CONTACTS 

SUBJECTS
Cancer Neck Lumps Lymph Nodes Swelled
Boipsy Lymph Nodes Swelled Lumps Neck

0504 -
0504 -    ..
0505 - Summary/Objective
0506 -
050601 - Follow up ref SDS 2 0000, ref SDS 1 0000.
050602 -
050603 - Clinical examination revealed 2 or 3 more swelled lymph nodes in
050604 - addition to the one previously noticed by the patient.  It was good to
050605 - hear that breast cancer rarely has follow on impacts in the neck area.
050606 - ref SDS 0 Y158  None-the-less Doctor Laio indicated that good practice
050607 - is to remove lymph nodes that swell and do not respond to treatment,
050608 - as seems to be the case here. ref SDS 0 VF77  A biopsy was taken by
050609 - Doctor Laio during the examination. ref SDS 0 Y171  The doctor will
050610 - call Millie next week to report results of the pathology report, and
050611 - if urgency is indicated, then Doctor Laio will refer the matter to a
050612 - colleage for immediate surgery within two (2) weeks.  If the report
050613 - does not show any specific problems, then the surgery will be
050614 - scheduled in about 6 weeks, after Doctor Laio returns from family
050615 - leave. ref SDS 0 VG59
050616 -
050617 -           [On 040309 pathology report on biopsy shows cancer cells.
050618 -           ref SDS 3 HD5N
050619 -
050620 -
050621 -
050623 -  ..
0507 -
0508 -
0509 - Progress
0510 -
051001 - Lymph Nodes Multiple Swellings Biopsy Taken Surgery Scheduled
051002 - Cancer Not Evident from Tissue Biopsy Procedure Need Pathology Report
051003 -
051004 - Doctor Laio performed the examination ordered by the primary care
051005 - physician in Oncology on 040227 when a stiff neck and swelled lymph
051006 - node did not respond to treatment. ref SDS 2 886G
051008 -  ..
051009 - Doctor Laio found 3 or 4 lumps.  This is different from examinations
051010 - by Millie and the primary care physician, who previously found only
051011 - one (1) lump, reported on 040211. ref SDS 1 WP7L  Doctor Laio
051012 - indicated these lumps are all swelled lymph nodes in the
051013 - supraclavicular region of the neck.
051015 -  ..
051016 - Examined mouth and found no indications of problems.
051018 -  ..
051019 - Millie reports no pain other than occassional stiffness associated
051020 - with swelled lymph nodes in the neck.
051022 -  ..
051023 - Doctor Laio used an instrument that fed a tube down the right nostral
051024 - of the nose.  It was uncomfortable, but Millie did this without
051025 - complaining.  This seems to be a method of sending a camera or manual
051026 - viewing scope into the breathing system.
051028 -  ..
051029 - Doctor Laio gave a good explanation that lumps in the neck are from
051030 - the structures in the neck.  There are several hundred lymph nodes
051031 - where white blood cells do somthing.  Lymph nodes can swell from a lot
051032 - of very common issues that are unrelated to disease.  Swelling
051033 - typically lasts for a few days, then recedes, similar to getting a
051034 - bruise on the arm or leg.
051036 -  ..
051037 - Doctors are taught to remove all lymph nodes.  Doctor Laio has found
051038 - in his practice that this common solution is not practical because
051039 - there are hundreds of lymph nodes in the neck.  Doctor Laio instead
051040 - focuses on lymph nodes where swelling is persistant and does not
051041 - respond to treatment, as occurred in this case, based on treatment
051042 - prescribed by the primary care physician on 040211. ref SDS 1 S159
051044 -  ..
051045 - Most common problem is lymphoma.  Cancer of white blood cells.
051047 -  ..
051048 - The biopsy is performed to look for material that does not belong in
051049 - the lymph nodes.
051051 -  ..
051052 - Doctor Laio indicated that it is rare for breast cancer to spread into
051053 - the neck area; and, that more often problems in the neck originate in
051054 - the lungs.
051055 -
051056 -     [On 040429 breast cancer diagnosed in skin will require masectomy
051057 -     after 4 - 6 months chemotherapy to reduce redness of skin; tumor
051058 -     board review pending. ref SDS 4 4K5J
051059 -
051060 -
051061 -
051063 -  ..
