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CT VS MRI VS PET

CatchingDavidsHume
Posts: 4
Joined: Feb 2021

Hello all, I'm sorry to ask what might be an ignorant question.

I've never been diagnosed with lymphoma, but I'm very concerned about the way I've been tested in the past. My symptoms are enlarged lymph nodes all around my neck, even one that I can actually see. Some have been there for years without changing, whereas others are more recent, though it's hard to say if they've changed. Besides that, it's mostly just itching (thighs).

In 2016 I had a neck CT that said "Increased number of upper normal bilateral neck lymph nodes. None exceeds 1 cm in short axis dimension. Reactive nodes would be favored."

In 2018 I received a chest x-ray and ultra-sound, the latter of which showed a 1.2 cm lymph node in my neck, which I can feel. The report says to correlate clincally. My ENT said it's nothing to worry about.

Now in 2021, I've received another ultrasound, where they found several lymph nodes that are about 0.7 cm, but the report does not mention the 1.2 cm lymph node. The radiologist said it's nothing to worry about.

I've had blood tests throughout each of these ordeals.

Tomorrow, I'm getting an MRI.

Everything I read says that a CT scan rather than an MRI is useful in diagnosing potential cancers, that or a PET scan. I think there are too many potential spots for them to do an individual biopsy on each node.

I keep thinking to myself that I will be able to move on from this after the next test, but then I read something that says that my tests may not have been sufficient, or I start feeling new lumps, or new symptoms, like the itching.

Should I demand/plead for a CT scan? A PET scan? Is an MRI even worth the time/money?

I really try to trust my doctors and I try not to let paranoia get the best of me, but I can't stop thinking about the possibility of them having missed something. Thank you for reading and please forgive me if this is not appropriate for the forum. 

PBL
Posts: 329
Joined: Jul 2016

Hi,

Sorry to read of your concern.

An MRI, like a CT scan and a sonography, has its full place among the diagnostic tools when investigating for possible cancer - as well as for many other things. MRIs are often used to take a look in detail at soft tissues in a portion of the patient's body. The doctor who prescribed an MRI to you may have considered that it might yield some new or complementary information, since you've already had CTs and US exams. One other reason for opting for an MRI is to try and limit the irradiation dose. At the other end of the spectrum, a PET-CT represents a high dose of radioactive material, and does not likely offer any more precision.

I am intrigued: In the absence of any particularly significant symptoms, and considering the unimpressive dimensions of your lymph nodes as well as their seemingly "permanent" nature over the course of several years - and finally, after having received concurring "nothing to worry about" reassuring opinions from several medical professionals - what makes you remain worried that you've got lymphoma? Is there a specific reason?

Has any of the doctors you've consulted with offered any other likely diagnosis?

CatchingDavidsHume
Posts: 4
Joined: Feb 2021

Hello, thanks so much for taking the time to respond. 

I hope I didn't come off as a rude or too paranoid. I suppose it would be unreasonable for me to simply assume that it is lymphoma, as the doctors have not said this. 

I assumed it was the case just due to the lymph nodes and that I seem to find new ones from time to time. The only diagnosis that has been reached is from the ENT who said that the lymphnodes are simply doing their job and that sometimes they just become permanently enlarged. 

Beyond that, my fear comes from the fact that I haven't had the CT scan since 2016 and that I've read that ultrasounds and MRIs are not necessarily conclusive? 

 

ShadyGuy
Posts: 709
Joined: Jan 2017

For a persistent viral infection? Several viral infections which could cause this exact situation come to mind including shingles, genital herpes and even chicken pox or mumps. May be worth looking at. Your nodes are really small, tiny even. Is there any pain associated with them?

CatchingDavidsHume
Posts: 4
Joined: Feb 2021

I've never been checked for those infections, though my blood tests are always in normal ranges, if that offers any insight. 

Thank you very much for the suggestion. I suppose I should realize that there are other potential causes for enlarged nodes. 

There is pain in certain lymph nodes sometimes, especially the one just below my ear. For example, when I am outside in very cold weather, it begins to hurt a bit. 

Besides that, they aren't tender or sore. 

po18guy's picture
po18guy
Posts: 1222
Joined: Nov 2011

PBL is correct. Why lymphoma? Sounds like persistent Googling. 0.7 nodes are within normal range. The 1.2 is something to be watched, but it sounds as though it has resolved. If your lymph nodes did not react/expand from time to time, you would never have survived childhood. They are evidence of your immune system at work fighting infection. One radiologist stated that the image favors reactive nodes. Reactive means that they are engorged with lymphocytes that are there to fight infection in that general area. Sore throat? Sinus infection? Toothache? Tonsils? These and many more can cause cervical nodes to react and enlarge.

