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Lymph Nodes
Mar 28, 2012

Dr. McGowan,

Recently, I submitted a question about lymph nodes and lymphoma. However, I submitted it to "any expert." I'm not sure whether those get put into a seperate inbox. I realize you and Dr. Young get many questions. And, I know this is technically a forum about meds. However there isn't a forum for poz folks to ask basic health questions.

A few weeks ago, I noticed a large lump in my right armpit. I realize HIV is notorious for causing swollen nodes, but I hadn't had any swollen in about 9 years. The fact that it didn't ache concerned me, as I've always heard those are ones to keep an eye on for things like cancer. I went to the doc. She was concerned by its size and that it wasn't painful. We were going to do a needle biopsy, but the swelling went down. All I can feel now is just a pea-sized node where it was. But, as I felt around more, I'm feeling a couple more pea-sized. Some have told me normal nodes should be that size and that you should be able to feel them. But, I don't feel any in my other armpit. So, I'm not sure whether that is correct. I have been feeling bad lately with fatigue and dizziness. I thought perhaps that was just anxiety.

These nodes worry me, especially since they aren't painful/tender. And, the fact that one swelled up pretty big. I've read lymphoma can start off this way--slowly swelling and then spreading. Having HIV makes one question whether something is more serious or just HIV--as if HIV is just HIV. I'm worried about dismissing something and it turn out to be more serious. I'm not sure whether a problem would show up on bloodwork?? I guess I'm just curious what you would do in this situation. Is this nothing to be concerned about and something that just happens with a virus like HIV? Monitor things and see if nodes in other parts of the body swell? Do an ultrasound or needle biopsy just to be on the safe side? I know lymphoma is more common in poz folks.

I appreciate any info and direction you can offer.

Response from Dr. McGowan

I am sorry to hear about what you are going through.

What you have said is very true.

The things to worry about are when the nodes are "asymmetrical", that is when one side is much bigger than the other, or if the nodes are firm (hard) or fixed (not moveable). Those types of nodes should be biopsied.

Since lymph nodes are part of the immune system, they can swell and shrink normally as part of a local infection. For example if you had infection in the hair follicles under the arm, or a skin infection in the hand on that side the nodes may swell, this is normal.

Symptoms of a lymphoma can vary, or there may be nothing that you feel. Sweats, weight loss, fever and fatigue can be seen, but may be due to many causes.

Since this has been going on for a few weeks and you have other symptoms, you should speak with your doctor about getting a CT scan to look for other nodes that may be abnormal internally (around teh intestines) and to see if the spleen (which is like a big lymph node) is enlarged. If everything is normal, or very small nodes, that may be watched.

Hope this helps, Joe



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