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Question about Biopsy

Roni1970
Posts: 4
Joined: Jul 2019

Let me start by saying that I have not had any diagnosis.  I presented to the ER with lung pain upon inhaling after several weeks of battling seasonal allergies.  I was having a hard time breathing and being almost 50, the pain worried me about clots.  Ultimately, they did a CT scan and while they found no clots (nor any lung abnormalities), the ER doc said they saw something suspicious on the CT.  A 1.5 x 1.8 "nodule" in the anterior mediastinum just left of center.  They referred me to an internist, who referred me out to a pulmonary specialist.  Based on the radiology report, he has a diagnosis of "mediastinal lymphadenopathy".  He said that he was going to present the CT images to the "lump board" this Friday, but he was pretty sure that it would need to be biopsied.

The reason I ended up on this discussion board (Lymphoma) was mainly that as I research my current diagnosis, Lymphoma keeps coming up.  So I did a lot of reading of posts and the one thing that I keep seeing is that a needle biopsy can miss certain conditions - like lymphoma.  So my question is:  If the doc suggests a FNA (which he described when he spoke about doing a biopsy), should I push for a total excision of the lymph node (if in fact, that's what it is, versus an actual tumor)?  I'm fearful that a FNA will miss something that could ultimately end up festering inside me, all the while I'm thinking I'm okay.

What would be the pros and cons of FNA vs excision?  I realize that the area where the "nodule" is in is not an easy area to get to.  Is it more risky to try to excise the node considering its location and perhaps an FNA would be a good first shot?

A little history:

I moved to Denver for school 11 months ago.  Since then, I have honestly felt like crap the entire time.  I chalked it up to the elevation and the fact that I can't seem to stay ahead of dehydration here (I'm from N. Texas).  During my first two terms, my load was pretty heavy - Full-time classes, full-time job and maintaining a 4.0 GPA pursuing two degrees.  Feeling like crap didn't raise any alarms.  During my 3rd term (Spring), I was doing my internship, so no classes, only 40 hours a week and I was getting plenty of rest.  I still felt like crap all of the time.  On my days off, all I could do is stay in bed.

Over the last several months, I have developed anxiety problems which I attributed to being away from my family and taking on a huge load.  I am typically very hot at night, but I figured it was because the guy I rent a room from doesn't like to run the AC much.  My hair has become thin and brittle, but I chalked that up to the dry air here in Denver.  My bones and joints hurt, especially at night when I lay down, but i figured that was all because I stay in bed so much.  I want to get out and walk, but I'm just so tired that I can't bring myself to do it.  I do have a cough that I've had for a couple of months now; it sometimes produces mucus, sometimes it doesn't.  About 10 years ago, I was diagnosed with premature ventricular contractions (palpitations), which only become bothersome a couple of times a year.

I am a current smoker.  I quit at 37 and just started back up two years ago at 47.  I smoke less than a pack a day.  I am a chef, so I don't eat well.. LOL.  As I usually live on sugary and caffienated beverages.  I have actually made it a point to start eating better over the last several weeks, hoping it would make me feel better.  Sometimes I feel a bit closer to normal, but other days it takes all I have to finish out a dinner shift at work.

My blood work has been sort of all over the place.  My parathyroid hormones are elevated, but the pulmonary doc doesn't think it's anything because my calcium is not also elevated and he thinks it's just the gland doing its job.  My kidney function is a bit wonky with my BUN elevated, as well as my creatinine to BUN ratio.  My RBC and WBC are all within normal limits.  No diabetes, I do have elevated cholesterol, no Lupus - no reason for feeling like I do.  I do have psoriasis that I've had for about 20 years.

Not sure if the history is necessary to answer my biopsy question, but I figured it couldn't hurt to give it.

I appreciate ANY opinions or feedback on biopsies that you have.

Thanks,

Roni

PBL
Posts: 185
Joined: Jul 2016

Hi,

Sorry you find yourself posting on this forum,

Based on your description, it may be highly inconvenient to attempt excision of that node due to its location. Unless your medical team can locate another, more superficial suspicious node, they may have to settle for a FNA or core biopsy of the one node in your mediastinum.

Since you brought it up, I hope you will allow me to say this: you need to give up smoking altogether. This is the one thing that cannot be half-done. If you should end up with a lymphoma diagnosis and require chemotherapy, smoking (whatever the number of cigarettes) could cause another cancer while your immune system is knocked out by the treatment. I know how difficult it is, but you've successfully done it before, so you can do it again. Smoking is the one thing that was strictly forbidden by my hematologist on our first appointment when I was diagnosed with lymphoma.

Best of luck to you.

PBL

Roni1970
Posts: 4
Joined: Jul 2019

Hi there.. thank you for your response and input on the biopsy.  As for the smoking.. yes, I know I have to quit and when I met with my doctor, he gave me some resources to utilize.  While I'm being positive that this lymphadenopathy is a benign issue, I am fully prepared to quit at the drop of a hat if it's something else. In the meantime, I am weaning myself off, allowing myself only a certain number of cigarettes per day, scaling back daily.