Straight up: Are you an anxious person? Do you suspect health anxiety? Everyone is telling you not to worry, correct? Yet you are still worried. It appears that you doubt that the plethora of medical professionals and the litany of tests you have undergone. This sounds to me exactly like an anxiety issue. Constant poking and prodding, palpating nodes only drive this on. I note that you use the worlds "paranoia" and "trust" in the same sentence. Hmmmm.

Shady is correct. You may have a chronic, low grade infection - one which flies under the radar. You may have an autoimmune condition unrelated to cancer. You may have one of millions of viruses, since we are still in the virus season. I am no doctor, but the pattern of throught and behavior, the wording in your post strongly suggest to me that you may suffer from anxiety. Consider: Anxiety is the true epidemic of our age. 1 in 5 suffer from it. That is 64 million Americans.

And, as to symptoms which appeared during all of this testing, consider that anxiety csn prodiuce all of them and about 100 more - with no actual disease being present. Pull up this page nd scroll down to see the incredible variety of actual symptoms that can be caused by anxiety - even if it is only the anxiety of the testing.

https://www.anxietycentre.com/anxiety-symptoms.shtml

ShadyGuy
Posts: 709
Joined: Jan 2017

Swollen nodes caused by lymphoma are generally painless. In my non professional opinion, based on observations - not training,none of the tests you have had or are planning to have are ever going to tell you if you have lymphoma. They are screening tests to see if further testing is warranted. They could however give clues to a cause other than lymphoma. In the meantime I would suggest not being "anxious about anxiety". This is called anxiety sensitivity. PO18GUY for example seems to be very anxiety sensitive but has it under control. Keep it under control. Be the hammer not the nail. Still, as Woody Allen said in one of his movies '(sic) just because you are paranoid doesn't mean they are not really out to get you". In other words there is something obviously wrong. In my lay opinion its "almost" certainly not lymphoma - but something is not right. I suggest that you "stay calm and return fire". Keep up with your pursuit of answers but don't let this situation dominate your life. Anxiety, like the boogey man in the closet is not nearly so scary when you get him out into the light. You can do it! 

 

"I thought I was wrong once but I was mistaken" A memorable quote by guess who?

po18guy's picture
po18guy
Posts: 1222
Joined: Nov 2011

Not really a sufferer, but from moderating another cancer forum, and from working with mental health patients for 31 years in another life, I can spot the patterns and behaviors which indicate that anxiety is likely involved.

Max Former Hodg...
Posts: 3699
Joined: May 2012

David Hume,

My B.A. was in philosophy, so I find your moniker intriguing.  David Hume was a Scottish rationalist and skeptic.  He did watershed work in scientific method and INDUCTION, as well as probability.  He was no doubt the most influential philosopher of the 18th Century, and one of the most influential thinkers in our current world as well.  His message was that gathering enough data was never (ever) truly conclusive, but more evidence is better than less.   There is no absolute truth in his system, even in science.  He would say that, for instance, the sun having risen in the east on earth for four billions of years does not PROVE that it will do so tomorrow, but grants that for all practical and reasonable purposes, a person would be a fool to think that it would do otherwise.  So take his message in your current search:  there is little to nothing in your results to prove, much less suggest, that you have lymphoma.   There is significant evidence that you have an autoimmune issue going on.

A few responses to your results:  A 1.2 CM node would attract the attention of few or no oncologists, especially if it is not showing marked growth.   PET scans are extremely expensive, and most doctors will not perscribe one, and most insurance carriers will not pay for one, with out substantial, evidence-based cause.  An MRI vs a CT is totally reasonable for you currently.   Excise biopsies are virtually always of ONE node only, even when situated in a cluster of enlarged nodes (prostectomy and mastectomy are exceptions to this, when all sentinel nodes readily at hand are extracted to check for metastasis).    I had massively heavy HL in 2009, in remission since.   Six months ago, a cluster of nodes were discovered under both axillaries (armpits).   The surgeon extracted only one, and it was 6.4 CM -- a tennis ball, essentially.   It was an oddball, extrememly rare condition, benign.  I then had a PET, and it showed more nodes also in the gut and pelvic chain.   My doc, who is a prominent Hematologist/Medical Oncologist who runs a SCT lab, said forget about it.   This is how these things work, my friend.

