Enlarged Lymph Nodes After Salivary Gland Cancer Surgery

Enlargement of cervical lymph nodes?

Hello, I have been diagnosed with salivary gland cancer.
I discovered a malignant tumor in my parotid gland last August and underwent a parotidectomy in November.
During the lymph node surgery, three lymph nodes were examined, and one was found to be metastatic.
However, I did not undergo subsequent lymphadenectomy or radiation/chemotherapy.
Recently, during two follow-up appointments, there were one or two lymph nodes near the neck and parotid area, each measuring less than 1 cm—one approximately 0.8 to 0.9 cm and another around 0.5 cm.
Imaging suggests they appear benign, and their sizes have not changed significantly.
I would like to know if these two lymph nodes could potentially become malignant in the future, or if they are currently normal lymph nodes.
Why haven't they decreased in size or disappeared? Given their proximity to the primary site, I am curious why there are two slightly enlarged lymph nodes in this area.
Considering the time since my diagnosis last August, if these lymph nodes were malignant, would they not have increased in size rapidly? It has been about five months since my surgery, and since their sizes have not changed significantly, can I feel somewhat reassured? I apologize for the many questions, and thank you.

Alex, 40~49 year old female. Ask Date: 2023/04/22

Dr. Zheng Jueyi reply Otolaryngology

Hello, if there are no significant changes in the size or number of lymph nodes, observation may be appropriate.
However, due to the previous diagnosis of malignant parotid gland tumor with lymphatic metastasis, it is recommended to have regular follow-up visits at least once a month.
If there is any pain, enlargement, or increase in the number of lymph nodes, please return to the clinic earlier for reevaluation by the physician.

Reply Date: 2023/04/22

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your health situation following your surgery for salivary gland cancer. I understand that you are concerned about the enlarged lymph nodes in your neck, especially given your history of malignancy. Let’s address your questions systematically.

Firstly, it’s important to recognize that lymph nodes can react in various ways after surgery, especially in the context of cancer. The presence of lymph nodes that are less than 1 cm in size, particularly those measuring around 0.8 to 0.9 cm and 0.5 cm, is not uncommon. In many cases, lymph nodes can remain enlarged due to reactive changes following surgery or inflammation, rather than malignancy. The fact that imaging studies suggest these nodes appear benign is a positive sign.

Regarding your concern about whether these lymph nodes could potentially become malignant in the future, it is essential to understand that while there is always a possibility of change, the stability in size over five months is reassuring. Typically, malignant lymph nodes tend to grow more rapidly and exhibit changes in characteristics, such as becoming more irregular in shape or showing increased metabolic activity on imaging studies. Since you have not observed significant changes in size, this is generally a good indicator that they may not be malignant.

The reason these lymph nodes have not decreased in size or disappeared could be due to several factors. After surgical intervention, lymph nodes may remain enlarged as part of the body’s healing process. They can also be involved in filtering out residual cancer cells or responding to inflammation from the surgical site. It is not unusual for lymph nodes near the original tumor site to remain reactive for an extended period.

You mentioned that these nodes are located near the original site of the tumor, which could explain their persistence. Lymph nodes in proximity to a surgical site can remain enlarged due to the local immune response. In the absence of new symptoms, such as pain, fever, or significant changes in the nodes’ characteristics, it is reasonable to maintain a watchful waiting approach.

In terms of follow-up, it is crucial to continue regular monitoring with your healthcare provider. They may recommend periodic imaging or physical examinations to ensure that there are no changes in the lymph nodes over time. If any new symptoms arise or if there are changes in the size or characteristics of the lymph nodes, further evaluation may be warranted.

In summary, while there is always a concern for potential malignancy in the context of your history, the stability of the lymph nodes and their benign appearance on imaging are encouraging signs. Continue to communicate openly with your healthcare team, and do not hesitate to express any concerns you may have during your follow-up appointments. Regular monitoring will be key in ensuring your ongoing health and peace of mind.

Best wishes for your continued recovery, and please feel free to reach out with any further questions.

Sincerely,
Doctor Q&A Teams

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