1) Prednisone and lymph nodes 2) ultrasounds

My podiatrist prescribed prednisone for a inflamation in my foot. After a few days there was a noticeable decrease in the size of my lymph nodes. Does anyone understand the mechanics of this?

And while trying to look up info on that I found some postings about ultrasound being bad for people with CLL. Since I am scheduled to have an ultrasound along with my mammogram, I kinda want to know about this.


16 Replies

  • Hi Virginia,

    Could you please provide references to the postings about ultrasound scans being bad for CLL?  Did you find them on this site?  I'm very dubious about the accuracy of any statements about ultrasound testing having an adverse impact when used to image CLL related changes.  Unlike CAT scans, there is no ionizing radiation involved, so there is no associated risk of secondary cancers.  To my knowledge, the only risk could be due to ultrasound not giving an image as accurate as could be obtained with a CAT scan.

    Interesting observation about prednisone reducing your nodes.  Prednisone is sometimes used to reduce autoimmune complications associated with CLL and can be used in conjunction with chemotherapy treatments, particularly the older, less effective, but gentler treatments.



  • healthunlocked.com/cllsuppo...

    There were a few others but I can't replicate the route I took to find them.

  • Thanks for your reply - and believe me, I appreciate your difficulty in finding the references if they are to posts on this site. We very much desire a better internal search feature!

    Unfortunately, the references you turned up are frustratingly second hand with no supportive links.  I suspect doctors are being cautious per the Health Canada Ultrasound Guidelines - 4.1.5 Contraindications and similar: hc-sc.gc.ca/ewh-semt/pubs/r...

    "Care should be taken not to irradiate neoplastic tissues as there is some evidence that inappropriate heating patterns, giving rise to temperatures less than 42°C, may stimulate tumor growth or promote metastases."

    A neoplasm (neoplastic tissue) is an abnormal growth of tissue, so would arguably include swollen lymph nodes in the case of CLL, though I suspect the original intent was more in respect of solid cancers.

    You've raised a good question though and given some CLL patients request ultrasounds in place of CT scans to hopefully reduce any associated risk from an examination of internal nodes/spleen, etc, I hope someone can turn up some research papers regarding this very interesting topic!

    Thankfully, it's good to hear you are on the mend, so hopefully you won't need the answer today :) .


  • These Canadian guidelines are almost 35 years old... hardly state of the art, I suspect...

    However, when I had an ultrasound guided punch biopsy done on my Richter's lump, I had to sign a consent and that the ultrasound in rare curcumstances might promote tumour growth and I was made aware of this fact.

    Along with about 20 other 'might' happens...

  • I think I'll give a call to the breast center and ask them directly. The ultrasound part of the exam is sort of optional.


  • May I suggest you'd be better off asking your CLL specialist.  With CLL being fairly rare, I'd expect the breast centre would not know and hence take the conservative approach, recommending you avoiding the ultrasound.

    While the ultrasound part of the exam may be optional, given we have a higher risk of secondary cancers with CLL and can fare less well with other cancers, you would be wise to try and catch any suspicious lumps early.  CLL can't metastasise - it's already throughout our bodies, so the concern is with the potential risk associated with excessive heating from sound energy being absorbed by our tissues.  If you do go ahead with the ultrasound, you should ask the person giving the ultrasound to avoid concentrating it on one area, e.g. by returning to an area that looks suspicious, rather than having an intensive look at the area in one long pass.  The idea is to let the blood supply take away some of the heat between passes.

    I'm not medically trained, but have an interest in the effects of radiation on body tissue.


  • Met with my new oncologist today and asked his nurse practitioner about ultrasounds. She said she has never heard that they are a problem. 

  • HDMP +R (high dose methylprednisolone) and rituxan was a common treatment for 17p- deleted CLL about 10 years ago, still used in some case... end stage refractory


     methylprednisolone is a variant of prednisone... they are not chemically identical


  • Who knew??

  • Hi, 

    I've just had Prednisone for auto immune haemolytic anaemia, and found the same as you. My lymph nodes reduced in size dramatically. I asked my consultant about it, and he said that steroids do have a lymphocytic  effect. When the dose was dropped to 10 mg, the lymph nodes increased in size again. Sorry, I don't know the mechanism though.


  • Regarding inflammation in foot, Tenosynovitis, a very painful, red, swollen area, often in hand, foot, has been experienced by myself, others. Unclear whether due to cll, or Ibrutanib. Subsides on its own, after week or more. Anti inflammatory meds such as Motrin, celebrex may speed resolution. Ice packs give some relief, tends to recur, though, it seems, not as bad.

    Consider this for your findings, unfortunately Podiatrist, most docs have no awareness of this. We are so often in uncharted waters.

  • There is no sign of redness etc and I am not on treatment. No idea how this happened. Fortunately I am on the mend and limping less.

  • Virginia

    I took steroids for my auto-immune haemolytic anaemia.  I have no idea if the following is right as to why they work (in my case in reducing the spleen size, but I think principle is same in lymph nodes), but he is my understanding.......

    The spleen and lymph nodes contain white blood cells that are fighting disease (or stationed in the lymph node ready to fight).  I guess our lymph nodes swell, as our immune systems are not properly controlled....so extra white blood cells gather in them readied to fight (against some disease cells - I guess not the CLL ones) and we gather too many due to our imbalanced immune response system.  So lymph nodes swell.

    The steroids effectively raise the threshold at which we (our white blood cells) respond to a disease alarms  - so our immune system is less sensitive to foreign cells and the whole fighting system is much more laid back.  So less white blood cells are stationed around our body to fight.  So less white blood cells in lymph nodes and they reduce in size.

    So if steroids stopped, and our bodies go back to where they were before, the lymph nodes will again increase in size 

    I don't know the science behind all this.....and can anyone correct me (or even say the thinking is on right lines!)


  • Interesting. With cll I keep saying "who knew" again and again and again...

  • I'm wondering if the post about ultrasound was referring to it in the setting of physical therapy, not instead of X rays or scans. It was used for me dealing with back issues and again during therapy for a broken shoulder.

    I have read many posts about ultrasound being used instead of CT scans to reduce unwanted exposure. Ultrasound as a part of a mammogram is very common if something questionable shows up. They will differentiate between cysts and solid tumors. When I was younger I had several along with my mammograms because of cysts that popped up. It was very reassuring to know that I was only dealing with cysts, which my doctor always had drained and the fluid biopsied, mostly to insure that nothing could hide behind the cysts. 

  • The post I could relocate had a passing comment about her doctor saying something like ultrasound was not good for cll patients. No further explanation. Because of dense breast tissue (and family history) I plan to have a mammogram and ultrasound. 

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