What tests are necessary for a diagnosis or rule-out?

kinderteach

I hope it's okay for me to post this here as I don't have a diagnosis, but I figured you would all know better than anyone about what tests are necessary.

A few months ago I noticed a rock solid lump below my ear. I was (still kinda am?) convinced it was a Parotid tumor and just left it alone. A few weeks later the lymph node beneath it swelled up to a little bigger than a pea and its hard and rubbery. Still awsn't too concerned, but then a few weeks later on the opposite side of my neck I noticed another swollen node on the side of my neakc somewhat near my shoulders.

I finally went to an urgent care, figuring they'd perscribe antibiotics, but instead he sent for a CBC with auto diff and a referral to an ENT for an ultrasound and possibly a CT. He confirmed the swollen nodes I was feeling and said the one under my ear could be a node too and kinda mumbled during the exam about feeling a few more too. My auto diff came back with my having microcytic anemia, likely caused by iron deficiency. No sign of any infection and my white counts were all perfectly in range. My ENT appointment isnt scehduled until June.

Well I made the mistake of telling my parents (I'm 25F) and my mom told one of her friends who is an internist what was going on, and now the internist called me, took my records, and wants to run more rests on me. She said nothing in my CBC screams lymphoma, which I was under the assumption that lyphoma didn't show in bloods usually, but she wants to run a whole battery of tests like fecal, urine, another CBC, a comprehensive panel, etc.

I'm of the opinion that it's better just to wait for the ENT. Wouldn't a simple Ultrasound be able to rule out lymphoma? In that case, what's the point of doing all these other tests? I should also mention that the only symtpom I have other than the swollen nodes is extreme fatigue. No signs of being sick, no infection, swollen tonsils, night sweats, or anything. I've been perfectly healthy all year.

ShadyGuy

The only thing ..

which can give a reasonably reliable diagnosis is a biopsy. Incisional biopsy and BMB have a low false positive and false negative rate. Anything else is just a screening test. IMHO.

Max Former Hodgkins Stage 3

Blood

teach,

Blood tests seldom strongly indicate lymphoma unless it is highly advanced.  But lymphoma can cause anemia.  The tests recommended by your internalist friend are typical in cases of anemia, especially the fecal.   If the fecal comes back suspicious, a full colonoscopy would forrow.  The idea is that anemia is either caused because the patient is LOSING blood via GI bleeding, or enough is not made, either due to poor diet or blood disorder.   It is good to have her go ahead and do whatever tests she thinks necessary.    Nodes as small as you describe are seldom cancerous, but they will figure it out.  Most swollen nodes are due either ot infection or an autoimmune issue going on, not cancer.

 

SCTridash

Please check it out

KT,

 

Unless your doctors can confirm an infection, I would encourage you to push either your internist or your ENT specialist for a biopsy, just for piece of mind. Most lumps are not cancerous, but if there is a possibility of lymphoma, catching it early will most likely mean a full and successful treatment. Some lymphomas will not show up on a CBC or even on a needle aspiration biopsy - my follicular lymphoma was not picked up on blood counts, or an US scan of a swollen neck node, or by a needle biopsy on that node until 5 years later when the disease had spread elsewhere and we did a full excision and x-section biopsy of several other swollen nodes to confirm the diagnosis.

Chances are you have some kind of ENT infection which is causing both the swollen node and the fatigue but would encourage you to fully check it out rather than "wait and observe" to ensure you address it properly and have peace mind. A biopsy is usually a simple bedside procedure, wth local anesthesia is virtually painless, and most often takes only a few minutes. Hope it all goes well for you