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Very painful lymph nodes; I have both HIV and cancer. Which disease is causing these nodes?
Apr 20, 2003

HIV+ for over 7 yrs, CD4 190, viral load 45,000 recently started anti-retrovirals. Had a growth removed from under left arm about 5cm and was diagnosed with a peripheral nerve sheath sarcoma. I am about to start radiation therapy, but I have more nodes that are very painful and enlarged. My CT shows many enlarged lymph nodes in neck and armpit area (all on the left side)There was a needle biopsy done on one in the neck and that was non-malignant.My Oncologist feels there are too many to remove to see which ones are malignant and which ones are not and because of the HIV that could also be the reason why they are swollen.My question is what do I do to relieve the pain of the swollen lymph node? There are days i can't move my arm. My Radiologist put me on Prednisone (10mgs) to reduce the swelling but so far no luck. Do I insist on having them removed? I am confused and scared and starting to doubt my health care givers. Any advice would be helpful and appreciated. Thanks.

Response from Dr. Dezube

Your situation is not an easy one, and I have many patient in similar situations. Specifically patients who have a known cancer and enlarged lymph nodes on CT scan. It is VERY difficult to tell whether the lymph nodes are enlarged due to the cancer or due to the HIV. Biopsies, as you indicate, sometime don't help since you can biopsy one lymph node and see HIV, and biopsy another lymph node and get cancer. In fact, in my last patient who had AIDS lymphoma, we biopsied a particularly problematic lymph node and he had a mycobacterium (MAC) infection.

So what would I recommend? You state that you recently started HIV drugs. This was a good move. In time, they will help treat lymph nodes related to the HIV disease. You should get the treatment for the cancer as you outlined. Prednisone, for the short term, is a good idea since it should help the swelling and pain of lymph nodes.

You will need follow-up CT scans. If one or two groups of nodes becomes particularly worrisome, e.g. growing out of proportion to other node sets, then your health care provider may want to explore further to get a better sense as to what is going on.

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