Can Fibrotic Lymph Nodes After Chemotherapy Lead to Cancer Recurrence?

Hello, Dr. Cheng. I was previously diagnosed with Hodgkin's lymphoma at the Taoyuan Hospital?

After undergoing 12 rounds of chemotherapy, my most recent PET scan confirmed that there are no active cancer cells in my body.
However, I still have one or two fibrotic lymph nodes in my neck.
I consulted with a hematologist-oncologist, who mentioned that these are like scars left by the lymph nodes after chemotherapy and that the fibrosis may gradually decrease in size, or it may remain as it is.
Doctor, is there a possibility that the fibrotic lymph nodes could develop cancer cells again? Is surgery necessary to remove them?

Pak, 30~39 year old female. Ask Date: 2023/07/05

Dr. Zheng Jueyi reply Otolaryngology

Hello, if the current examination results indicate fibrosis, you can continue to observe it for now and surgery for removal is not necessary at this time.

Reply Date: 2023/07/05

More Info

Fibrotic lymph nodes following chemotherapy can indeed raise concerns about potential cancer recurrence, but it is essential to understand the context and the nature of these changes. After undergoing extensive chemotherapy, such as the 12 cycles you mentioned, it is common for lymph nodes to undergo fibrotic changes. This fibrosis is essentially a scar tissue formation that occurs as a result of the body’s healing process after inflammation or damage caused by cancer or its treatment.

In your case, the positron emission tomography (PET) scan indicating no active cancer cells is a reassuring sign. It suggests that the chemotherapy has effectively eliminated the active cancer, and the remaining fibrotic lymph nodes are likely remnants of the previous disease rather than indicators of new or recurrent cancer. The oncologist's description of these fibrotic lymph nodes as "scars" is accurate; they can remain for a long time without indicating active disease.

Regarding the possibility of recurrence, fibrotic lymph nodes themselves do not typically lead to cancer recurrence. Recurrence is more closely associated with the presence of viable cancer cells, which, in your case, have been ruled out by the recent imaging studies. However, it is crucial to continue monitoring these lymph nodes through regular follow-ups with your healthcare provider.
As for the need for surgical removal of fibrotic lymph nodes, this is generally not necessary unless there are specific concerns, such as significant growth, changes in characteristics, or symptoms that suggest a new problem. In most cases, if the lymph nodes are stable and there is no evidence of active disease, a conservative approach of observation is recommended.
In summary, while fibrotic lymph nodes can be concerning, they are often a normal part of the healing process after chemotherapy. The absence of active cancer cells on imaging is a positive indicator. Regular follow-ups and monitoring are essential to ensure that any changes in the lymph nodes are promptly addressed. If you have any further concerns or notice any new symptoms, it is always best to consult with your oncologist for personalized advice and management.

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