Neck Lumps: Key Questions for ENT Specialists

Q: Neck Lumps: Key Questions for ENT Specialists

Hello： Regarding the issue of the neck mass you mentioned, here are my responses： <br>1. <br>The gradual disappearance of the mass does not necessarily indicate complete healing, so it was appropriate for the second physician to arrange for a biopsy. <br>Sometimes, there can be c

Neck concerns?

Dear Dr.
Hsu,
I discovered three lumps in my neck around May 11.
One is a small, independent lump located at the junction of the head and neck, approximately 0.5 cm (A).
The other two are connected, with one being significantly larger, filling the supraclavicular fossa on the left side, about the length of my little finger (B).
Above this larger lump, there is a smaller lump (C).
Initially, none of the lumps were painful, and they could be moved upon palpation.
Since I have never experienced this before, I felt it necessary to see a doctor, so I visited an ENT specialist on May 18.
The first doctor, after palpation, suspected lymphadenitis and prescribed (1) CEKODIN (CEPHRADINE) 500 mg; (2) VENALOT; (3) FLUFEN 250 mg; and (4) MAGAN 400 mg to be taken after each meal.
After the first day of medication, there was no reduction in size.
However, on the second day, the largest lump (B) noticeably decreased in size but became significantly painful.
By the third day of medication, lump (B) began to increase in size again, which felt concerning, so I returned to the ENT department on May 21.
The second doctor performed a fine needle aspiration on the large lump (B).
While waiting for the test results (over the course of a week), the doctor prescribed (1) UCEFA 500 mg; (2) SERADASE 5 mg; (3) PANADOL (TINTEN) 500 mg; and (4) LEDERSCON to be taken after each meal.
After three days of this medication, all three lumps significantly decreased in size.
By the follow-up appointment on May 28, lumps A and C were no longer palpable, and lump B had shrunk to the size of a fingernail.
However, upon reviewing the test results, the doctor noted that the cells appeared abnormal.
When I inquired about what was abnormal, the doctor indicated that the cells were not typical and that further investigation was necessary.
Consequently, I underwent a nasopharyngeal biopsy, with results expected next week (June 4).
During this waiting period, I continued taking the same medications.
I have three questions for you, Dr.
Hsu, as I am concerned about bothering you with my lengthy description:
(1) Will the prolonged use of antibiotics for over two weeks place a burden on the kidneys?
(2) Do abnormal cells always indicate tumor cells?
(3) The doctor has two suspicions: one is a tumor near the nasopharynx, and the other is lymphoma.
If the nasopharyngeal biopsy results are normal, is it still necessary to undergo a detailed examination for lymphatic diseases in oncology? Since confirming lymphoma requires a lymph node biopsy, and my lumps have already shrunk significantly, is this still necessary?
I would greatly appreciate your response, Dr.
Hsu.
Thank you!

beauvoir, 20~29 year old female. Ask Date: 2004/05/28

Dr. Xu Jiazhen reply Otolaryngology

Hello: Regarding the issue of the neck mass you mentioned, here are my responses:
1.
The gradual disappearance of the mass does not necessarily indicate complete healing, so it was appropriate for the second physician to arrange for a biopsy.
Sometimes, there can be concurrent tumors and infections or inflammation present.
The use of antibiotics can be seen as a necessary evil; although it may not be ideal, it is unavoidable, and a two-week course should not pose any issues.

2.
The distinction between true cancer and normal cells is not binary; there are intermediate forms as well.
Your cytology report may reflect results that fall in between, so it is important to identify which form it is to determine the next steps.
You should trust your attending physician and discuss this matter with them for a more informed answer.

3.
The type of cancer will influence the treatment direction, but there are established medical treatment protocols that can be followed regardless of the outcome, and there is substantial documentation for all potential results.

Reply Date: 2004/05/28

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your neck lumps and the ongoing medical evaluations you are undergoing. I understand that this situation can be quite concerning, and I will address your questions one by one, providing additional context and information relevant to your concerns.

1. Antibiotic Use and Kidney Function: It is generally true that prolonged use of antibiotics can have implications for kidney function, especially if the antibiotics are nephrotoxic. However, the risk largely depends on the specific antibiotic used, the dosage, and the duration of treatment. In your case, medications like Cephradine (CEKODIN) and Ucefa are typically considered safe for short-term use in patients with normal kidney function. If you have no pre-existing kidney issues, the risk of significant kidney damage from a two-week course of these antibiotics is low. Nevertheless, it’s always prudent to monitor kidney function through blood tests, especially if you are on long-term medication.

2. Abnormal Cells and Tumor Concerns: The term "abnormal cells" can be quite broad and does not automatically indicate the presence of tumor cells. Abnormalities can arise from various causes, including inflammation, infection, or benign conditions. The pathologist will look for specific characteristics of the cells to determine if they are malignant (cancerous) or benign. It’s important to wait for the results of the biopsy to get a clearer picture. If the cells are indeed atypical, further investigation will be warranted to rule out malignancy.

3. Further Investigations for Lymphoma: If the nasopharyngeal biopsy results come back normal, it does not necessarily eliminate the possibility of lymphoma or other lymphatic diseases. If your physician suspects lymphoma based on clinical findings and imaging studies, further evaluation may still be necessary. This could include imaging studies like a PET scan or a CT scan to assess lymph nodes in other areas of the body. A lymph node biopsy may also be recommended if there are persistent or suspicious lymph nodes. Given that your lumps have decreased significantly in size, it may be reasonable to monitor them closely, but this decision should be made in consultation with your healthcare provider.

In summary, your situation requires careful monitoring and possibly further testing based on the results of your current evaluations. It is essential to maintain open communication with your healthcare team, as they can provide personalized recommendations based on your specific circumstances. If you have any further questions or concerns, do not hesitate to reach out to your physician for clarification.

Best wishes for your health and recovery.

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