Lymph Node Removal - All inquiries greatly appreciated! :)

[xrachaelx]

Hello! My name is Rachael, and I am a 2nd semester student nurse at the University of Nevada, Reno. For our theory class, we have an assignment to post a question on an online forum.

Because our 1st semester was basically all assessment, while doing my reading I realized I had a unilateral (left) nontender, nonmobile (i thought), firm preauricular lymph node. I didn't want to think much of it because, as everyone probably knows, when we're reading about all of these disorders you always think, "Holy moly, I think I have that!" For every single disorder!!

Worried, I had two of my nursing professors feel it for me and both claimed it was in fact mobile. One passed it off saying "Oh, it feels like a muscle." The other teacher felt and told me it would be best to have my primary doctor check it out as soon as possible. I was really scared. It took everything in me to not go home right then and dive into all of my books to see what I had.

First, I went to my primary doctor who treated me with a 2 week course of antibiotics (can't remember off the top of my head which). He told me that if it didn't go down, he was going to refer me to an ENT. 2 weeks passed, it didn't go down, so I went to a local ENT. He claimed that he believed it was a parotid neoplasm. He did a biopsy, which later came back as lymph cells. They (ENT and primary) prescribed a different 2-week antibiotic.

Also, during this time, I had some blood work done (CBC, insulin, & hormones) which all came back within normal limits.

Initially from the get-go, all my ENT discussed was SURGERY, SURGERY, SURGERY, which is understandable. To me he seemed not as thorough as I wanted, so I went to a new ENT for a second opinion.

He was much more thorough; he actually felt all of the lymph nodes in my neck, instead of just the one of concern. The new ENT became more concerned with the lymph node directly below the preauricular one (tonsilar lymph node) as it is just a little smaller than the size of a golf bal. He stated he wanted to do an MRI. Results came in last week, and both masses appeared to be lymph tissue.

He still wants to remove the tonsillar lymph node because he claims there's less side effects and risks as opposed to removing the one near my ear. An appointment is now set for the end of April.

Some questions I was not able to find through research, or ask him yet (phone call still pending) is:

1. What is the reason for the removal of a lymph node, if it is assumed to not be cancerous?

2. Although we have many lymph nodes in the body, is there a significant effect on the immune system after having 1 lymph node removed? Immune status?

3. What are the adverse effects of lymph node removal?

4. What is the possibility of encapsulated infection (I asked ENT1 this and he stated this was a rarity and it was most likely not the cause)?

Thank you all for your time. Your input and responses will be greatly appreciated!! :)

[RNinJune2007, RN]

Hello! My name is Rachael, and I am a 2nd semester student nurse at the University of Nevada, Reno. For our theory class, we have an assignment to post a question on an online forum.

Because our 1st semester was basically all assessment, while doing my reading I realized I had a unilateral (left) nontender, nonmobile (i thought), firm preauricular lymph node. I didn't want to think much of it because, as everyone probably knows, when we're reading about all of these disorders you always think, "Holy moly, I think I have that!" For every single disorder!!

Worried, I had two of my nursing professors feel it for me and both claimed it was in fact mobile. One passed it off saying "Oh, it feels like a muscle." The other teacher felt and told me it would be best to have my primary doctor check it out as soon as possible. I was really scared. It took everything in me to not go home right then and dive into all of my books to see what I had.

First, I went to my primary doctor who treated me with a 2 week course of antibiotics (can't remember off the top of my head which). He told me that if it didn't go down, he was going to refer me to an ENT. 2 weeks passed, it didn't go down, so I went to a local ENT. He claimed that he believed it was a parotid neoplasm. He did a biopsy, which later came back as lymph cells. They (ENT and primary) prescribed a different 2-week antibiotic.

Also, during this time, I had some blood work done (CBC, insulin, & hormones) which all came back within normal limits.

Initially from the get-go, all my ENT discussed was SURGERY, SURGERY, SURGERY, which is understandable. To me he seemed not as thorough as I wanted, so I went to a new ENT for a second opinion.

He was much more thorough; he actually felt all of the lymph nodes in my neck, instead of just the one of concern. The new ENT became more concerned with the lymph node directly below the preauricular one (tonsilar lymph node) as it is just a little smaller than the size of a golf bal. He stated he wanted to do an MRI. Results came in last week, and both masses appeared to be lymph tissue.

He still wants to remove the tonsillar lymph node because he claims there's less side effects and risks as opposed to removing the one near my ear. An appointment is now set for the end of April.

Some questions I was not able to find through research, or ask him yet (phone call still pending) is:

1. What is the reason for the removal of a lymph node, if it is assumed to not be cancerous?

2. Although we have many lymph nodes in the body, is there a significant effect on the immune system after having 1 lymph node removed? Immune status?

3. What are the adverse effects of lymph node removal?

4. What is the possibility of encapsulated infection (I asked ENT1 this and he stated this was a rarity and it was most likely not the cause)?

Thank you all for your time. Your input and responses will be greatly appreciated!! :)

I highly recommend that you talk to your doctor about this, as allnurses.com does not give out medical advice...

but from what I've learned...

1) Better to be safe than sorry. Also, you have been treated with a couple rounds of antibiotics, and the swelling did not go down, so sometimes removing it is just easier.

2)There would be no major immune-system effects from removing one node.

But definitely ask him for clarification on both parts.

[Angels']

xrachaelx

Welcome to allnurses.com

Angels’

[xrachaelx]

Thank you very much for responding. I'm not looking for medical advice from allnurses.com. I'm looking to see if there are any nurses who have personally experienced this, or have worked with patients pre or post-op in this situation. I'm looking for situational/clinical examples nurses have seen and perhaps, discharge planning post-op. I should have clarified that before. Thank you again.

[Daytonite, BSN, RN]

Wow! I'm reading your post and it was almost like deja vu. I had a parotid tumor removed about 10 years ago followed by radiation therapy. Like you I was having everyone palpate "the lump" because I really wasn't sure there was a lump there. Mine was just behind my ear lobe. Unfortunately, mine did show up as a solid mass on an MRI. I looked at the surgical report to see if any lymph nodes were removed and I don't see any mentioned. Something has gone on in there, however, because I have a chronic inflammation of the tissues of the left side of my face and jaw going on all the time.

My mother had mastectomy done about two years ago with about half the lymph nodes in the right axilla removed. They were removed because the first two that were distal to the tumor were postive for malignant cells. The others were removed as a precaution that they might also have malignant cells since the malignant cells spread through the lymph system. She has been functioning fine without them. Over the years I have seen women who had total axillary lymph node removal along with their mastectomies. Their biggest side effect was edema in the affected arm as the lymphatic system also drains fluids. As an IV therapist we were always careful about putting IV's into women's arms who had had mastectomies on one side or the other. However, a number of doctors who had done teaching inservices with us over the years have been split on this. Some have said it doesn't make a difference when it comes to a matter of fighting off infection in the affected limb, so much as the compromised circulation in the limb being the bigger problem.