Could I have lymphoma or metastatic cancer?
Hello Dr.
Fan: Three months ago, I discovered a lump above my right clavicle that has been growing larger and harder, approximately 4 centimeters.
I consulted multiple specialists, but none could determine the cause, all stating it was normal.
Eventually, a biopsy revealed suspected lymphatic tuberculosis (no tuberculosis bacteria were cultured).
I started taking anti-tuberculosis medication on October 26.
The lump hasn't grown larger, but it hasn't significantly decreased either.
Later, the incision site began to discharge fluid (initially watery with blood streaks, which later turned white) and has become somewhat open and ulcerated.
I would like to ask: 1.
Is it necessary to take the medication for a full year? Will it affect my body? 2.
Is there a possibility that the biopsy result indicating suspicion of tuberculosis could be inaccurate and turn out to be cancer?
Jiajia, 20~29 year old female. Ask Date: 2004/11/20
Dr. Fan Sheng reply Oncology
Dear Miss Chia-Chia: Lymph node tuberculosis does not always culture Mycobacterium tuberculosis, and the pathological biopsy results should be reliable.
It is essential to take anti-tuberculosis medication for a sufficient duration to achieve recovery.
Please collaborate with your doctor to monitor liver function and vision regarding potential side effects.
However, it seems that your wound has developed into a tuberculous sinus, making it very difficult to close.
This is concerning! Sincerely, Fan Sheng.
Reply Date: 2004/11/20
More Info
When it comes to lymph nodes that have become enlarged or hard, there are several potential causes, including infections, benign conditions, and malignancies such as lymphoma or metastatic cancer. Based on your description, you have a lymph node that has grown to about 4 cm and has been diagnosed as possibly related to tuberculosis (TB) after a biopsy. You are currently on anti-tuberculosis medication, and you have concerns about the duration of treatment and the possibility of a misdiagnosis.
1. Duration of Treatment: The standard treatment for tuberculosis typically lasts for at least six months, but in some cases, it may extend to a year or more, particularly if the infection is complicated or if there are concerns about drug resistance. It is essential to adhere to the prescribed treatment regimen, as stopping early can lead to treatment failure and the potential for the disease to return. Your healthcare provider will monitor your response to the medication through follow-up appointments and possibly additional imaging or laboratory tests. If the lymph node does not reduce in size or if you develop new symptoms, your doctor may consider further evaluation.
2. Possibility of Misdiagnosis: The concern about a misdiagnosis leading to cancer is valid, especially when dealing with lymphadenopathy. While the biopsy results indicated a suspicion of tuberculosis, it is important to note that not all lymph node enlargements are due to malignancy. In many cases, lymph nodes can remain enlarged for a prolonged period due to chronic inflammation or infection. The fact that the biopsy did not culture the tuberculosis bacteria does not rule out the diagnosis, as some cases of TB can be non-culturable. However, if there is a persistent concern about the nature of the lymph node, further diagnostic procedures, such as repeat biopsies or imaging studies, may be warranted.
In your case, the hard and enlarging nature of the lymph node, along with the discharge from the surgical site, raises questions about whether there might be an underlying issue that requires further investigation. It is crucial to maintain open communication with your healthcare providers about your symptoms and any changes you notice. If you have persistent concerns about the diagnosis or the treatment plan, seeking a second opinion from an oncologist or a specialist in infectious diseases may provide additional insights and reassurance.
In summary, while your lymph node issue could potentially be related to lymphoma or metastatic cancer, the current diagnosis points towards a possible infectious cause (tuberculosis). It is essential to follow your treatment plan and keep your healthcare providers informed about your condition. Regular monitoring and communication will help ensure that any changes in your health are addressed promptly.
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