Lymph Nodes: When to Seek Further Evaluation

Q: Lymph Nodes: When to Seek Further Evaluation

C / 24 years old / Female Hello： 1. <br>Do I need to go to a major hospital's ENT department to request an ultrasound or fine needle aspiration? Due to the pandemic, it's a bit difficult right now. <br>A： Currently, it is not necessary. <br>2. <br>Can lymph node fibrosis reach su

Cervical lymph nodes

Hello Doctor: About five or six years ago, I developed a movable, oval-shaped mass approximately 1.5 cm in length in the area where my right lower jaw connects to my neck.
It has a rubber-like texture, and pressing on it causes discomfort.
At that time, I had it examined by an ENT specialist at Linkou Chang Gung Memorial Hospital, who diagnosed it as a fibrotic lymph node, but no ultrasound or fine needle aspiration was performed.
Since it hadn't increased in size, I didn't pay much attention to it.
Two weeks ago, I had it examined by an ENT at a clinic, who also believed it to be a lymph node.
However, I recently noticed that its perceived size changes depending on the angle of my head; it feels largest when I tilt my head to the left and smallest when looking straight ahead.
Therefore, I'm suddenly uncertain if it has actually increased in size.
I would like to ask the doctor: 1.
Should I go to a larger hospital's ENT department to request an ultrasound or fine needle aspiration? I'm a bit hesitant due to the pandemic.
2.
Is it possible for a fibrotic lymph node to reach this size? Thank you!

C, 20~29 year old female. Ask Date: 2021/05/29

Dr. Chen Sirong reply Oncology

C / 24 years old / Female Hello: 1.
Do I need to go to a major hospital's ENT department to request an ultrasound or fine needle aspiration? Due to the pandemic, it's a bit difficult right now.
A: Currently, it is not necessary.
2.
Can lymph node fibrosis reach such a large size? A: It is possible; any irregular mass can appear to be of different sizes when viewed from different angles.
Wishing you peace and health.
Best regards, Chen Sih-Rong, Taoyuan.

Reply Date: 2021/05/29

More Info

When it comes to lymph nodes, particularly those that have been present for several years, it is essential to monitor any changes in size, texture, or associated symptoms. In your case, you have a lymph node located in the right submandibular area that has been stable for several years but has recently raised some concerns due to perceived changes in size depending on the angle of your head. Here’s a detailed response to your questions and some additional context regarding lymph nodes and when to seek further evaluation.

1. Should You Seek Further Evaluation?
Given your history and the recent changes in perception regarding the size of the lymph node, it is advisable to seek further evaluation. While the lymph node has been stable and was previously diagnosed as fibrotic, any new changes—especially those that cause discomfort or a feeling of size variation—should not be ignored.
A referral to an ENT specialist at a larger hospital for an ultrasound or fine needle aspiration (FNA) biopsy would be prudent. An ultrasound can provide a clear image of the lymph node's characteristics, such as its size, shape, and whether there are any concerning features like irregular borders or increased vascularity. An FNA can help determine the nature of the lymph node by analyzing the cells within it, which can provide reassurance or indicate the need for further investigation.

2. Can Fibrotic Lymph Nodes Become This Large?
Lymph nodes can indeed undergo changes over time. Fibrosis in lymph nodes typically indicates a chronic process, often due to previous infections or inflammation. While fibrotic lymph nodes can be stable, they can also change in size due to various factors, including infection, inflammation, or even malignancy.
A lymph node measuring 1.5 cm is not uncommon, especially in the context of reactive lymphadenopathy, which can occur due to various benign conditions. However, if you notice that the lymph node feels different or if there are new symptoms (such as pain, fever, or unexplained weight loss), these could be signs that warrant further investigation.

Additional Considerations
- Monitoring: If the lymph node has not changed in size for several years and there are no new symptoms, your healthcare provider may recommend a watchful waiting approach. However, given your recent concerns, it is wise to have a professional reassess it.

- Symptoms: Pay attention to any additional symptoms that may arise, such as persistent pain, fever, night sweats, or unexplained weight loss. These symptoms can be significant and may necessitate more urgent evaluation.

- COVID-19 Considerations: While the pandemic has made healthcare access more challenging, many hospitals and clinics have implemented safety protocols to minimize risk. It is essential to communicate your concerns to your healthcare provider, who may be able to facilitate an evaluation while ensuring your safety.

In conclusion, while your lymph node has been stable, the recent changes in perception and discomfort warrant further evaluation. An ultrasound and possibly an FNA biopsy can provide clarity and peace of mind. It is always better to err on the side of caution when it comes to changes in lymph nodes, especially those that have been present for an extended period.

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