Neck Tumors: Seeking a Second Opinion on Diagnosis

A tumor on the neck?

Hello Dr.
Chen: I have had a lump on the left side of my neck for almost three years.
Recently, I had a CT scan, and the doctor said they are still unsure what it is, only suggesting it might be a hemangioma.
To confirm, I would need to undergo surgery for a biopsy.
Initially, I consulted an ENT specialist who performed a nasopharyngoscopy and confirmed that it is not nasopharyngeal cancer, but there are two lumps, one measuring 4 cm and the other 2 cm.
Based on what the doctor said, it seems that surgery for a biopsy is the only way to determine what it is.
I would like to ask if you recommend getting a second opinion at another facility or consulting an oncologist for further evaluation.
Thank you for your response.

Hei, 20~29 year old female. Ask Date: 2016/03/30

Dr. Chen Sirong reply Oncology

Dear [Recipient],
I apologize for the delayed response as I was out of the country.

1.
To achieve a definitive diagnosis for any tumor, the only reliable method is through surgical excision and histopathological examination.
2.
Regarding your inquiry: Are you suggesting that I should seek a second opinion at another hospital or consult an oncologist for further evaluation? It seems you have already made a presumption about switching hospitals or consulting an oncology specialist.
3.
A tumor measuring 2-4 cm is considered significant.
If left untreated, it may cause ongoing concern.
While anxiety may fluctuate, over time, the tumor could continue to grow or exert pressure, leading to symptoms that may necessitate surgical intervention.
Would it be better to address it sooner rather than later?
4.
Please note that our national health insurance does not restrict you from seeking a second opinion.
Thank you for your message.
Sincerely,
Chen Sih-Rong
Taoyuan Hospital

Reply Date: 2016/03/30

More Info

When it comes to neck tumors, particularly when you have a lump that has persisted for nearly three years, it is crucial to approach the situation with thoroughness and caution. Based on your description, you have already undergone imaging studies, including a CT scan, and have received a preliminary diagnosis suggesting a vascular tumor. However, the uncertainty surrounding the diagnosis, especially with the presence of two tumors measuring 4 cm and 2 cm, warrants further investigation.

In general, the evaluation of neck masses often begins with a detailed clinical history and physical examination, followed by imaging studies such as ultrasound, CT, or MRI. Each imaging modality has its strengths. For instance, ultrasound is excellent for assessing soft tissue characteristics and can help differentiate between solid and cystic masses. CT scans provide detailed cross-sectional images and can help visualize the extent of the tumor and its relationship to surrounding structures. MRI is particularly useful for soft tissue evaluation and can provide information about the tumor's composition and involvement with adjacent tissues.

Given that your CT scan has not provided a definitive diagnosis, and considering the size of the masses, it may be prudent to seek a second opinion. Consulting with a different ENT specialist or a head and neck oncologist could provide you with additional insights. These specialists often have experience with complex cases and may suggest further imaging or a different approach to diagnosis.

If the consensus remains that surgical intervention is necessary for a definitive diagnosis, it is essential to understand the risks and benefits of the procedure. Fine needle aspiration (FNA) biopsy is often a less invasive option that can provide valuable information about the nature of the tumor without the need for a full surgical excision. However, if the tumor's characteristics suggest a higher likelihood of malignancy, a more extensive surgical approach may be warranted.

In your case, since the initial ENT evaluation ruled out nasopharyngeal cancer, it is essential to consider other potential diagnoses, including benign tumors like hemangiomas or lymphangiomas, as well as malignant tumors. The fact that the lump has been present for three years without significant change might suggest a benign process, but the size and characteristics of the masses still warrant careful monitoring and evaluation.

In conclusion, I recommend the following steps:
1. Seek a Second Opinion: Consult another ENT specialist or a head and neck oncologist for a fresh perspective on your condition. They may suggest additional imaging or a different diagnostic approach.

2. Consider Less Invasive Options: Discuss the possibility of a fine needle aspiration biopsy with your healthcare provider. This could provide more information without the need for more invasive surgery.

3. Monitor Symptoms: Keep track of any changes in the size of the lumps, any new symptoms, or changes in existing symptoms. This information can be crucial for your healthcare provider.

4. Stay Informed: Educate yourself about potential diagnoses and treatment options. Understanding your condition can help you make informed decisions about your care.

Ultimately, your health and peace of mind are paramount. It is essential to advocate for yourself and ensure that you receive the appropriate care and attention for your condition.

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