What should I do about my lymph node? Could it be Hodgkin's?


I'm a 23 yrs old male. 2 months ago I noticed a small lymph node under my left jaw. At first just, it was a little painful. My lymph node is less than 1 cm. My blood tests- CBC, chemistry panel, protein electropheresis, viral serologies (including HIV and Epstein-Barr negative), all were in the normal ranges. I am also quite fatigued. Chest x-ray and a chest MRI were normal (therefore no mediastinal involvment). During the last 2-3 weeks I developed an itchy-skin (no rash), which reminded me about the posibility of being Hodgkin. Could this be parasitic (giardia) related ?

My questions would be: given this symptoms, also being 23 yrs, a peak-age for Hodgkin's disease (HD), would you consider a strong probability for HD involvment? Also, would you recommend now a risky lymph node biopy, or wait a couple of months before doing this? Or just others blood tests to rule in or out HD (even though the golden rule is biopsy)? I'm just 23, and at this age, the posibility of having cancer, even a very treatable one, as HD, is just awful.

Thank you from my heart in advance for your answer, Daniel.


Dear Daniel, Lymph node swelling is quite common, particularly in young folks like yourself. The majority of lymph nodes are due to the body trying to fight off infection. Most lymph nodes can be simply watched over the course of a month or two. I am more likely to request a lymph node biopsy if a lymph node is persistent, out of proportion to other lymph nodes, or associated with systemic symptoms (fever, night sweats, weight loss, itchiness). In your case, I imagine that you will not have piece of mind until the lymph node is out. A lymph node excision is usually a relatively minor procedure. Please make sure your surgeon knows to send it to both pathology and microbiology for culture. It sounds like you've already undergone quite abit of testing (the MRI sounds like a bit too much). Good luck. Please write back if you get a biopsy and if the lymph node shows anything. And no, I don't think this lymph node is related to Giardia.