051064 - Biopsy Tissue Sample Taken from Swelled Lymph Node Left Side Neck
051065 -
051066 - Performed in the examination room a biopsy procedure called...
051067 -
051068 -           [On 040309 pathology report on biopsy shows cancer cells.
051069 -           ref SDS 3 0001
051071 -       ..
051072 -      Fine needle asperations cytology.
051073 -
051074 -      Doctor Liao performed the procedure.
051075 -
051076 -      He did this twice on the same node, so there are two (2)
051077 -      samples.
051079 -       ..
051080 -      The doctor did not notice anything that looked troubling, and
051081 -      advised that results from the lab will be more definitive.
051083 -       ..
051084 -      The second biopsy was more painful, evidently hit a nerve.
051086 -       ..
051087 -      Lymph nodes will swell up even more for a few days, due to biopsy
051088 -      today....
051089 -
051090 -           After drawing the tissue samples, Millie had to hold
051091 -           pressure on her neck for about 5 minutes to stem bleeding.
051092 -
051093 -
051095 -  ..
051096 - Doctor Laio indicated that swelled lymph nodes identified today need
051097 - to come out even if the pathology report on the biopsies does not find
051098 - cancer.  He seemed to suggest surgical removal of suspect lymph nodes
051099 - is good practice to avoid risk of future problems because biopsies may
051100 - miss cancer cells causing swelling, which can later grow and spread
051101 - disease.
051102 -
051103 -           [On 040309 pathology report on biopsy shows cancer cells.
051104 -           ref SDS 3 HD5N
051106 -         ..
051107 -        Would like follow up to flesh out the rationale for this
051108 -        conclusion.
051109 -
051110 -           [On 040309 treatment plan changed from surgery to remove
051111 -           swelled lymph nodes, even if not cancerous, to not removing
051112 -           any lymph nodes, even those found to be cancerous.
051113 -           ref SDS 3 HD5N
051115 -            ..
051116 -           [On 050826 referral surgeon in Kaiser's Oakland office
051117 -           recommends removing additional lymph nodes in left
051118 -           auxillary, which at the present time are not identified as
051119 -           cancerous; no discussion of Doctor Laio's recommendation to
051120 -           remove swelled lymph nodes in supraclavicular region.
051121 -           ref SDS 5 IZ8L
051123 -  ..
051124 - Doctor Liao wants surgery in 2 weeks.  His wife is scheduled to
051125 - deliver a baby about that that time, so he would be unavailable to
051126 - perform the work, since Doctor Laio plans to take 3 - 4 weeks off to
051127 - support operations at home while the family adjusts to a new member.
051129 -  ..
051130 - Doctor Liao offered to refer Millie to another doctor for doing the
051131 - surgery.
051133 -  ..
051134 - Millie decided to wait for results of the biopsy in a week to 10 days.
051135 -
051136 -
051138 -  ..
051139 - Pathology Report in 2 Weeks Determine If Surgery Needed Immediately
051140 -
051141 - Doctor Laio will review the pathology report, and there will also be a
051142 - CT scan test available for review, which was ordered by the primary
051143 - care physician in Oncology on 040227, ref SDS 2 LK5L, and which will
051144 - be performed on 040307.
051146 -  ..
051147 - Doctor Laio will analyse the available data and then call Millie to
051148 - offer an opinon about the need for surgery and whether it should be
051149 - done as soon as possible, in which case, he will refer the project to
051150 - a colleague.  If Doctor Liao determines there is no urgency to perform
051151 - the work, then it will be scheduled to occur in about 6 weeks for him
051152 - to do after returning from family leave.
051153 -
051154 -        Millie may need to touch base with the primary care physician
051155 -        to expedite making the CT test results available to Doctor
051156 -        Laio, since he gave an indication in the meeting today that
051157 -        since another doctor ordered the CT tests, he may be unable to
051158 -        get the results in time for his review next week.
051159 -
051160 -           [On 040309 pathology report on biopsy shows cancer cells.
051161 -           ref SDS 3 HD5N
051162 -
051163 -
051164 -
051165 -
051166 -
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051168 -
051169 -
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0512 -