What is the likelihood of cervical cancer in a 31-year-old patient with a history of high-risk Human Papillomavirus (HPV) and normal Pap smear results 10 and 6 years ago, presenting with intermittent left upper quadrant fullness, palpable left elbow and neck lymph nodes, fatigue, and extreme health anxiety?

Differential Diagnosis

• Single most likely diagnosis
  • Health Anxiety Disorder: The patient's excessive worry about having cervical cancer despite a history of normal Pap smears and the presence of high-risk HPV (which is common and often clears on its own) suggests health anxiety. The patient's symptoms such as fatigue and fullness under the left ribs are non-specific and can be exacerbated or perceived as more severe due to anxiety.
• Other Likely diagnoses
  • Irritable Bowel Syndrome (IBS): The symptom of fullness under the left ribs, especially when sitting down, could be related to gastrointestinal issues such as IBS, which is common and can cause abdominal discomfort.
  • Benign Lymph Node Enlargement: The presence of palpable lymph nodes in the neck and elbow can be due to various benign conditions, including viral infections or reactive lymphadenopathy, which is a common and usually harmless condition.
  • Fibromyalgia: Given the patient's complaint of fatigue and possibly the fullness sensation, fibromyalgia could be considered, as it often presents with widespread pain, fatigue, and sleep disturbances.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Cervical Cancer: Although the patient has had normal Pap smears, the presence of high-risk HPV warrants regular follow-up. Cervical cancer can sometimes present with non-specific symptoms or be asymptomatic until advanced stages.
  • Lymphoma: Enlarged lymph nodes, even if benign-appearing, should always prompt consideration of lymphoma, a type of cancer that can present with lymphadenopathy.
  • Other Gastrointestinal Cancers (e.g., stomach or pancreatic cancer): These can present with non-specific symptoms such as fullness or discomfort in the upper abdomen and should be considered, especially if other risk factors are present.
• Rare diagnoses
  • Sarcoidosis: A condition that can cause lymphadenopathy and might result in non-specific symptoms such as fatigue.
  • Other rare cancers (e.g., lymphoproliferative disorders): These could present with lymphadenopathy and systemic symptoms like fatigue.