Should my 21-year-old son with night sweats have a biopsy?

Question

Hello doctor,

I am the mother of a 21-year-old son who has been waking up drenched in sweat for the past six weeks, soaking through his clothes and bedsheets almost every night. I am scared because each time I was researching his symptoms, Hodgkin’s lymphoma kept appearing as a potential cause.

He has a swollen lymph node in his right side neck area which has been there for a month now and hasn’t shrunk. Also, he has lost weight of almost 11 pounds without altering his diet or any exercise routine.

Is a patient of age 21 suffering from night sweats ready for a biopsy? Our GP has planned for some blood tests, but no results have been received so far.

I would like to ask plainly whether, given this combination of symptoms, it would be appropriate to proceed with a biopsy now, or whether it is reasonable to wait for further blood test results before pursuing something as invasive as a lymph node biopsy.

I would also be interested to know about excisional biopsies in comparison with fine-needle aspirations that I have come across, and that could be potentially less accurate in detecting Hodgkin’s lymphoma.

Is it necessary to ask for a PET-CT scan at this time to look for any other involved sites prior to establishing a diagnosis?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand the level of your concerns and your worries about the situation.

A combination of persistent night sweats, unexplained weight loss, and a lymph node that has remained enlarged for a month are what doctors call “B symptoms,” which can be seen in conditions like Hodgkin lymphoma but can also occur with infections or other illnesses.

In a 21-year-old, these findings do not automatically mean cancer, but they do raise enough concern that waiting too long for clarity is usually not advised. Blood tests are helpful, but they often cannot rule out lymphoma.

If the lymph node is still enlarged and the symptoms are ongoing, most clinicians would strongly consider proceeding to a biopsy rather than waiting indefinitely for additional blood tests.

An excisional biopsy is the method most commonly used in cases where lymphoma is suspected, because it entails the surgical removal of the entire lymph node or at least a significant part of it, which allows the pathologist to analyze the tissue structure in great detail, which is very important in Hodgkin lymphoma diagnosis.

A fine needle aspiration entails the removal of a few cells using a small needle, which makes the process minimally invasive, although sometimes there may not be enough data to either confirm or rule out lymphoma in the patient, which might result in delayed diagnosis.

The excisional biopsy is a minor surgical procedure, usually done under local or light general anesthesia, and while it is more invasive than a needle test, it is generally safe and provides a much clearer answer.

As for imaging, a PET-CT (positron emission tomography and computed tomography) scan is typically used after a diagnosis is confirmed to determine the extent of disease, rather than as a first step before biopsy, although in some cases doctors may order imaging earlier to guide which lymph node to sample.

Given the persistence and combination of your son’s symptoms, it would be very reasonable to discuss with your GP or request a referral to a specialist, such as a hematologist, and ask directly whether proceeding to an excisional biopsy now would be appropriate rather than waiting further.

I hope this helps you.

Kindly revert in case of further queries.

Thank you.