A couple of months ago I noticed a lump in my neck. My doctor referred me to an ENT who did some tests and felt that it was a swollen lumph gland that had probably enlarged because of an infection and would either go away on its own or maybe just not increase in size. I was supposed to have gone back for a recheck but it really never changed, so I put it off. It has been about four months now. I have always had recurrent ulcerations on the roof of my mouth and inside my cheeks. About a month ago, I had four at one time, but they disappeared in about two weeks. Now a hard lump has formed on the roof of my mouth. There are no ulcers, just a pronounced hard lump about the size of a dime. Should this be checked out and by whom? My ENT? My dentist? Oral cancer info seems to point out that lumps in the hard palate of the roof of the mouth are uncommon. So should I even be concerned? Any info would be helpful. Thanks TGF

TGF, I would get in touch with your ENT imediatly. As in today! It may be nothing serious but you do not want to take chances with this kind of thing!

Personally, 6 months went by from the first doctor I saw, he was not all that concerned. I wish badly I had not waited.

Anything which has not healed or resolved in two weeks is suspect and needs to be definitively diagnosed. You need to see a professional and not put this off any longer. In all disease, those with the earliest diagnosis have the best outcomes....

TGF,
I completely agree with Mark and Brian. If you your symptoms haven't disappeared, have it checked out right away with a biopsy, either by an ENT or oral surgeon!
Like you I had an asymptomatic lump on my palate that actually became smaller between the time my dentist noticed it and the biopsy. To everyone's surprise it turned out to be malignant, but since it was found at an early stage, I got away with surgery only. I am not suggesting that whatever is going on in your mouth/ neck is cancer, but at least get peace of mind by having it checked out with a biopsy. Hope everything will turn out well, and you won't become a member of this club.
Good luck!

Thanks to Mark, Brian, and Sigrid for your replies. The lump in my neck has not changed, just a small enlarged rubbery feeling lymph gland, I'm sure. I'm just a little concerned that it has never shrunken or completely gone away since I had never had it before. My ENT stated that it was not uncommon for people to have those swollen lymph glands and he was not impressed enough to risk surgery on my neck. He did not feel that other lymph glands were involved, so he felt it was not a major concern. I have not put it off intentionally, it's just that I don't want to be overly concerned if he is not. My biggest question is with the hard lump in the roof of my mouth. I am 45 and I actually felt the roof of my husband and daughter's mouths to make sure that it was not supposed to be there. There are no lumps in their mouths, but it is not even sore, feels more like a knot. If it doesn't go away, I'll have it checked. If you can refer me to any info that might help, please share. Thanks for your help. It is good to have someone to ask so I can better determine if I should really be concerned. TGF

Surgery is not necessary to determine what is going on with your neck. The doctor, TODAY, could do a fine needle biopsy, something that is only a little uncomfortable and will give him cellular material to have analyzed in the next 48 hours. You should ask for this, if this node has remained the same for an extended period of time. If he is unwilling to give you better answers to what is going on, he should refer you to another doctor for a second opinion, or you should seek one out yourself. As to the roof of your moth, I was going to say that this was a torus, but you mentioned that it has recently appeared. It may be a cyst, or something else, but at minimum, radiographic examination should be conducted. An oral surgeon who has a Panorex in his office can do it in just a few minutes and offer you a professional opinion. Whatever path you choose, it shouldn't be to wait and wonder.

