single Lymph node above pancreas noted on ultrasound imaging, should I be worried about pancreatic cancer?

	Asked by sononicole (Female; 23; Appy (1998) Ear tubes (1989); Relevant drugs:Penicillin VK 500 mg Multi Vitamin ) on Sun 06, Dec 2009 06:46pm :
	Hello, I have a question for the Doctor. First I will give you a little clinical history. I'm a 23 year old female, no major health problems, non smoker, never drink alcohol and I'm 5"7 177 lbs. I have no known family history of cancer or pancreatic cancer. I'm a contingent sonographer at a local hospital specializing in general and vascular ultrasound. I was letting the students scan me and they noticed a lymph node above my pancreas. The lymph node is well rounded, homogenous, and hypoechoic compared to the pancreatic tissue. There is no flow within this area, which is located above the pancreatic head/neck. The pancreas itself does not look enlarged and is homogenous and hyperechoic compared to the liver. I do not see any masses or any areas of concearn. The lymph node area measures 1.4 (long) 8.9 mm (AP) 1.5 (trans) My spleen is also on the prominent side measuring 12.2 cm's. I'm worried because I read in a few journals this could be a sign of pancreatic cancer if a lymph node is found near the pancreas, but most places say abnormality is over 1-2 cm. I have no medical insurance at the moment because I do contingent between 2 hospitals but I want to know if I should be concearned about this area and what I should do. Given the profession, and all the pathology I've seen this worries me to death. I also must tell you about a week ago I just got over a really bad sinus infection it must have been viral because I had severe Laryngitis and also on 12/2/2009 I had a root canal for a really bad infection in the pulp of my molar, I'm now on penicillin and finishing up my doses could this be why the lymph node is enlarged or looks prominent? or should I be worried about pancreatic cancer?
	Actions: | Forward |
	Answer by Dr Bhupinder K, MD (doctor) on Sun 06, Dec 2009 09:35pm: Hello, Welcome to the AMD forum of doctors and we are glad to lend you a helping hand. I can understand your confusion regarding the solitary swollen lymph node and the enlarged spleen. See, both these were incidental findings in your case which were seen only by coincidence on an ultrasound. Moreover, since you have a history of infection of the larynx and molar tooth, so the most rational cause of these findings is an infection. As you must be aware that the prime function of the lymph nodes and spleen is clearance of microorganisms and infections, so they usually swell up whenever there is association with various infections or inflammatory processes because of an increase in the defense activities of the organs. Normally the spleen is 11cm in craniocaudal length so 12.2 cm can be considered mild splenomegaly. It is true that anyone will have apprehension of a malignancy with such findings, but your history(age, non smoker, non alcoholic, no family history, no exposure to carcinogens) is defying it. In the absence of any symptoms of pancreatic malignancy like abdominal pain, weight loss, loss of appetite, diarrhea and jaundice; pancreatic malignancy is less likely. You are also right in saying that the size of the nodes greater than 2 cm is of concern and in your case, that is also not justifying. I would suggest you to repeat the scan after 12-15 days (lymph nodes take longer to return to normal size than the time they take to swell up) and if there is persistent node enlargement or splenomegaly, then you should consult a gastroenterologist/ hepatologist and get a CT abdomen and maybe a biopsy of the lymph node(percutaneous or endoscopic) done to confirm the diagnosis. Another possibility to be ruled out in that case would be a lymphoepithelial cyst of the pancreas. In this, there is a pancreatic cystic lesion lined by squamous epithelium with surrounding lymphoid stroma and filled with keratinous debris. I hope it helps. Take care and please do keep me posted in case you have any additional doubts. Kind regards.
	Please rate my answer (select the stars below, no need to log in.)
