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Forum Name: Lymphoma

Question: Hard, immovable lump right above hairline


 sj - Sat Mar 24, 2007 2:12 pm

Hello doctor,

i realize that posts with similar questions are on this forum, but i cannot seem to find a satisfactory answer pertinent to my particular problem. this is the reason i am posting again. i apologize for causing you inconvenience if this sort of question has been asked too many times.

i am a 20 year old male, in good condition. i am not taking any medications, have not had any surgeries before, and do not have any illnesses or conditions. i recently discovered a hard, immovable lump on the back of my neck. it is just about an inch or so to the right of the very middle of the back of the neck and is perhaps 0.5 to 1 inch above my hairline.

the size is small, and it feels somewhat smaller than a pea. to give you a better idea, if i am sitting with my neck up, and if i pass my hand over the region, i feel nothing. even if i move my neck in all directions, and just pass my fingers over the region, nothing can be felt. but if i tilt my neck to the bottom and press hard, it can be felt. if i tilt to the bottom and to the left, it can definitely be felt even more.

it's not causing any kind of discomfort so far. but if it is pressed hard on and off for a 10-15 seconds, there is a level of pain sensation, though nothing excruciating. it does, however, seem to be embedded deep within.

i discovered this by accident, and thought it was a pimple at first. i haven't had an all-out flu in the last 2-3 months, however, i did get 5 vaccinations recently since i will be leaving the country soon. i consulted with a family member who is a physician, but he said that it was nothing and that it's fairly common. he explained that it's a chronic hardening of the lymph node and nothing to worry about. but i need a second opinion.

i have been reading that if a lump is hard and immovable, it's commonly malignant cancer (there is no cancer in my family yet). perhaps you can understand why i'm extremely worried and anxious.

please let me know as soon as possible as i'm feeling very scared.

thank you so much.

god bless.
 Dr. Chan Lowe - Sat Mar 24, 2007 2:30 pm

User avatar While it is true that cancerous nodes tend to be hard and immobile as well as painless, there are other reasons for lymph nodes to be hard.

I suspect your family member is correct. The description you are giving is very consistent with a reactive lymph node that may have had some scarring. It may also simply be a lymph node that did not shrink back down to unfeelable size after it was enlarged during infection. This is quite common and termed shotty lymph nodes.

If the node is not getting larger there is really little to worry about. If you notice that the node does seem to be getting larger it is a good idea to have it checked out.

Also, the area you describe would be a little unusual for a cancer to first present (though not impossible).

Best wishes.

By the way, we never mind having people post similar questions. Our goal is to provide helpful information to any who need it.
 sj - Sat Mar 24, 2007 2:52 pm

dear dr. lowe,

thank you so much for the quick response. it is greatly appreciated.

i have a few more follow up questions that i hope you don't mind addressing.

1) what kinds of infections can cause such a hard, immovable cyst like this? i am reading a lot about enlarged lumps but everyone mentions that if that is due to an infection, they tend to be rubbery and even movable.

i did have the flu perhaps twice during november and december, and i had a very minor attack of flu perhaps a month ago, but it was far from serious. again, however, i did get 5 vaccinations just last week (typhoid, yellow fever, hep A, polio booster, meningitis), and i'm wondering if there could be any link.

2) how likely is it for hard, immovable lumps that are stuck to a surface NOT to be cancers? i understand that you mentioned location and continuous growth of the lump. however, i just discovered this. how long i should wait to see if it does grow or expand?

3) are there any other indications, apart from increasing size, that i should be looking out for in case this may be a malignant cancer or lymphoma? you mentioned that cancer wouldn't appear at the neck for the first time, but perhaps this is a sign of another cancer that has gone undetected?

4) can you please further explain the scarring phenomenon you mentioned?

i understand i must sound like a crazy hypochondriac asking you all these questions, but your time and empathy are greatly appreciated.

god bless.
 det - Sun Mar 25, 2007 10:54 am

i'm having an extremely similar issue as well.

i'm a 22 yo male in good health, no past or current health problems. i found a lump in the back of my neck on the left side that's small, close to the hairline. it's hard, and seems attached to underlying tissue. you have to press a bit hard to detect it, and it's more easily detected if i turn my neck down. there's no pain but if it's touched or pressed a few times, there is a mild sensation of pain.

i'm very interested in the above poster's questions too, esp that if this is hard and doesn't move, what exactly rules out malignancy, leukemia, lymphoma, or something like that?

the prospect of something serious, esp cancer, is weighing down on me pretty hard and i'm really nervous. please do respond. thank you.
 Dr. Chan Lowe - Sun Mar 25, 2007 5:17 pm

User avatar I'll try to respond to both posts with these answers. If I really don't answer your questions please feel free to post a follow up.

Scarring of lymph nodes can occur when the lymph node itself gets infected. Typically with infections the lymph nodes swell not because they themselves are infected, but because they are processing the infection information and presenting it to the immune system. In essence, the lymph node is the command center giving the order to the immune cell soldier to go out and find the infection that looks like this.

When the lymph node itself becomes infected, inflammation sets in. This results in parts of the lymph node being damaged. Then scar tissue sets in to help heal the lymph node.

Typically, as a cancer invades a lymph node and begins to expand there the cancer cells clump together into a solid ball. As the mass grows, the lymph node expands. This gives the characteristic hard feeling rather than the rubbery feeling of normal reactive lymph nodes. Often along with expanding in the lymph node, the cancer invades into the surrounding tissue. This causes the lymph node to become fixed to the surrounding tissue rather than be movable as a typical lymph node is.

