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Need advice/opinions pre biopsy

Posts: 2
Joined: Jul 2010

I am writing for a friend who is allergic to computers :-)
Here is some backround about what is going on: Last yr. at age 46
she had her first mammogram. Apparently, there was evidence of lymph
node enlargement in both armpits, which they never told her about. This year, her mammo showed the nodes again, but they were larger. There is no evidence there is anything going on in her breasts. I dont know the measurements, but on the left side, I could feel it, and i would say grape size-ish. She has rheumatiod arthritis which is currently in a pretty big flare up. The reading I have done says two things ~ one is that in severe RA situation that a person has 70x higher chance of lymphoma. Then, i have read that they could be enlarged just because she has RA. Her father and all 6 or so of his siblings passed away from various cancers.
After the mammo, the radiologist ordered an ultrasound. After the ultrasound, he now wants a biopsy. This is my main burning question...one surgeon wants to take a piece of the lymph node out (the step higher from needle aspiration, i guess), the other surgeon wants to get the whole thing out and biopsy.
If it were you, knowing all you have learned, would you take out the whole or just a piece of the lymph gland for the biopsy? and why?
she hasn't developed other obvious symptoms, but it's hard to tell even if she ever feels flu-ish or achy because she hurts 24/7. She is not on any RA drugs, but has an appt with a rheumatologist in about 4 wks. (she made the appt before all of this)
also, any other wisdom you could share would be so appreciated.
thanks so much!

Posts: 592
Joined: Jul 2009

Hi Polliepocket and welcome to this board. I am very sorry to hear about your friend but she is very lucky to have a caring friend like you. A little back ground on me, 2 time BC surviver and 2 time NHL surviver, just finished RCHOP chemo 5 mo.ago. My NHL was a result of the RA drugs I was taking, makes me pretty angry. I know about RA pain and it is miserable. My heart goes out to her. Is it posible that she could put off the biopsy until she sees the Rheum.dr? For getting a differential diagnosis on lymphomas the more tissue taken the better. Although lymphoma is easy to diag. the specific types and sub types are much more difficult. What could happen is if a small sample is taken and it is lymphoma they may need a second surgery to get a full node.
I'm a person who has not allow any surgeon to remove a lymphnode because of another health problem I have. However I have been repeatedly told pathologists want a lot of tissue.
Good luck to your friend and please post and let us know how she is.
Blessings to you,

dixiegirl's picture
Posts: 1043
Joined: Apr 2006

My first biopsy, they took a portion of a node in my groin. The 3rd biopsy they took 2 nodes (they were fairly little). I have an exceptionally great pathologist this coming from my surgeon AND my onc.

When she needed the second opinion, it went straight to Mayo Clinic. I am very happy she did it. Personally I have no clue how many different types of lymphoma a body can have, but I have seen 4 types on my biopsy reports. First it was Lymphoplasmacytic Lymphoma (about 1% of ALL lymphomas) and MALT (about 7% of all lymphomas)which was the reason for the 2nd opinion. Then came the rare cases of nodal marginal zone lymphoma, and finally the major player, Follicular.

So, bottom line, I have cancer and I am looking for cure sometime. Of course I'd be happy with a long remission this time. :)

Take care,

COBRA666's picture
Posts: 2413
Joined: May 2010

What kind of Rhumatoid arthritis drugs were you taking that caused your nhl? I wasn't aware they could cause lymphoma. Then again we are not aware of a lot of things that go in the medical field are we? john

Posts: 2
Joined: Jul 2010

She isn't on any drugs for the RA. But if you google rheumatiod arthritis and Lymphoma together, you will find the startling risk factors. It seems as though just the joint inflammation puts one at risk, as the white blood cells in the lymph system go haywire. It is quite compelling reading ~ and the more active the swelling, the higher the risks get.

With lymphoma, can anyone tell me if the nodes can be large one day and smaller the next, and vice versa? or do they enlarge and stay that way? Today she said the one feels smaller. But, they have been enlarged for a year and she never knew it. So i was wondering if one day they can be grape sized and the next day smaller, then maybe bigger again.

she hasn't gone in for the biopsy yet. But, today when she said the armpit node felt smaller, I am wondering if she thinks she should forego the biopsy.
any opinions on that?

btw, I soooo appreciate everyone's comments. This is all new territory

Posts: 592
Joined: Jul 2009

Has your friend had any doctor proscribe antibiotics for the swolllen nodes. Could she possibly have an infection? Cancer filled lymp nodes don't usually go down. However I did have a large node biopsyed, came back lymphoma, and than disappear on both PET & CT scans. Had a SUV of 35. Anyway, that's my 2 cents worth as I'm not a doctor.

Posts: 592
Joined: Jul 2009

Hi John,

Although RA does increase the risk of getting lymphoma my type is only seen with the use of immuno suppressing drugs. I was taking Methotrexate, a chemo therapy agent and Humira, a TNF inhibating drug. My doctors can not be sure but feel it was caused by the Humira. All current TNF drugs for RA carry a black box warning which was not on it when I started using the drug and didn't hear about it until I was already diagnosed. They also now carry a warning for breast cancer. Methotrexate has a lymphoma warning but not a black box warning as far as I know. Ok kids consider this your lesson for the day, lol. Now take a nice long recess.

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