	This questions is open for comments. Please share your opinion. Name Email Comments Enter your comments here Enter the text as shown above E-Mail me when someone replies to this post
	Follow up: Clarification by sononicole on Sun 06, Dec 2009 11:37pm: Thank you Doctor! I must also let you know my spleen has been the same size 12.2 for a year now and it was found incidently in my ultrasound class. A few of the sonographers at the hospital asked me if I ever had mono to which my reply was yes when I was 13, can the spleen stay enlarged after having that? I never had any problems or symptoms and did not think it was much of a big deal since most radiologist said they did not consider it spleenomegaly until it was past 13 cm on ultrasound. I however did have a CBC done a year ago which showed a normal hematocrit the only things that were slightly off were my WBC count was slightly high which was 13.4, normal WBC range is 3.5-10.5, my platelet count was low as well it was 113 normal range 150-450. I asked my aunt a year ago whom is an ER physician and she told me not to worry about the platelets unless they get below 90 and that the WBC really isnt that high to be of concearn and that the body changes. Do you agree with this? I have not had a CBC since so I don't know my levels as of today. The only thing I often feel is tired and fatigued all the time but this is an ongoing problem I have had for a few years now. I don't have any pain in my abdomen, no weightloss, no loss of appetite, no diarrhea usually and I haven't noticed my skin or whites of my eyes turning jaundice. I do however feel very nauseated but its been happening ever since the dentist started me on the Penicillin so I know thats what is making my stomach upset. What are the chances of someone with my history and age even having pancreatic cancer? I know I'm worrying myself but I just want to put my mind at ease. Request for Clarification by Dr Bhupinder K, MD on Mon 07, Dec 2009 06:13am: Hi, Many thanks for reposing your faith in the forum. In my opinion, the lymph node doesn’t appear to be a sinister one taking into account your young age, elevated WBC counts in recent past, history of sinusitis. However, not to take a chance, I’ll suggest a CT scan of abdomen after a course of antibiotics in case the WBC counts are still enlarged and the lymph node continues to persist as it will put to rest any speculation of an underlying sinister pathology like a cancer which doesn’t seem likely. As mentioned by Dr Anurag, if any other lymph node is palpable like in the neck or the axilla, then an FNAC from the mentioned regions should help. I sincerely hope that helps. Take care.
	Comments: Response by Dr. A. Srivastava on Mon 07, Dec 2009 01:33am: Hi, Dr Bhupinder has nicely explained all possibilities of your unexpected incidental finding of lymph node. I would like to add a few points to it. As you said lymph node was an incidental findings by your students and presently there are no symptoms related to abdomen or jaundice etc( as mentioned by Dr Bhupinder) and there is no primary pathologic foci visible in the scan of pancreas, liver or any other abdominal organ( except spleen). Therefore I would advice you to keep your mind at rest for a while. You have history of ear tubes (so I feel may be you had frequent middle ear infections which can be inducible by frequent cold and flu too. Presently, you have sinus infection which can be allergic or viral infection with excessive mucus collection leading to stagnation of secretion and superimposed bacterial infection. So, lymph nodes may have enlarged due to viral infections or subclinical infections. Second possibility is that it can be part of generalized lymphadenopathy therefore an examination of all major lymph nodal groups like neck, axillary and inguinal area should be conducted and if there is any other palpable node found then some general causes of lymphadenopathies like TB, frequent and intermittent respiratory infections, kidney conditions should be ruled out. Mild splenomegaly is another finding you got but for that too we have good news for you!! Size of spleen varies according to racial differences and also antigenic stimulation due to infections can cause splenomegaly ranging from mild to moderate size. Associated generalized lymphadenopathy (if found upon examination) is frequent in many of these infectious causes. As your spleen size is still the same in one year then may be it is your actual size. Therefore as far as you don’t have any symptoms of pancreas problem, stay calm and eat healthy to improve your immune system. I would advice a complete blood count (WBC count may be increased due to your recurrent and present infection and mild lowering of platelet count also can occur in viral infections), hemoglobin (to check anemia), chest x-ray (or scan) should be conducted to reach to a diagnosis. There is a well known saying in medicines “General problems are generally found but rare conditions are rare”. Your young age also defies possibility of malignancy though I agree your profession is towards the higher side of risk. In such case I would advice you to keep all precautions as per recommendations of radiology to avoid unnecessary exposure to radiations. These are just precautionary steps so don’t panic stay stable minded and go ahead with your profession with safety. Lastly, I too agree for a follow-up scan but after your symptoms of sinus infection has subsided or at least after a month as lymph node enlargement takes a longer time to resolve after the infection is completely eradicated and later 6monthly. Hope this information helps you. Take care and do keep us posted in case of further doubts.