It can be quite difficult to distinguish between a scarred lymph node and a malignant (cancerous) lymph node. In these cases, generally time will tell. Cancerous nodes tend to get bigger while a scarred lymph node does not. If there are other symptoms suggestive of a possible cancer, generally physicians will choose to biopsy the node rather than wait. Biopsies will also be done if the node seems a little more suspicious than a typical scarred lymph node.

The best thing to do any time you are concerned about a lymph node that seems to be changing or one that meets the descriptions of a cancerous lymph node is to have it checked out.

I hope this helps.

Best wishes.
 sj - Sun Mar 25, 2007 5:45 pm

thank you for your response, doctor.

i understand that it can be difficult to distinguish between a cancerous node and one that's scarred. i am confused, however, since your first resposne seemed to dismiss the possibilty of cancer and favored the likelihood of scarring.

does that still stand correct?

is size the only factor i should be looking for? i can try to get an appointment, but i have to leave the country on a project in 10 days and appointments take longer to get. what would your recommendation be, give the symptoms i have described?

thank you so much.
 Dr. Chan Lowe - Sun Mar 25, 2007 6:06 pm

User avatar You are correct. I do still believe that it is unlikely for the lymph node to be cancerous. This is based on several factors. While the characteristics that I’ve mentioned previously are accurate there also considerations regarding location, age, and how long the node has been present.

Both of you are young. In general your odds of cancer are low. In addition, the areas that you are describing are not the typical areas for cancers to spread. The common areas for cancers to spread are above the clavicles, to the neck, and to the arm pit. Depending on the cancer type it may spread to other locations; however, these are the most easily felt areas.

SJ, if you are returning to the country soon it is unlikely that you need to be evaluated prior to your trip.

I hope this helps some. Sorry for the confusion previously. If you have any other questions or I have not answered your original question, please feel free to post again. Best wishes.
 sj - Sun Mar 25, 2007 6:07 pm

dr. lowe,

i apologize for another post. but if it is scarring (or something else that's non cancerous), is it harmful in any way? is there anything i can do in that case?

thank you.
 sj - Sun Mar 25, 2007 6:14 pm

dr. lowe,

thank you so much for your quick response. i hate to bother you again, but a few more followups.

i will be away for two months. is that considered too long in these cases?

you mentioned that "areas that you are describing are not the typical areas for cancers to spread." are we looking at a cancer of the lymph node or cancer of some other part that has spread somehow to the node? i am sorry if you have already explained this, but i would appreciate the clarification. do you feel i may have cancer elsewhere that i don't know of and it's gotten lodged in this neck node? or if there is any kind of cancer, it is cancer of the node itself?

in case this is cancer of some sort, how will i be able to detect it? should size of this hard node be my only consideration?

thank you again.

god bless you.
 det - Mon Mar 26, 2007 10:50 am

thank you so much for your response.

your assurance that this could be something else is assuring. again, some of the other poster's questions seem pertinent to me as well. i can't tell if the lump's getting bigger, but it isn't getting smaller.

what kind of size increase should be seen as significant?

how long should i monitor to see if it increases?
 det - Mon Mar 26, 2007 11:23 am

regarding lymphoma, i am reading, in fact on this website, that it can occur in people 15-35 years of age. and that cervical lymphadenopathies are an indicator.

is there something i am missing here?

thank you very much.
 Dr. Chan Lowe - Sat Mar 31, 2007 11:14 pm

User avatar Det, you are correct in your assessment of lymphoma characteristics. Keep in mind, though, that for people in this age group in general cancer risk is low. The other causes of swollen lymph nodes are much more common.

Unfortunately statistics are only helpful if you happen to not be the one in the 1 in 10 chance. If there is any concern it is always safest to be evaluated by your doctor.

Best wishes.
 lil_angel - Wed May 20, 2009 5:02 am

im 18 years of age an have a lump under were the hair line ends on my neck its slightly on the side of my neck it hurts when touched might be a bone out of place but can it possibly be anything else? iv been getting sharp stabbing pains in my head and if i do any sudden movement with my head it feels like my brain is hitting against my scalp its very painful.

i need some answers please im really scared

thanks
 CassWys - Sat Sep 05, 2009 6:02 pm

Hi, I have the same thing and I've had it for probably about 5 years or so now(at least that's when I first noticed it). It is a small hard bump at the back of my neck under the skin, not noticable just by looking and I can't feel it if my neck is perfectly straight. It is right around the hairline, right under where the head would be considered to start right about the middle of the back of the neck, but slightly to the right. I think it still moves a little bit but not too much and it is definitely hard. But mine DOES cause me quite a bit of discomfort and some shooting pains and twinges in my neck and into my head. Do you think this is the same thing, Doctor,(scarred lymph node)? It has never gotten any bigger I don't think since I first discovered it like 5 years ago. I had mono when I was a kid(was hospitalized for three days because they didn't know what it was at first) and I have had issues with my glands swelling up(they are actually swelling up off and on right now too and have been for the past week or two and causing some discomfort under chin, around groin, shoulders, ears and even under my arms a little) and I have caught A LOT of colds while growing up. Is this maybe the same thing as the others or is mine probably something else considering it has always caused me some discomfort and pain and I've had the bump for a long time? A couple things to note: I have always been prone to headaches and used to wear glasses for reading, writing, etc. and stopped wearing them years ago, now I notice a lot of eye strain(dunno if that would have anything to do with it though). Over the last few years I have been stressing over many things, and also I have never had the greatest posture when sitting at a computer desk or anywhere really. Would any of this pertain to the discomfort and pain coming from the area around that bump? A response would be greatly appreciated. Thank you!!
 mckinnon07 - Thu Dec 17, 2009 10:01 pm

Hello im an 18 year old female , im very athletic , and i have notice this hard lump on my neck on underneath my hair line , i was wondering do you think this may be some form of cancer?

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