Neck Lumps: When to Seek ENT or Hematology Care

Neck issues

About 30 days ago, I noticed a lymph node approximately 0.5 cm in size at the posterior edge of the sternocleidomastoid muscle on the left side of my neck.
At the same time, I experienced night sweats, fever, and weakness/fatigue.
I initially thought it was a respiratory infection, so I did not seek medical attention.
Today, upon re-examination, the lymph node is still present and has not changed in size (it is not very painful and is non-mobile).
The night sweats still occur occasionally, but I do not have a fever or cough, and my energy levels have almost fully recovered.
However, I noticed that I have lost about 8 kg in weight over the past month (from 76 kg to 68 kg), and I am unsure if this is related to increased work stress.

1.
If I visit an otolaryngologist, will they generally use a fiberoptic endoscope for examination? Or is it sufficient to continue monitoring and take antibiotics?
2.
If lymphoma is suspected, is surgery for biopsy the only option? Or can we first observe whether the lymph node size changes, or arrange for ultrasound or CT scans?
3.
Given this situation, would you recommend that I first see an otolaryngologist or a hematologist? Thank you very much!

Cao Lao De Ren, 20~29 year old female. Ask Date: 2019/06/01

Dr. Chen Sirong reply Oncology

1.
If I visit an ENT specialist, will they generally use a fiber optic endoscope for examination? Or is it sufficient to just continue observing and taking antibiotics? A: They will likely use it.
2.
If lymphatic cancer is suspected, is surgery for a biopsy the only option? Or can we first observe whether there are changes in the size of the lymph nodes, or arrange for an ultrasound or CT scan first? A: What you mentioned are also options; you should see a doctor for a personal evaluation and decision.
3.
Given this situation, would you recommend I first see an ENT specialist or a hematologist? A: Either is fine; I hope you seek medical attention soon and recover your health.
Taoyuan Hospital, Dr.
Chen Sih-Rong.

Reply Date: 2019/06/01

More Info

When it comes to neck lumps, particularly lymph nodes that are persistent and associated with systemic symptoms like night sweats, fever, and significant weight loss, it is crucial to approach the situation with caution and seek appropriate medical evaluation. Here’s a detailed response to your questions based on the symptoms and concerns you’ve described.

1. Consulting an ENT Specialist: If you choose to see an Ear, Nose, and Throat (ENT) specialist, they may perform a thorough examination of your neck and throat. While a fiberoptic endoscopy is a common procedure used to visualize the upper airway and throat, it may not be necessary in every case. The ENT doctor will likely assess your symptoms, perform a physical examination, and determine if imaging studies, such as an ultrasound or CT scan, are warranted. Given your symptoms, especially the persistent lymph node and systemic signs, they may recommend imaging to evaluate the lymph node further before deciding on any invasive procedures.

2. Concerns About Lymphoma: If there is a suspicion of lymphoma or another malignancy, a biopsy is often the definitive method to obtain a diagnosis. However, it is not the only option. In some cases, doctors may recommend a period of observation to see if the lymph node changes in size or if other symptoms develop. Imaging studies like ultrasound or CT scans can provide valuable information about the characteristics of the lymph node and help guide further management. If the lymph node remains stable and there are no alarming symptoms, your healthcare provider may suggest monitoring it for a while.

3. Choosing Between ENT and Hematology: Given your symptoms, it would be prudent to start with an ENT specialist. They are well-equipped to evaluate neck lumps and can perform necessary examinations and imaging. If there is a strong suspicion of hematological issues, such as lymphoma, the ENT may refer you to a hematologist for further evaluation and management. Hematologists specialize in blood disorders and cancers, including lymphomas, and can provide comprehensive care if a malignancy is confirmed.

In summary, your symptoms warrant a thorough evaluation. The combination of a persistent lymph node, systemic symptoms like night sweats and weight loss, and the duration of these issues suggests that further investigation is necessary. It is essential to communicate all your symptoms clearly to your healthcare provider, as this will help them determine the most appropriate diagnostic and management plan. Early evaluation and intervention can be crucial in addressing potential underlying conditions effectively.

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