	Other medical questions you might be interested in. Please rate doctor’s answers.
	Gound glass lung nodule and possibility of it being cancer  (Answered) - Viewed 1579 times   I have a 7mm ground glass nodule in lung..I am being told now that I have to go for another ct of lung in 3 months. I am female... stages of cancer - Stage IV cancer in the adrenal gland near top of kidney  (pending) - Viewed 1294 times   my father-in-law has stage 4 cancer in the adrenal gland near top of kidney due to cancer from his lung. how many stages of can... colon cancer - Does CEA test as high reflect great possible of colon cancer?  (Answered) - Viewed 3893 times   I am scheduled for a colonoscopy on the 5th of March as the result of a cea blood test with results of 24. Does the cea test as... Breast cancer - Puckering and dimpling of skin on both breasts  (Answered) - Viewed 8306 times   What is meant by 'puckering and/or dimpling' of the skin? I have just done a breast self-exam and when I sit down, put my arms a... b cell - Malignant lymphoma diffuse large b cell found  (Answered) - Viewed 531 times   they found malignant lymphoma diffuse large b cell in my dad body i like to know if you can tel me how bad it is . and thank you... Hodgkin's disease - Survival rate for Hodgkin's disease  (Answered) - Viewed 464 times   my sister has stage 4 Hodgkin's at age 44, what kind of survival rate can we expect? We also lost a sister to Pancreatic at age... Pancreatic Tumour - Tumour found on Pancreas only head left visible on CT Scan  (Answered) - Viewed 1888 times   Tumour found on Pancreas only head left visible on CT Scan, matasized to lungs and Liver and possibly bowel. We are wondering wh... Prostate Cancer - Is external radiation and hormonal treatment sufficient  (Answered) - Viewed 856 times   I have prostate cancer (psa was 14 - 7 4+3) My Urologist did a biopsy (30 samples were taken, only one came back showing cancer)... life after surgery without chemo but using natural products and diet  (Answered) - Viewed 847 times   I refused chemo for stage111C colon cancer.I had the surgery to remove the tumor of which they got it all.My Ct scan after surge... what if i don't follow up with an abnormal pap smear?  (Answered) - Viewed 1786 times   I had an abnormal pap smear eight years ago, i ended up having to have a cone biopsy "leep procedure" done. i had normal pap's f... POSSIBLE ORAL CANCER - Should i visit a dentist or an oncologist?  (Answered) - Viewed 1142 times   I THINK I MIGHT HAVE SIGNS OF ORAL CANCER, BUT I DONT HAVE HEALTH CARE INSURANCE.UP UNTIL ABOUT 3 YEARS AGO, I SAW MY DENTIST ON... Skin Cancer - blisters appear to have turned into moles  (Answered) - Viewed 1583 times   I am a 56 year old female who was diagnosed with GBS last March. Over the past year I have noticed red spots that look similar t... Enlarged lymph nodes - sign of secondary lymph node cancer?  (Answered) - Viewed 4142 times   Diagnosed with breast cancer in 2000 and DCIS in other breast 2001. Mastectomy, chemotherapy, radiotherapy. 4 weeks ago I h... Bone tumor - MRI revealed bone tumor, bone cyst, bursitis, effusion possibly aneurysmal bone cyst  (Answered) - Viewed 1115 times   I fell and have had lots of pain, so the ER ordered an MRI shows that It showed a bone tumor, bone cyst, bursitis, effusion pos... breast lump in the elderly - Should lumps be removed regardless if it is cancer?  (Answered) - Viewed 601 times   my grandmother, age 95, has recently had a needle biopsy of a lump in her breast. She will go back soon to be told if it is canc... Toxicity due to chemotherapy - What does Grade 1 constipation and Grade 1 PPE mean?  (Answered) - Viewed 653 times   I have undergone 18 weeks chemo for recurrent disease of cancer of the oesophagus. Toxicity from my chemotherapy includes gr... cancerous breast tissue? - Cancerous tissue in breast:: Is it Stage I breast cancer  (Answered) - Viewed 739 times   my mom has just found out that she has cancerous tissue in her breast but no lump is cancerous tissue the first stage in cancer ... Prostrate cancer - Terminal prostate cancer spread to bones  (Answered) - Viewed 1177 times   high my dad has a very agressive prostrate cancer, he has been told it is terminal as it is spread into his bones now, can you ... Pancreatic Cancer - Opinion of cancer clinic in Ziol IL  (Answered) - Viewed 974 times   Hi, my name is Pam and my mother was diagnosed with Pancreatic cancer that has spread to her liver. We are trying to decide on ... Prostate Cancer Treatment - How often should i have chemotherapy?  (pending) - Viewed 379 times   I am about to have chemo ?for Prostate cancerin addition to Zoladex injections, how often am I likely to have the chemo and for...
	Visitors to this page searched for: what does lymph node on pancreas mean:1 visits 0 bounces 1089 secs spent on page; my ultrasound report says unlikely to show sinister pathology:1 visits 0 bounces 456 secs spent on page; lymph nodes behind pancreas were enlarged in ultrasound:1 visits 0 bounces 217 secs spent on page; swollen lymph nodes in pancreas:1 visits 0 bounces 61 secs spent on page; "cea blood test" '3.5" pancreas:1 visits 1 bounces 0 secs spent on page; 2cm abnormal area found near pancreas on ultrasound:1 visits 1 bounces 0 secs spent on page; bad notice lymph nodes ultrasound:1 visits 1 bounces 0 secs spent on page; causes swollen lymph nodes near pancreas:1 visits 1 bounces 0 secs spent on page; enlarged lymph node near pancreas:3 visits 3 bounces 0 secs spent on page; enlarged lymph nodes by pancreas:1 visits 1 bounces 0 secs spent on page; enlarged lymph nodes near pancreas:1 visits 1 bounces 0 secs spent on page; is a lymph node adjacent to the pancreatic head something to wory about?:1 visits 1 bounces 0 secs spent on page; is a lymph node on the pancreas a cause for concern?:1 visits 1 bounces 0 secs spent on page; pancrease and lymph:1 visits 1 bounces 0 secs spent on page; swolen lymph nodes pancreas:1 visits 1 bounces 0 secs spent on page; swollen glands around pancreas:1 visits 1 bounces 0 secs spent on page; swollen lymph node near pancreas:2 visits 2 bounces 0 secs spent on page; swollen lymph node near the pancreas:1 visits 1 bounces 0 secs spent on page; swollen lymph nodes near pancreas:1 visits 1 bounces 0 secs spent on page; swollen lymph nodes near pancreas and liver:1 visits 1 bounces 0 secs spent on page; symptoms of a root canal infection amd sinus problem:1 visits 1 bounces 0 secs spent on page; what do spots on pancreas mean and swollen lymph nodes:1 visits 1 bounces 0 secs spent on page; what does a lymph node on my pancreas mean?:1 visits 1 bounces 0 secs spent on page; what would cause a swollen lymph node next to my pancreas:1 visits 1 bounces 0 secs spent on page; why would i have an inflamed lymph node between my pancreas and duodenum:1 visits 1 bounces 0 secs spent on page;