infection. Lymph nodes often swell in response to infections as they play a crucial role in the immune response.

2. Inflammation: Conditions such as autoimmune diseases or localized inflammation can also lead to lymph node enlargement.

3. Malignancy: While the biopsy results indicated no cancerous cells, it is essential to remember that lymph nodes can enlarge due to various types of cancer, including lymphoma or metastasis from other sites. However, in this case, the absence of malignant cells is reassuring.

4. Other Causes: Other potential causes include benign tumors, cysts, or even systemic conditions that may not be immediately apparent.

Treatment Options
Given that the biopsy confirmed lymph node hyperplasia without malignancy, the treatment approach may vary based on symptoms and the size of the lymph node:
1. Observation: Since the lymph node has decreased in size and there are no signs of malignancy, a watchful waiting approach may be appropriate. Regular follow-ups can help monitor any changes.

2. Pain Management: If your boyfriend is experiencing significant discomfort, it might be worthwhile to explore alternative pain management strategies. While over-the-counter pain relievers can be effective, they should be used judiciously to avoid potential side effects.

3. Surgical Intervention: Surgery may be considered if the lymph node continues to cause significant pain or if there are concerns about its nature. However, it is crucial to weigh the risks of surgery, including potential complications such as lymphedema (swelling due to fluid retention), loss of strength, or other functional impairments in the arm.

4. Physical Therapy: Engaging in physical therapy post-surgery can help mitigate some of the risks associated with lymphedema and improve overall function.

Lifestyle Modifications
In terms of lifestyle changes, weight management through diet and exercise can have a positive impact on overall health and may help alleviate some discomfort. Regular physical activity can improve circulation and reduce inflammation, which may contribute to symptom relief.

Conclusion
In summary, the decision to proceed with surgery should be made collaboratively with your boyfriend's healthcare provider, considering the benefits and potential risks. If the lymph node continues to decrease in size and symptoms improve, monitoring may be the best course of action. However, if pain persists or worsens, further evaluation and possibly surgical intervention may be warranted. It is essential to maintain open communication with the healthcare team and discuss any concerns or changes in symptoms promptly.

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