The top reason to have a biopsy (whether an FNA or a core needle biopsy) is to rule out the worse possibility: cancer.
What types of cancers are found in lymph nodes?
- lymphoma ( kind of like a solid form of leukemia)
- metastatic carcinoma (cancers that have spread from one part of the body to the lymph node
– Lymphoma is a malignancy of the cells that live in the lymph nodes: Immune cells such as B cells, T cells, plasma cells, and other blood/immune cells (histiocytes, neutrophils, mast cells etc.)
– Lymphoma can be found in one lymph node or many lymph nodes (lymph nodes are connected to each other in chains) as well as lymphoma can afflict only part of one lymph node (before occupying the entire lymph node or having spread). Therefore, the classic implications of staging are kinda different than usual cancers. That is, stage 4 cancer means it has spread across the diaphragm, far away from the original site, to other organs and possibly into the bones; whereas lymphoma can spread to all lymph nodes which is part of what it does, and that has different outcomes than a stage 4 carcinoma.
2. Metastatic cancer
– Metastasis into an adjacent lymph node can happen with any malignancy. Metastasis is invasion of the lymph node by a foreign entity: cancer. Certain types of cancers spread either through the lymphatic system to lymph nodes, or through the bloodstream to other body parts, organs or bones.
-The type of cancer that goes to the lymph node is usually connected to the region that has been previously affected by cancer (i.e. a left breast cancer may spread to the regional lymph node of the nearest left axilla (left under arm pit). Sometimes a lymph node has cancer, but the original site of the original tumor cannot be found. This happens quite often with head and neck squamous cell carcinoma (the type Michael Douglas had). A neck lymph node appears enlarged, has cancer in it, but the original tumor cannot be found. That is, when the ENT looks down the throat or up the nose, no tumor is found.
You can usually assume that it is from the oropharynx from the “look” of the metastatic cancer as well as from ancillary testing, such as immunohistochemical staining and molecular testing.