Thanks for your reply, Brian. What is a torus? Also, is it uncommon for a lymph gland to remain swollen? The ENT conducted an ultrasound and then subsequently a CT scan on this lump. The radiologist stated that it appeared to have blood flow but was small and appeared uniform, not jagged, so he suspected it was just a swollen lymph node. The ENT agreed. I don't want to appear paranoid, I just am a little concerned that it has not gone away or seemed to have changed. You're right, I guess I should have it rechecked and should ask for a needle biopsy to be sure. I just wondered if it was common for others to have lymph nodes appear swollen and it not amount to anything. Like everyone else, my life is busy and I always want to think that it will go away. Maybe I've waited long enough. But is it possible that it will just stay that way forever with no problems? Thanks, TGF

TGF,
In the words of my Ear Nose & Throat Doc (I rember them well) "There are many things that can cause a lump". Some are not a serious problem. I know life is busy but IF it is one of the serious things, time is not a help. I do not want to scare you but be assured anyone who has been through the treatments for the serious problem will tell you to get it checked thoroughly and soon. Pain is not always an indicator for cancer at the beginning.

In my case I had a doctor who was not too concerned at first. That was 6 months before a friend (a pathologist) told me in a very terse way to get it checked out! I probably owe my life to him. I too was busy and it didn't hurt, it wasn't changing, and I felt absolutly fine, just a firm painless small lump. In addition I was "too young" and no tumor was seen. It still was a bad thing for me. According to my surgeon 50% survival bad!

If you read in this forum there are several folks here who were mis-diagnosed at first. This is not to say that yours is a serious problem (and I truly hope it is not) but YOU NEED TO KNOW FOR SURE.

If you need an excuse, print this post and bring it with you show it to your doc. Tell him/her you are there to make me happy.

Don't forget to let us know the results.

Please remember that I am not a doctor, through well informed. In my personal opinion I do not believe that a node should stay swollen for any length of time without resolution. I think if you read the past messages regarding nodes, those that were related to infections that people had, were very sore, and resolved with anitbiotics in short order. In my own case, my swollen node was painless. Your doctor should determine if you have an infection causing the swelling (blood test, etc.). But for sure, he should be determining what the cause of the swollen node is. A swollen node is a symptom, not a disease. It is the result of something else going on......

A palatine torus is a bony growth of no consequense in the palate and they are very common. They usually only cause problems for people who wear an upper denture.

Lastly, hopefully expecting something to stay wrong (and that be OK) is the incorrect mindset in my opinion.

Thanks, guys. You made your point. I will get it rechecked and will make an appointment today. I know things should not go undiagnosed. It's just that I have no other symptoms and the doctor was so unconcerned. But you're right. Only those of you who have been through this can know how serious it really can be. I will not ignore it. Thanks, again, and I'll let you know what the ENT decides.

TGF,
one last input: I just returned from a bi- monthly check-up with my surgeon, and here is what he told me about regarding the enlarged lymph node (painless) I had in my neck for about 2 weeks before it vanished. I did not have a cold, and never had a visibly enlarged one before

Thanks, Sigrid. I have an appointment lined up for Tuesday, April 22nd with my ENT for the recheck on the node in my neck. I told his nurse Friday that I had also noticed a small hard lump in the roof of my mouth and did not know if it was anything to be concerned about. She said she would make a note of it in my file and then she scheduled me to come in Tuesday, 4/22. Hopefully, I will get some answers on that date. I'll keep you all posted, and once again, thanks for the advice and concern. TGF

Just a quick update. I saw my ENT yesterday afternoon who related that the hard lump in the roof of my mouth appeared to be as Brian said, "a torus", which is common. He rechecked the lymph node in my neck/cervical area and related that he really thought it would have gone away on its own by now. He stated that we could continue to watch it or he could remove it. I asked about the fine needle aspiration, but he stated that he felt sure from the ultrasound and CT scan that it was a lymph node and stated that he expected the fine needle aspiration to reveal lymphocites(?)which would cause the pathologist, in turn, to ask for a tissue biopsy. So, he suggested doing one procedure instead to remove the entire node. He said it would involve about a 2" incision in my neck under general anesthesia but would be faily simple. I am scheduled for my pre-op visit on Monday and surgery on Friday of next week. It just seems radical for such a small lump. The doc stated that my options were either to continue to check it about every two months or get rid of it and make sure everything is alright. He said he was 90% sure it would be benign, but it was best to be safe. I am anxious to find out just what the surgery will entail. I hope I've made the right choice. Thanks for your e-mails. TGF

