9 replies to this topic

[SandyG353]

My daughter has CML and has been in remission for 7 and a half years.  She had chest pains, and the cardiologist sent her for a chest xray.  It appears that there is an enlarged area between the lungs.  The internist interprets the report as lymph nodes.   A CAT Scan will be ordered.  Has anyone experienced this?

Does anyone know whether CML patients can develop Lymphoma?  Is there a simple explanation of pleurisy?  Does anyone have any feedback for me?

Sandy

[Trey]

If the "enlarged area" is a solid mass, then the CAT scan will tell more about the story.  If it is something else, it could be fluid build-up. 

 

Here are the lymph nodes between the lungs.  It would need to be a very large node to cause pain there.

http://www.nhlcyberf...images/lung.jpg

[SandyG353]

Thank you so much , Trey, for your input.  I greatly appreciate it.

[SandyG353]

Sandy Greene

This message is for Trey.  My daughter had her Cat Scan and it shows an enlarged lymph node on the lung.  Have you heard of others with this problem?   Do you think that it is anything to be scared about? 

[Trey]

Whether it is "something to be scared about" is not the question, since there is not enough information at this point.  But it does need to be investigated.  I assume there was no infection/viral illness prior to this developing.  Enlarged lymph nodes can be benign (including from recent illness), show sarcoidosis (discussed below), show lymphoma, or show some form of localized cancer that has drained to that node from a tumor. 

 

Sarcoidosis is a non-cancerous enlargement of lymph nodes due to unknown reasons, sometimes an autoimmune response or rarely a response to prescription drugs.  TKI drugs, especially Sprycel may rarely cause such issues, and I have seen others mention nodules near the lungs but there was not much other information given.  This article describes the issue in general terms, not specific to CML drugs:

http://emedicine.med...343451-overview

 

Here is some info about enlarged lymph nodes and Gleevec:

http://www.ncbi.nlm....pubmed/23569448

 

For mediastinal lymph nodes of the chest, if it is malignant (no way to know without biopsy) the prime suspects would be lymphoma or lung cancer, although they are not the only possibilities. 

 

Here are some questions to ask the doc:

 

1) Which lymph node is involved and what tissue does it drain?

2) Is the node large enough to cause concern?

3) Should a biopsy be done?  What type (needle or excision)?

4) Should other areas be scanned for enlarged nodes?

5) Could this be caused by Gleevec? (Probably won't know, but bring up the issue)

6) What is the plan for discovering the underlying issue?

 

https://www.verywell...h-nodes-2252159

 

I would not automatically assume it is caused by TKI drugs, since that would not be the proper way to proceed in case it has some other cause which needs to be discovered.  But attempts to discover the cause of lymph node enlargement can be difficult.

Edited by Trey, 25 August 2016 - 04:34 PM.

[SandyG353]

Hi Trey.

Thank you for your feedback.  My daughter is on Gleevec, and I don't know whether it could be the cause of the problem.   A cardiologist sent her for an x ray and based on that she was sent for a Cat Scan.  Her oncologist is on vacation, but is aware of the situation.  His office called her and told her to see a pulmonary doctor.  Do you think that she should see a pulmonary oncologist or a regular pulmonary doctor?   I found a regular pulmonary doctor who made the top docs in New Jersey Magazine for 10 years.  However, he is booked until October.  Should I recommend that she schedule an appointment with the first doctor who is available and schedule a second opinion with the top doc?

[Trey]

I have very little information to go on, but I do not know what a Pulmonologist can do if it is a lymph node and not attached to the lungs except to rule out lung cancer and other lung disease (which is probably why the Onc said to see a Pulmonologist).  I would just use any available Pulmonologist since it should not be hard to tell if it is lung cancer or a lung disease. 

 

Here is some info about enlarged lymph nodes and Gleevec:

http://www.ncbi.nlm....pubmed/23569448

[SandyG353]

Trey, thank you for your help and information. The oncologist is back from vacation and looked at the CAT Scan. It appears that there are 3 lymph nodes that are together, but only one is enlarged. It is
slightly enlarged. He called my daughter and told her that she does not have lung cancer and told her not
to worry. He gave her the name of a pulmonary doctor, and I found one that is listed in New Jersey's top docs for 10 years. She made an appt. with the one that I found and will be seen Sept. 28. The doctor
that the oncologist recommended will see her on Oct. 13. The oncologist didn't feel that this was an
emergency that needed to be addressed immediately. However, she asked if the enlarged lymph node is what
was causing the pain that she felt when she went to the cardiologist, and the answer is no. She has chest pains that come and go and hopefully the pulmonary doctor will have answers for her. So, we will not have answers until she sees the doctors. The internist called my daughter and gave her the name of the chief
Pulmonary Doctor at a hospital in New Jersey. She probably will see him for a third opinion. For all we
know the chest pain can be due to acid reflux which she has been experiencing all year, and the enlarged
nodule appeared when checking the chest for pain. She has ben on medication for acid reflux all year. My
guess is it is a side effect from Gleevec. She does seem to have odd situations for which she has needed biopsies. One was a cyst in the pancreas which was filled with blood. Hopefully, things will improve for her.
Sandy

[Trey]

That enlarged lymph node could possibly have been like that for many years so may not be the source of pain.  Doesn't sound like it is since it is not that large.  It could be calcified and no longer functioning (sort of like lymph node scar tissue formed during some infection long ago), but don't ignore that it could be more recent if there are no previous xrays for comparison.  But one enlarged lymph node would not cause concern about lymphoma, and probably not other cancers.  The issue may possibly be related to a small amount of pleural effusion which may not show up on the scans.  It is a good idea to pursue the issue.  But a drug break could show it is related to the Gleevec if the pain ceases.

 

http://www.newhealth...ymph-Nodes.html

[SandyG353]

Thank you Trey for the information,  It will be interesting to see what the pulmonary doctor says about the lymph nodes.  The oncologist stated that the pain my daughter is experiencing is not from the lymph node.   When reading the information that you sent, I thought of how terrible my daughter's immune system was as a child.  She had mono twice.  The treating doctor told me that whenever she runs herself down or doesn't get enough rest , her glands will swell.  Perhaps, that is part of the problem.  She even had chicken pox twice and had allergies as a child.  One of her friends told her that since she lifts weights at the gym, that she may have sprained something in her chest.  She, also, has a hiatis hernia.  Unfortunately, she has had a lot of health issues.  Another one is superventricular tachycardia.

However, the cardiologist ruled out the pain as not  being related to the heart and ordered the x-ray.  The situation is that the one enlarged node was not enlarged in a prior CAT scan.  Therefore, the past history of illnesses may have nothing to do wilcih it or have created the buildup of calcium. ;. I did e-mail Dr. Druker and asked him if Gleevec can cause an enlarged lymph node, and his answer was that it could not.