Thank you again.

Now, I'm just waiting for the pulmonary doc to call me and let me know what the group of docs decided after viewing my CT images.  The waiting is excruciating.  The only time I'm not fretting over his call is when I'm at work.  That's a double edge sword because I usually don't enjoy work because of my fatigue and generally feeling ill, but it has been a nice distraction of late.

ShadyGuy
Posts: 426
Joined: Jan 2017

no smoking of anything, including pot. Pot is not a miracle drug, it is just a very expensive habit and quite dangerous to your health. Plus it has been shown that people who smoke pot quite often use cigs as a fill in when pot is not allowed or unavavailable. Same for cigars, pipes and chews. Stay away from that crap. Your body will love you for it.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3323
Joined: May 2012

I absolutely know all of what you wrote to be true, Shady.   Nanny states condemning vaping and cigarettes, but insisting that pot  become legal and readily available..... I would ask when it will end, but I don't think that it will.

.

Roni1970
Posts: 4
Joined: Jul 2019

Thank you for your input.  Even tho' I live in Denver, I don't smoke weed.  I've tried it.. it doesn't agree with me.  I can't even tolerate a low dosage edible.  The morning after I try anything I have worsening double vision and a feeling of a hangover.  The only two vices I have are smoking (which I know I have to quit) and craft beer (which I only have about 5 a week, maybe).  Thanks again! :-)

ShadyGuy
Posts: 426
Joined: Jan 2017

I hope! I drink a six pack of Raging Bit Ch per week. Best of luck with your journey.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3323
Joined: May 2012

Roni,

I am assuming that the 1.5x1.8 nodule was in cm, since mm that small would not register on a CT. 

I know from personal experience what you are going through, since a pulmonologist a few years ago noted that I had a tumor INSIDE a lung.  Protocol sets Best Responses based on tumor size, as does response to single nodes OUTSIDE organs, but these responses are DIFFERENT; the commonality just being that they are based on SIZE.  I cannot site extensive details on this, except to say that one node the size you described would NOT demand biopsy by most oncologists in the US today as I understand it, based on reading and personal experience. Like everyone else here, we do NOT write as medical authorities. 

My pulmonologist told me that my node, which was only about 4 mm (significanly smaller than yours), demanded a two-year monitoring, via CT every six months.  I asked if it should be biopsied, and he responded that "it was too small for a surgeon to even find, most likely."   He told me that if it enlarged significanlty over the two years, action would be required. But it did not (it was static in size), and after the two years, he said that protocol says ignore it and assume it benign, unless that are new developments. While this was going on, I mentioned what I was going through with my family doc, and he instantly repeated the monitoring program, before I even got much into it, which told me that indeed it was standardized.

"Lymphadenopathy" is simply a generic term for any enlarged node. Virtually everyone on earth has these at times, for reasons completely unrelated to cancer.

[Content Removed by CSN Support Team]

Collectively, all that you have shared taken together does not much suggest lymphoma, in my lay opinion. But do stop smoking.  Fearing lung disease and being a smoker are strange, coexisting in the same individual, sort of like an iron worker who constructs skyscrapers being afraid of heights.

max

 

Roni1970
Posts: 4
Joined: Jul 2019

Hi Max,

Thanks for your input on the nodes and biopsy.  It gives me some things to think about.  Yes, the nodule is in cm - sorry for that.

I just wanted to clarify that I do not think I have lymphoma - but I do think something is going on with me.  While researching the mediastinal nodule they found on CT, it kept coming back with lymphoma as one of the reasons for it.  I've researched everything (which I guess one does while waiting for docs to call back) and I ended up on this forum (mainly going down a rabbit hole of online research).  I decided to pose my question here because there were so many folks on here that were so educated, and I figured a question about a nodal biopsy would be best asked here.  I have gotten some good feedback, and feel a bit better as I move into my next visit with the doctor.  

Thanks again for your input!

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3323
Joined: May 2012

Everyone is glad that you are sharing here, Roni. It was a smart move on your part.  People who are either newly diagnosed, or think it possible that they could have Lymphoma, are among the most common writers.   What is not a good idea is looking at non-professional websites, that is, any site not run by a legitimate medical facility or an academic institution.   Any major cancer center like MD Anderson, Sloan-Kittering, Johns Hopkins, the Cleveland Clinic, will provide the answers to most questions in the information on thier sites, free of charge.  The American Cancer Society, The Lymphoma Society, and others are great also.

What is usually bogus are "Holistic" or "homeonatural" places, which are not FDA or AMA vetted, and which usually ARE trying to sell something.   Any site that claims they cure cancer via nutrition is lying.    Within these guidelines, web searching is reasonable and beneficial.  Please share what further testing reveals in your case.

max

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