A fine needle biopsy IS a biopsy, and yes since it is of a lymph node (which is obvious) it will contain lymph tissues(cells, ie. LYMPHOCYTES, and fluid). The question for the pathologist who reads the cells from the needle aspiration is...are any of them malignant or do they have abnormal nuclei. You are undergoing a general anesthesia procedure for something that can be determined from a simple needle aspiration. For sure you should not wait and see...that just isn't a good idea, but excising the node under a general may not be necessary either. IF they find some malignant cells (hopefully not)...then the question for the doctor is where is the primary? Excising the node isn't going to give him any more information than the FNB if they find abnormal cells.

Brian,
Our Fine Needle Biopsy experience was a little different. They originally thought my husband's neck mass was a brachiocyst, but did a CT Scan and Fine Needle to confirm. The fine needle biopsy came back as negative for malignancy and the CT scan looked benign, too. The doctor told him not to worry but that he should probably have the mass removed at some point. It wasn't until I got on the internet and started reading some information that we decided to get things moving more quickly. They got him in and removed the mass and it was the frozen section that showed cancer cells (at which point they also confirmed that it wasn't a brachicyst, but a lymph node).

Anita

Is there an exception to every test...yes. For sure a fine needle biopsy is highly dependent on the operator collecting enough material to include malignant cells. This may involve several punctures within the node, and even then, as in your case, it may not hit a hot spot. My point is simply that patients should try the least invasive procedure which will give them the quickest results (in 24 hours in this case). If that node is a malignant metastasis, and the FNB finds it, you have eliminated a general anesthesia procedure, and know this week if something is there. Ceretainly taking out the whole node will guarantee that you won't miss those malignant cells. FNB's are not infallable, but then neither is an mri, pet scan, CT etc. Everyone of these is dependent on someone reading it correctly, the contrast medium lighting it up, etc. etc. FNB's have provven themsleves to be a valuable tool for many years. They take 5 min, they are inexpensive, and if done correctly, (collecting enough material) they can be highly accurate. 100%? No. I am always wary of anyone who wants to cut first.......unless they have significant suspicions from other symptoms that are fingers pointing at a potential diagnosis.

Also to Sigrid (since you are probably following this thread): I have tried to respond to your private message or send you an email in relationship to your question. You have the prevent private message and email buttons selected in your profile and I can not write to you.

Hi TGF, I'm glad you are getting this thing resolved.

For what it is worth my ENT wanted to set up a surgical removal of my lump regardless of how the needle biopsy came out. The only difference was how fast it would be scheduled. (it was about 1 cm in size)

The best way to be really sure what it is would be the complete removal and then the pathologist can look at everything.

I guess my ENT felt that the full removal would give him the best results. He stated that sometimes he uses a local anesthesia and sometimes he uses general anesthesia depending on his evaluation. He stated that he would probably use a general anesthesia since he's not sure how much it may have changed in the past five months. I can't tell that it has changed much, maybe just a little more elongated. When I go for my pre-op appt on Monday afternoon, he stated they would go over everything with me and let me know his final evaluation and recommendation. He stated that they would do a lot of blood tests also at that time, and my surgery is scheduled for Friday at the hospital ambulatory surgical section. What is generally involved in an excision of a small lymph node? A 2" incision doesn't sound too radical, but then I don't know what others have had. I'm mostly concerned about muscle tissue and nerves in that area, and I plan to speak to him at length on Monday about this. Any suggestions? Thanks, TGF

TGF, The type of incision that he is talking about should not create many problems with nerves nor any other major structures.

To put it into perspective the "radical neck dissection" you see mentioned here in various posts creates an incision from behind the ear to the tip of the chin and then from about the middle of that to the collar bone. The long term dificulties with radical neck are related to a nerve that parallels a string of lymph nodes and is sometimes removed causing the Trapezius muscle to stop functioning, (this can result in shoulder problems) and a muscle called the Sternocleidomastoid (who comes up with these names!) which is also removed to gain access to the deeper regions of the neck. The surgery usually gets you 3 to 6 days of hospital stay.

