Neck lumps
A 40-year-old man first saw me a couple of months ago. He wasn’t the patient but he brought his son for a hernia repair. He said he had a lump at the side of his neck. I felt it and said that we should investigate. He said “ok, but later”.
Recently he came back because he remembered the lump. I felt it … it had increased in size and number. It was alarming to find them growing so quickly. And not only in the neck, there were lumps in the armpit as well. So I took a few out and sent them for pathological examination (microscopic examination). After the results came back, I ordered a CT scan from the neck to the pelvis. This is a view of the CT image:
Can you spot the difference between the right and left sides of the neck?
Here is the CT at the level of the chest… there are some lumps in the armpit as well.
The pathological diagnosis was mixed-cellularity Hodgkin’s lymphoma. Hodgkin’s lymphoma is a malignant growth of lymph node cells. I referred him to the oncologist in nearby Kepala Batas Hospital for oncological treatment. These are treated mainly with chemotherapy and sometimes accompanied by radiotherapy.
Do you take responsibility for the delay? I wish I had insisted that he got the lymph nodes sorted out right after the child’s hernia was repaired.
My brother has a lumpon his wrist…any possibility it could be cancerous?
I guess the patient has to be responsible to follow through with your earlier suggestion that the lump be further investigated. I hope he responds to treatment.
i know exactly how u feel…but then if u had insisted that time , and still he had procrastinated , would u have felt better n blame urself less?..i dun think so..
i had a pt , similar situation ,despite my insistence that she go for further check, decided to wait n see..i even took the trouble to call her once in a while to check on her, got her husband to talk to her..still nothing..until about a yr after that , her son came n informed me that she has passed on…do i feel less guilty?..nope..
Chelsea, please ask him to get it examined by a doctor.
nyonya, I hope he responds too. It’s not a surgical disease. I’m the “tukang” here. So, I’m not familiar with the prognosis of these lymphomas.
eve, maybe not. Thanks.
well many people are not aware of how severe can some symptoms be. Mostly they just neglects it hoping it will go away. Some may say its nothing, save the trouble and money getting it check on. Can’t really blame them. It’s normal human psychology. So many usually wait until the symptoms persist for a long time or worsen to the extends that they thing it is harmful. That’s why many at times you get get patient coming in with delays. I’m going off for holidays soon! yay… blek!
every time i read something like this i worry a little more..both my parents dies of cancer..mum..of the brain, dad…of the blood..does this mean i will die early too? ( not joking
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Oh dear! More lumps!! I got a couple, but a skin doctor in Subang I visited told me they weren’t all that malignant.. *touchwood*… Hmmm…. Hmmmm… Hmmmm…. HMMMM..
Bernard, you did tell the patient that it should be investigated. You have done your job.
It would be different if the patient came and you sent him off and told him to come back a month later if the lump has not subsided.
The way I read it, you are a good doctor and quick to investigate.
We need more doctors who is as dedicated as you.
If I come to you must pay ah? :))
Now hor, I am really confused but then I am easily confused.
So, are you a surgeon or GP?
Kat, yes! This is called the illness behaviour of people. It’s influenced by the background, attitudes, knowledge and resources available to them.
Happy holidays!
Bengbeng, sorry to hear about your mom and dad. Brain tumours aren’t that common. They might have come from somewhere else? I’m not familiar with blood cancers (physician’s field) but i don’t think that they are hereditary.
LB, *gulp* what does not all that malignant mean? Just a little malignant? Hey you’d better find out what that means, mannn!
Judy, yes! Assam laksa for lunch and dinner! Haha… and supper!
Thanks. I actually forgot about his lump until he came back again. But then horr… if i remembered also.. I don’t think I would’ve called him to remind him. Mebbe he wanted to see someone else leh? Right or not? Perasan meh?
I’m a surgeon lo.. that’s why I cut it out and sent it for pathology. Why the confusion?
It’s helpful the next time you put some indication the x-ray. I don’t see any different wor. Lump? What lump!
Since it’s on the wrist. which doc or which specialist should I refer to?
chelsea, see an orthopaedic surgeon.
Queen, oh yes I should…