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How to push for excisional biopsy?

Lorelei528
Posts: 3
Joined: Jan 2018

Hi all-

I'm not sure if it's ok for me to be posting  here, as I know a number of boards insist on diagnosis to join etc.

My husband is 40 years old and has had a mostly painless lump in his groin for just over 2 weeks now.  No other symptoms, although he did have a cold (no fever) for over a week that started before he noticed the lump.

Also, it was hurting him for a few days last week, but now it is not.  We have done bloodwork and so far everything is normal.  We went to see primary care doctor and although I was hoping she'd go to the next step of ordering a biopsy, she said, let's wait for 2 weeks, make the appointment and if it's the same, come back and we'll discuss next steps then.

I will say, my husband's brother passed from lymphoma as a child (he had a lump in his neck and this was back in the early to mid 1980's in Ireland).

So, taken into consideration the family history and what I've read online so far, I do think there is a strong possibility of a lymphoma diagnosis.

 

I do know a FNA or a core needle biopsy are not the best choices and I just wanted to ask here, who decides what type of biopsy it will be?  Is it our PCP or a specialist?  Would he see an oncologist before the biopsy or just go to a general surgeon first and see what the results are?

Is there a way to push for an excisional biopsy if they only want to do a FNA or core needle?  Any advice must appreciated.  We go back to PCP on Tuesday everning and so far, no change in size of swelling etc. 

I just want to be prepared to push for excisional..

 

Thanks all!

Lori

 

po18guy
Posts: 989
Joined: Nov 2011

Generally: As "in between" the young, who may have Hodgkin's and the older set (55+ who are subject to non-hodgkin's. There are always exceptions. From a single node with no other symptoms, I would not be worried. The fact that it coincides with an infection only shows that his immune system is functioning - a very good thing. If imaging shows additional nodes, if he develops the "B" symptoms, then further investigation is warranted. Just be vigilant for new symptoms and report to doctor as needed. Lymphoma is very rarely an emergency, and it remains treatable at all stages. I've been stage IV at least twice and have had close to 100 tumors total. Disease free as we speak.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3257
Joined: May 2012

Lori,

You ask a lot of proceedural questions: Who decides what, when ?   It varies by the protocols of his doctor's medical group/practice/hospital, and especially the insurance carrier.  GP or specialist ? Practices vary a lot in WHEN a person can see a specialist, and whether or not a referral is required. Also, many oncologists require a referral from a GP, while others do not.  So the answer is all over the board.

Like Po, I would say that nothing you described thus far suggests Lymphoma, or at least certainly not a serious case.  

While an aspirational biopsy is often maligned, USUALLY they are accurate.  It would be much better than nothing.   But what might be most revealing now is a CT of the region affected.

A sibling having had Lymphoma increases risk some, but not a huge amount. Lymphoma is not usually considered a "family disease."

Many here had lymphoma for YEARS prior to diagnosis. One detectable node is not a cause for alarm.  And emerging sugddenly is much more indicative of infection than cancer.  The doctor saying to wait two weeks is a pittance....many people fight years for diagnosis of this disease and nonetheless get completely cured.  I was highly advanced Stage III, with huge nodes from the neck to goin area when I first met my oncologist. He said I would begin chemo about a month later, and I asked if that would matter, and he replied "absolutely not."   So hubbie is in no danger at all with his doctor's current attitude and timetable.  Be conscientious, but not distressed.

max

 

Lorelei528
Posts: 3
Joined: Jan 2018

Hi and thank  you both for your supportive posts!  Well, the swelling went down a bunch fairly quickly before our last appt. with PCP...we were both hoping/thinking she'd say, "oh! It looks great, let's just wait another 2 weeks to a month and see if it goes away etc."

But...she actually was not that happy.  She said she would've thought it would've been gone entirely or be even less swollen by then.  (This was 3 weeks from when it was first noticed by hubby).  She wanted us to come back in a week and she said if it's still the same she was going to send him for CT scan...I would've thought a biopsy would be better?   Why choose CT scan over biopsy?  Less invasive?  He still has no other symptoms or swollen lymph nodes that we can see or the doctor saw/felt...

Just checking in to say thanks and get opinions/thoughts on our latest update...

Our appt is tomorrow night.  Of course we are both nervous...though even the doctor said she still has a swollen lymph node for over 20 years from when she breast fed one of her kids and she got some sort of infection? I forgot what it was called...anyway, I know that sometimes after being swollen from anything else, they sometimes just never go all the way down etc.?

 

Thanks!

Lori

Evarista
Posts: 254
Joined: May 2017

Just a couple of comments (note: I am not a doctor!).  His doctor may be hesitant to do a biopsy because of concern about spreading a localized infection in the LN.  So a CT would be less invasive and possibly sufficiently diagnostic that a biopsy could be avoided.  Should a needle biopsy be indicated, that would typically be done by a Surgical Pathologist (in my 2X experience).  One reason for not doing an excisional biopsy would be that downstream procedures, such as a "blue dye" injection, would not be possible.  This procedure is perhaps more associated with breast malignancy, but it gives the doctor a way to evaluate possible spread via lymphatic vessels.  Good luck to both of you...Hope it's nothing.

 

Lorelei528
Posts: 3
Joined: Jan 2018

Went back to PCP last night and got the prescription for the CT Scan...now just waiting on the insurance auth so I can make the appt.  She actually also said she'd probably want it biopsied after as well...I guesss one step at a time?  She hadn't mentioned biopsy in any of our previous appointments, so my caution meter just went up a bit.

My husband also I know is now freaking out a bit more. 

Just wanted to post an update in case anyone has any words of advice or support etc.  (plus it helps for me to post here).

 

Thanks!

Lori

po18guy
Posts: 989
Joined: Nov 2011

Since he does not have cancer, i.e. no pathology report states so, I see no reason to freak out. Even if, freaking out will not and cannot help, right? What if all of this eliminates the possibility of a malignancy? We so often forget the purpose of diagnostics - both to identify as well as to eliminate. CTs are nothing to go through, and neither are biopsies, actually. Walk in and walk out.

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