Neck Tumors: Concerns About X-Ray Radiation and Treatment Options

Q: Neck Tumors: Concerns About X-Ray Radiation and Treatment Options

Hello, I would like to ask you two questions： 1A. Theoretically, the dosage used in medical practice is within an acceptable and reasonable range. 1B. This reasonable range does not imply that it will not stimulate the original tumor or any normal parts of the

Neck problems

Hello Dr.
Chen,
I would like to ask you two questions:
1.
About four years ago, I noticed a lump on the upper side of my neck (it is elongated, not nodular).
I consulted an ENT specialist who said it was nothing (I was concerned he might not have palpated it clearly).
A few months later, I felt tightness in my neck when I lifted my head to swallow, which made me worry about esophageal issues.
I went to a teaching hospital where they performed an X-ray after I drank a white liquid (which they said was barium).
It was challenging to synchronize the timing as I had to drink three cups before they could take the images.
The result indicated that there were no issues with my esophagus.
My question is: will the radiation exposure from multiple neck X-rays affect the likelihood of developing a tumor in my neck in the future?
2.
I visited a surgical clinic for a thyroid examination because the original lump is still present, and I have now developed another noticeable one (it becomes prominent when I lift my head to swallow).
After an ultrasound, they mentioned that this new tumor will need a biopsy (on the right side), but they also noted several others on the left side (which were only visible on the ultrasound).
Should I consider surgery regardless of whether the biopsy results are positive or negative? How should I manage the multiple small nodules on the left side?
3.
I often feel that doctors in the health insurance system rush through consultations and cannot provide detailed explanations (which is frustrating!).
I sincerely hope Dr.
Chen can help clarify these concerns.
Thank you very much!

Bei, 50~59 year old female. Ask Date: 2016/04/07

Dr. Chen Sirong reply Oncology

Hello, I would like to ask you two questions:
1A.
Theoretically, the dosage used in medical practice is within an acceptable and reasonable range.

1B.
This reasonable range does not imply that it will not stimulate the original tumor or any normal parts of the body to become malignant, but rather that the risk is very low.

1C.
No one should refuse necessary examinations due to a very low risk.

2A.
So, are all tumors located within the thyroid?
2B.
Regarding these questions, I am sharing an article from the internet: http://www.tch.org.tw/tch/14/14_1_08/14_08_001.aspx
When a lump appears in the neck's thyroid, the most concerning question is, "Is it cancer?" Clinically, ultrasound and radioactive iodine scans are used to differentiate whether the tumor is cystic or solid, and whether it secretes thyroid hormones (hot or cold).
If it is a cold solid tumor, there is a 20% chance it could be thyroid cancer.
Before surgery, fine needle aspiration can be performed for cytological examination to determine if it is thyroid cancer.
An exception is for follicular cells, where malignancy cannot be distinguished.

The treatment approach varies depending on whether the tumor is benign or malignant:
1.
Benign thyroid tumors: If it is a simple cystic tumor, it can be observed or the fluid can be aspirated with a fine needle.
If the mass enlarges or recurs after aspiration, surgical removal should be considered.
Other benign tumors should undergo surgical excision.
However, it is important to note that some tumors initially thought to be benign may be found to be malignant upon pathological examination after surgery, necessitating a second operation for formal malignant tumor excision.

2.
Malignant thyroid tumors include four types: papillary carcinoma (accounting for 70%), follicular carcinoma (15-20%), medullary carcinoma (about 5%), and anaplastic carcinoma (5%).
The prognosis follows the same order, with papillary carcinoma having the best prognosis and anaplastic carcinoma the worst.
Additionally, the patient's age is a factor; females over 50 and males over 40 tend to have a poorer prognosis.
Surgical treatment typically involves a bilateral approach.

3A.
Many hospitals offer self-pay outpatient services to choose from.

Thank you for your letter.

Taoyuan Hospital, Chen Si-Rong

Reply Date: 2016/04/07

More Info

When it comes to neck tumors and the associated concerns regarding X-ray radiation and treatment options, it is essential to approach the situation with a comprehensive understanding of the risks and benefits involved.

1. Radiation Exposure from X-rays: You mentioned undergoing multiple X-ray examinations, including a barium swallow study, to evaluate your neck and esophagus. While it is true that X-rays expose patients to ionizing radiation, the doses used in medical imaging are typically within safe limits. The radiation dose from a single X-ray is relatively low, and the cumulative effect of several X-rays over time is also considered to be minimal in terms of increasing cancer risk. According to the National Cancer Institute, the risk of developing cancer from medical imaging is very low compared to the potential benefits of diagnosing and treating medical conditions. Therefore, while there is a theoretical risk of radiation exposure contributing to the development of tumors, it is generally outweighed by the necessity of obtaining accurate diagnostic information. It is crucial to discuss any concerns with your healthcare provider, who can help assess your individual risk based on your medical history and the specifics of your imaging studies.

2. Thyroid Nodules and Treatment Options: You have raised concerns about the presence of nodules in your thyroid, with one being more prominent and requiring a fine-needle aspiration (FNA) biopsy. The management of thyroid nodules depends on several factors, including their size, appearance on ultrasound, and the results of the biopsy. If the biopsy indicates that the nodule is benign, the standard approach may involve regular monitoring rather than immediate surgery. However, if the nodule is malignant or shows suspicious features, surgical intervention may be necessary. In cases where multiple small nodules are detected, the decision to operate may depend on their characteristics and the patient's overall health. It is essential to have a thorough discussion with your endocrinologist or surgeon regarding the biopsy results and the best course of action. They can provide guidance on whether surgery is warranted based on the findings and your symptoms.

3. Communication with Healthcare Providers: It is understandable to feel rushed during medical appointments, especially when dealing with complex issues like tumors. It is essential to advocate for yourself by preparing questions in advance and expressing your concerns clearly to your healthcare provider. If you feel that your questions are not being adequately addressed, consider requesting a follow-up appointment or seeking a second opinion. Clear communication is vital in ensuring that you receive the best possible care and understand your treatment options.

In summary, while the radiation from X-rays poses a minimal risk, the benefits of accurate diagnosis and treatment often outweigh these concerns. For thyroid nodules, the management strategy should be tailored to the individual based on biopsy results and clinical findings. Lastly, fostering open communication with your healthcare team is crucial for navigating your health concerns effectively. Always feel empowered to seek clarification and support in your healthcare journey.

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