There is a lump above my left collarbone. Is it cancerous?

Question

Hello doctor,

I consulted two doctors regarding a lump that I could feel above my left collarbone whenever I strain or turn my neck. Both doctors said that it was just a prominent tendon, but they gave me an ultrasound to ease my mind.

The ultrasound said 'there is a 6 by 4 mm hypoechoic nodule in my left supraclavicular area, presumably representing a small lymph node. If clinically indicated, an MRI or a CT can be done for further evaluation.

On seeing the reports, one of the doctors said that I need a biopsy right away. The other doctor referred me to an ENT. I followed up with the ENT, but he was unable to feel the lymph node and said the lump is just a prominent muscle and nothing to worry about. The ENT also said that the ultrasound was normal and that a 6-by-4 mm node is normal and nothing to worry about.

I have been reading online, and it is mentioned everywhere that a hypoechoic nodule is cancerous, especially in the left collar bone area. What does a hypoechoic nodule mean? Does this mean it is a small cancerous lymph node?
What does it mean by 'if clinically indicated, a CT or MRI can be done for further evaluation'? I also had a CBC done, and that was normal. I had a neck CT done six months ago for a pulled muscle, and that was normal as well.
If it did not detect this small nodule six months back, can it have grown in just six months? Is hypoechoic bad? Why did the ultrasound say presumably a lymph node? I am so worried now. Do I need a biopsy, or is there nothing to worry about?

Kindly assist.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

There is a lymph node in the left supraclavicular region called Virchow's node. If enlarged, it may indicate a malignancy of the abdominal region, as that is the draining pathway of the lymph from that area.

A lymph node from cancer is generally very hard to palpate. A soft node is generally secondary to some inflammatory response, generally an infection.

Please ask your doctor to have a look at your abdomen and re-evaluate the node, although I am almost certain it is nothing but an inflamed node. As it is of a short duration, it is highly unlikely to be anything dangerous.

I suggest you get the following tests:

ESR (erythrocyte sedimentation rate).

CRP (C-reactive protein).

HRCT ABDOMEN (high-resolution computed tomography).

I hope this helps.

Please let me know if I can assist you further.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

A significant lymph node in the neck is one that is greater than 0.3 inches in the long axis. As your node is 6 mm in the long axis and 4 mm in the short axis, there is absolutely nothing to worry about.

Normal, reactive, lymphomatous and tuberculous lymph nodes are predominantly hypoechoic when compared to the adjacent muscles. So, echogenicity is only a hint that this is a lymph node and this is not a metastasis from papillary thyroid carcinoma.

Hypoechoic does not mean abnormal. Hope that answers your question.

Basically, this is a lymph node of a size too small to be a malignancy or a metastasis. My frank opinion is that this is neither cancerous nor a metastasis from another cancer.

I hope this helps.

Revert in case you have any doubts.

Thank you.