Lymph Node Swelling: When to Seek Medical Advice

Suspected cervical lymphatic issues?

Hello, doctor.
Around April of this year, I felt a swelling sensation on the left side of my Adam's apple, so I went to the ENT department at a nearby hospital.
I was diagnosed with lymphadenopathy and was prescribed a five-day course of antibiotics.
However, I did not notice much improvement, so I went directly to the hematology-oncology department at the same hospital.
At that time, in addition to my neck, I also felt swelling and pain on both sides of my chest (not yet reaching the armpits) and near my navel.
After examining me, the doctor ordered blood tests, an ultrasound of the neck, and an abdominal ultrasound.
However, due to a long wait at that hospital, it took a month for me to get my tests done.
By the time of the examination, I felt that my symptoms had somewhat alleviated.
During the follow-up visit to review the results, the doctor said that no significant issues were found, except for one lymph node about 1 cm in size near my left jaw (which I believe is near the tonsils, not the original swelling on my Adam's apple) that is estimated to be benign, and that I should return for another check-up in six months.
The doctor also mentioned that they tested many things in my blood that I did not understand, but I did catch that the inflammatory marker was normal, which reassured me, and I went home.
However, about a month later, last week, I suddenly felt swelling on the left side of my Adam's apple and below it, which gave me a sensation similar to being choked, although calling out and eating did not cause any additional discomfort.
When I touched the area, I found a few small lumps on both sides of my Adam's apple, below it, and near my collarbone.
Today marks the tenth day since then, and these lumps have been fluctuating in size; sometimes I almost forget about their existence unless I touch them, while at other times they swell enough to cause slight pain.
I have a habit of monitoring my weight, and I have not noticed any abnormal weight loss.
I would like to ask the doctor:
1.
Does this seem more like a problem with the lymph nodes themselves, or could it be swelling caused by a lesion elsewhere?
2.
If it were a malignant lymphatic tumor, would it continue to grow consistently or fluctuate in size?
3.
I am considering seeking medical advice again soon; would you recommend I see an ENT specialist or a hematologist-oncologist?

Ka Fei, 30~39 year old female. Ask Date: 2018/07/11

Dr. Hu Ziren reply Oncology

1.
If you only feel lumps on both sides of the Adam's apple, it is usually a benign condition (such as upper respiratory infections or inflammation); however, if you can feel lumps above both clavicles, the issue could be more serious (some may be benign diseases of the upper respiratory or digestive tract, while others could be malignant).
2.
Some may resolve on their own (shrink or disappear), but they usually continue to grow.
3.
It is recommended to consult an otolaryngologist first.

Reply Date: 2018/07/11

More Info

Lymph node swelling, or lymphadenopathy, can be a concerning symptom that often prompts individuals to seek medical advice. Your situation, characterized by swelling in the left side of your neck and other areas, raises several important questions regarding the underlying causes, potential malignancies, and the appropriate medical follow-up.

1. Understanding the Cause of Lymph Node Swelling: Lymph nodes can swell due to a variety of reasons, including infections (viral or bacterial), inflammatory conditions, or malignancies such as lymphoma or metastasis from other cancers. In your case, the initial diagnosis of lymphadenopathy by the ENT specialist and the subsequent tests that showed no significant issues are reassuring. However, the persistence and fluctuation of the swelling you are experiencing could indicate an ongoing inflammatory process or a reaction to a previous infection. It is also possible that the lymph nodes are responding to a localized issue, such as a dental infection or throat irritation, which may not have been fully addressed.

2. Characteristics of Malignant Lymphadenopathy: Typically, malignant lymph nodes tend to be firm, non-tender, and may progressively enlarge over time. They often do not fluctuate in size as benign lymph nodes might. In your case, the fact that the nodes are changing in size and occasionally causing mild discomfort could suggest a benign process, but it is essential to monitor these changes closely. If the nodes were to become consistently larger, hard, or associated with systemic symptoms such as fever, night sweats, or unexplained weight loss, further investigation would be warranted.

3. Choosing the Right Specialist for Follow-Up: Given your symptoms and the previous evaluations, it would be prudent to follow up with a healthcare provider who specializes in lymphatic and hematological disorders. Both ENT specialists and hematologists/oncologists can provide valuable insights, but your choice may depend on the specific symptoms you are experiencing. If you have ongoing throat discomfort or concerns about your swallowing, an ENT specialist may be more appropriate. Conversely, if you are worried about the possibility of a hematological issue, a visit to a hematologist/oncologist could be beneficial.
In summary, while your symptoms may not currently indicate a serious condition, continued monitoring and follow-up are essential. It is advisable to seek medical attention if you notice any new symptoms or changes in your current condition. Regular check-ups, especially with imaging or blood tests, can help ensure that any potential issues are addressed promptly. Additionally, maintaining a record of your symptoms, including any changes in size or pain associated with the lymph nodes, can provide valuable information to your healthcare provider during your next visit.
In conclusion, lymph node swelling can arise from various causes, and while many cases are benign, it is crucial to remain vigilant and proactive in seeking medical advice, especially if symptoms persist or worsen. Your health is paramount, and ensuring that you receive appropriate care will help alleviate any concerns you may have.

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