Diagnostic Approach to Right-Sided Swollen Gland in Elderly Patients

Introduction to Diagnostic Considerations

• A right-sided swollen gland in an elderly patient requires urgent evaluation to exclude malignancy, particularly lymphoma, which is common in this age group and presents with lymphadenopathy as an initial finding, according to the European Society for Medical Oncology 1, 2
• The American Society of Clinical Oncology recommends a complete lymph node examination to assess all nodal basins bilaterally for generalized lymphadenopathy suggesting systemic disease 1, 3
• The National Comprehensive Cancer Network suggests a skin examination to look for primary cutaneous lesions that could represent Merkel cell carcinoma or other skin malignancies 4

Diagnostic Workup and Findings

• The European Society for Medical Oncology states that histologic confirmation is mandatory when malignancy is suspected, with excisional lymph node biopsy preferred over fine-needle aspiration for suspected lymphoma 2, 3
• The American Society of Clinical Oncology recommends the use of CT scan with contrast for neck, chest, abdomen, and pelvis if lymphoma is suspected, essential for staging 1, 2, 3
• The National Comprehensive Cancer Network suggests PET-CT reserved for confirmed lymphoma staging or when malignancy is strongly suspected 4, 3

Management and Treatment

• The International Society of Geriatric Oncology recommends fitness assessment using geriatric assessment tools to stratify patients as fit, vulnerable, or terminally ill 1, 5
• The European Society for Medical Oncology suggests that for follicular lymphoma, asymptomatic patients may undergo watch-and-wait, while symptomatic patients require treatment with rituximab-based regimens 2, 3
• The American Society of Clinical Oncology recommends treatment decisions for CLL based on Del(17p)/TP53 mutation status, with ibrutinib preferred for elderly patients with high-risk features 1, 5, 2