Cancer, or the possibility of cancer, are the ultimate curse for an individual with tendency toward obsession, with is very, very common in us human beings.   This is not psychobabble, just the way we are wired.    It was reasonable that you insisted on the tests run thus far.  Go with whatever your current MRI and the doctor ordering it determine.  Do share here if you are so inclined, as every case is interesting and a source of learning,

ShadyGuy
Posts: 709
Joined: Jan 2017

wrote a lot of pro-slavery works and was very popular in the Carolinas which were settled largely by his fellow Scots in the early to mid 1700s. Most of his wealth came from the slave trade, in which he was an active participant. His works were often used, along with those of thr ancient Greek philosophers, as justification for slavery In the antebellum south.

Max Former Hodg...
Posts: 3699
Joined: May 2012

None of which has any relevance to Hume's work in logic and mathematics.  Issac Newton believed in alchemy and reportedly could not calculate interest on a loan,  but was the premiere mathematical and scientific genius of all time.   Michael Faraday did not know multiplication tables, and would ask students what someting times something was during lectures that had the whole board covered in calculus.  But he is still a noteworthy man.  Einstein was a womanizer who couldn't find his way home after leaving the office at Princeton.

Hume is a darling in the current university systems world-wide, mostly among secularists and empiricists.   A darling because of most of his stuff, not what he may have penned for a side gig.   It is noteworthy that virtually all slave trading was run by liberal Europeans, especially the Dutch and English-speaking nations.   I will not write anything further of Hume here, which was inserted only to clarify when or not a medical concern is reasonable.  It was not meant to engender a cancel-culture debate.

ShadyGuy
Posts: 709
Joined: Jan 2017

Actually the Spanish, French and Portuguese were the ones with the majority of slaves. Portugal took about 12 million into Brazil alone. I consider myself cancelled. Thank you.

Max Former Hodg...
Posts: 3699
Joined: May 2012

"Friends don't let friends surf cancelled."    Appreciate the dialogue, even if this thread did get momentarily derailed.   Your Time Out is over......

BFF

ShadyGuy
Posts: 709
Joined: Jan 2017

you are great Max. I love bantering with you. No I  am not a cancel culturist. Just to me Hume is kinda out of context in the 21st century. Things have changed. He was definitely a great thinker for his times.

CatchingDavidsHume
Posts: 4
Joined: Feb 2021

Hello to everyone and thank you for having responded with so much detail. 

I feel almost a bit exposed, with the references to health anxiety, as I'm sure that's what I suffer from, if not anything else. 

@Max, I appreciate the reference to Hume, that certainly resonates. 

Reading your responses made me feel a lot better and take a more rational approach. 

Like I said, I had my MRI, and thankfully the results came back normal. I spoke with the radiologist and then my ENT, both of whom reassured me that these were not dangerous. 

The ENT mentioned my tonsils. He said if the nodes bother me, he would consider removing my tonsils, as it is likely they are the cause of their inflammed state, though he said it was not necessary. 

Beyond this, the only other possible causes I can think of would be Bruxism (I clench my jaw quite a lot, according to my dentist) or having dislocated my shoulder, though this was only 4-5 months ago. I went to the ER for the shoulder, where they took an x-ray to confirm that the bone was not broken, since then I've done physical therapy. 

My ENT reiterated what he has said before - we've kept an eye on these nodes for years now. Through CT scans, MRI scans, ultrasounds, x-rays, blood work. Not to mention that they have not changed in size as far as I can tell. He said, while it is possible something may have been missed, the consistency in testing, and their results showing no change, should make up for that possiblity. 

Again, I appreciate everyone's input, it really helped me in a time where I thought I was losing my mind. 

If anyone has any insight with regard to bruxism or my dislocated shoulder potentially causing the nodes to swell, I would appreciate it. If not, everyone has already done enough (thank you very sincerely). 

I have one more follow up appointment with my GP and I will see what she says, though I don't think it will be different than the ENT. If they order a different test, or if they do find some sort of cause related to my bruxism/shoulder, I will update the post.

Best regards to everyone. 

PBL
Posts: 329
Joined: Jul 2016

Hi again,

Congratulations on getting totally reassuring results and thanks for letting us know!

Regarding either bruxism or shoulder dislocation, I cannot imagine those having anything to do with slightly enlarged nodes at all...

As regards health anxiety though, you might want to discuss that with your GP and see if she could point you to a therapist to help you manage that issue. Although it is not cancer, health anxiety can really make your life miserable, and may well end up causing some genuine health problems if you keep worrying (constant stress can result in very real illness). What is more, repeatedly seeking x-rays and CT scans for reassurance piles up radiation, which can be harmful. I believe it is worth your while to have an open discussion with your doctor and try to get that problem under control for your own good.

Kind regards.

PBL

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