The incision to remove one node or lump is NOT what I described above. In other words, if that is all you need done it will likely be a walk in the park for you. No effects on eating, swallowing, taste, etc. and a quick recovery (Walk out same day).

I will Pray that you come home with a smile.

Thanks, Mark. The procedure you described to remove the one small node sounds like the type procedure the ENT plans to do. He stated that I would have it done in the morning and go home that afternoon. He stated that a follow-up appt would be made for the following Thursday to take out the stitches and go over the results of the pathology report. I'll keep you updated, and, again, I want to thank all of you for your input. I'm sure everything will come out good. The ENT said he was 90% sure it would be benign, so that's what I'm banking on. My faith is strong. This site has been more helpful to me than any of the research I have done myself. Thanks, again. TGF

Hey everyone. I had my surgery on Friday, and it seemed to go well. The surgeon told my husband that he removed a cluster of lymph nodes (2-3)instead of the one, and that granules (?) were present in them. He didn't say a whole lot except that the surgery went well, and he would give us a full pathology report on Thursday when he removes the stitches. He said he thought everything would be okay, but the pathology report would give us a definite answer. What does it mean when granules are present? Is that usually an indicator of something good? My husband didn't ask a whole lot of questions as he was a little surprised that the doctor removed more than one node. He said he just didn't think at the time to ask a whole lot. I'm still banking on everything turning out well, and the doctor seems to be positive also. But, I'm just asking for information only. I know that each case is different, but I just wanted to know if granules were normal. Also, I am numb from my ear lobe to my shoulder on the side the surgery was done. I was told by friends that it was normal for that to happen and that the feeling would eventually return. Hope someone can share some info with me. Thanks, TGF

Glad to hear from you TGF,

I do not know what he means by "granules" since that term was not used for me in my treatment maybe that is a good thing? (darn doctors for not explaining)

As to the numbness that should go away over time but nerves grow back at a pretty slow rate so it may take a while.

Take care and let us know when the pathology report comes back.

Good news! The results were benign. The doctor stated that they turned out not to be lymph nodes but were benign B-B like tumors (numerous ones) that had engulfed one of the major nerves in my neck. He stated that he did not tell my husband a lot after surgery because he was not sure what he had removed. He said he had never seen anything similar - that they appeared to be dried up lymph nodes but were wrapped like a fist around one of the major nerves on the right side of my neck. He said that we had a double blessing because if the tumors had not been removed, they would have continued to multiply and would have caused permanent damage to that nerve. He also said that he had to cut the muscle to remove a couple of more tumors located under the fatty tissue under the muscle. He is sending the results to my immunologist in Chapel Hill as they think it is related to my Behcet's disease. He said the numbness covers a large area because they had to manipulate the nerve so much, but assured me that the feeling would eventually return in several months to a year. I am so pleased and want to let you all know how much I appreciate your input and advice. If it had not been for you all encouraging me to have it biopsied or removed, it could have caused irreparable damage to the nerve and paralysis to some extent. Brian was right. Anything that shows itself that has not been there should definitely not be dismissed. Thanks for all your help and I will keep you all in my thoughts and prayers daily. TGF

Hey guys-if you go to the active topics for today, I went to the docs and got a few answers. It is under "My diagnosis....not!" I am just looking for a few opinions, besides telling me that I am getting the run around, I feel like I am finally heading in the right direction, even though it is towards the big "C", but in the right direction none the less. Thanks guys
Desiree'

TGF, That Is GREAT news! It makes my day!

I'm sure you can relate to what meaning a "new day" has. You got pretty close to the fire emotionally, very fortunately you did not get burned. I am happy for you and your family.
I hope your recovery is going well.
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