Should I Remove My Enlarged Lymph Node or Continue Monitoring?

Lymphadenopathy

Hello, doctor.
In 2019, an ultrasound revealed an enlarged axillary lymph node measuring approximately 3.6 cm, located deep within.
A core needle biopsy performed by a breast surgeon indicated benign results, and hematological tests were normal.
However, anti-Tg and anti-TPO levels were elevated, and the rheumatologist recommended taking quinine.
I have been undergoing ultrasound follow-ups every six months, and the lymph node has not decreased in size.
Would you recommend surgical removal, or should I continue to observe? If the lymph node is surgically removed, what potential complications could arise? Thank you.

Xia Shi, 40~49 year old female. Ask Date: 2021/10/29

Dr. Chen Sirong reply Oncology

Xia Shi / 45 years old / Female
Hello, I have been undergoing ultrasound follow-ups every six months, and the lymph nodes have not decreased in size.

1.
Should I consider surgery to remove them?
A: Yes, that is an option.
The benefits include being able to definitively determine the issue, and removing a 3.6 cm lymph node may provide physical and emotional comfort.
2.
Should I continue to observe?
A: Since no other issues have been detected, such as breast tumors or enlarged axillary lymph nodes, and there are no signs of deterioration, the likelihood of it being benign is higher.
Therefore, continued observation is also a viable option.
Additionally, some individuals may have enlarged lymph nodes that do not shrink back down.
As long as they do not grow larger, observation is acceptable.
3.
What are the potential complications if the lymph nodes are surgically removed?
A: This question may be better directed to a general surgeon.
Potential complications could include localized fibrosis, among others, but the incidence rate is likely low.
Wishing you good health,
Taoyuan Hospital
Chen Si-Rong

Reply Date: 2021/10/29

More Info

When considering whether to remove an enlarged lymph node or continue monitoring it, there are several factors to take into account. Based on your history, it appears that you have had a lymph node in your axilla (armpit) that has been stable at approximately 3.6 cm since it was first identified in 2019. The fact that a fine needle aspiration (FNA) biopsy returned benign results is reassuring, as it suggests that the lymph node is not indicative of malignancy. Additionally, normal blood tests and the absence of significant changes in the lymph node size over time further support a conservative approach.

Monitoring vs. Surgical Removal
1. Monitoring: Given that the lymph node has remained stable in size and has been classified as benign, many healthcare providers would recommend continuing with regular ultrasound monitoring. This approach allows for the observation of any changes in the lymph node's characteristics without the risks associated with surgery. Regular follow-ups every six months, as you have been doing, are typically sufficient to ensure that any potential changes are caught early.

2. Surgical Removal: The decision to surgically remove a lymph node is generally based on several considerations:
- Size and Symptoms: If the lymph node is causing discomfort, pain, or other symptoms, surgical removal may be warranted.

- Changes in Characteristics: If there are changes in the lymph node's appearance on imaging studies (e.g., increased size, irregular borders, or new symptoms), this may prompt further investigation or removal.

- Patient Preference: Some patients may prefer to have the lymph node removed for peace of mind, especially if they are anxious about the possibility of malignancy.

Risks of Surgical Removal
If you decide to proceed with surgical removal, it is important to be aware of potential risks and complications, which may include:
- Infection: As with any surgical procedure, there is a risk of infection at the incision site.

- Bleeding: There may be bleeding during or after the surgery.

- Nerve Damage: Depending on the location of the lymph node, there is a risk of damaging nearby nerves, which could lead to numbness or weakness in the arm or shoulder.

- Lymphedema: Removal of lymph nodes can sometimes lead to lymphedema, which is swelling due to the accumulation of lymph fluid, particularly in the arm on the side of the surgery.

Conclusion
In summary, the decision to remove the enlarged lymph node or continue monitoring should be made in consultation with your healthcare provider. Given the benign nature of the lymph node and its stability over time, continuing with regular monitoring may be the most prudent approach. However, if you have concerns about the lymph node or if there are any changes in your health status, discussing these with your physician can help you make an informed decision that aligns with your health goals and preferences. Always ensure that you feel comfortable with the plan moving forward, whether it involves monitoring or surgical intervention.

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