Navigating Uncertainty: Seeking Answers for Throat Pain and Tumor Concerns

Positron Emission Tomography (PET) Report Issue 3

Hello Dr.
Chen, I apologize for bothering you again, but I would appreciate your advice and assistance.
Previously, I mentioned that I have been experiencing a persistent foreign body sensation and pain in my throat, extending from the base of my left tongue to deep in my throat, for 24 hours a day.
It feels as if there is a bone lodged in my throat, and swallowing causes pain at a certain point.
This is accompanied by tinnitus and occasional ear pain.
The symptoms have persisted for over six months, during which I have undergone numerous examinations.
In late September, I had a PET scan, and the report indicated a suspected lesion in the epiglottic area.
Although it could be a physiological change, the possibility of a malignant tumor cannot be ruled out, with an SUV max of 4.9.
It has been two months since the examination, and my throat symptoms have become increasingly uncomfortable, with constant pain.
Today, I had my monthly follow-up appointment and informed the doctor that my symptoms have worsened.
The tinnitus and ear pain persist, and I mentioned that I felt a hard area at the base of my tongue.
The doctor performed an endoscopic examination and noted some swelling on the left side of the tongue base, and the area I feel pain in seems hard.
We discussed the possibility of a biopsy, but the doctor explained that the PET report indicated a bright area that spans a larger region, making it difficult to pinpoint the exact spot for a biopsy.
He suggested that if a biopsy is to be done, it would need to be a larger section, but he cannot guarantee that the entire area is problematic.
The doctor mentioned that due to the nature of the area, a standard surgical procedure is not feasible, and I would need to undergo a Da Vinci robotic surgery, which would cost at least 200,000 NTD out of pocket.
I do not have insurance or savings, which leaves me feeling helpless, especially since I have a 3-year-old child at home.
I am also afraid that if I do not have the biopsy, it could lead to an untreatable condition.
I am terrified of the pain and unknown issues that may arise after surgery, and I am unsure of what to do next.
I would like to ask you, Dr.
Chen, if there are any other options available for my situation? Should I seek a second opinion at another hospital? Do you have any recommendations for doctors in Taipei? If I do undergo surgery for biopsy, will it affect my swallowing or speaking in the future? If the results are unfavorable, would I need to undergo another surgery? Please help me understand the problematic areas in the report; I am confused about whether the issue lies in the tongue base or the epiglottis.
I would greatly appreciate your guidance on what would be the best course of action.
I am truly scared and in need of help.
Thank you very much.

Miss Lin, 40~49 year old female. Ask Date: 2021/11/24

Dr. Chen Sirong reply Oncology

Ms.
Lin / 45 years old / Female
Greetings!
1.
Given my current situation, are there any other options available? Should I seek evaluation at another hospital? Can you recommend any doctors in Taipei?
A: I believe that a surgery covered by the National Health Insurance is also a viable option.
I recommend: National Taiwan University Hospital, Department of Otolaryngology, Director Dr.
Ko Cheng-Yu, and attending physicians Dr.
Lou Pei-Ren / Dr.
Tan Ching-Ding.
2.
If surgery is performed and the tissue is sent for analysis, will it affect my ability to swallow or speak in the future?
A: Strictly speaking, this question should be directed to an otolaryngologist.
3.
If the results are unfavorable, will I need to undergo another surgery?
A: If it is benign, further surgery may not be necessary.
If it is malignant, another surgery is likely required after the biopsy.
4.
Please help me review the report to clarify where the issue lies—whether it is at the base of the tongue or the epiglottis.
I am really confused about where the problem is.

A: This is a concern that the physician performing the biopsy should address; you do not need to worry about this issue.
Wishing you good health,
Taoyuan Hospital, Dr.
Chen Sih-Rong

Reply Date: 2021/11/24

More Info

Navigating health concerns, especially when they involve potential malignancies, can be incredibly stressful and anxiety-inducing. Your situation, characterized by persistent throat pain, a sensation of a foreign body, and the recent findings from a PET scan indicating a suspicious area, understandably raises a lot of questions and fears.
Firstly, it’s important to acknowledge that the symptoms you are experiencing—such as the sensation of something lodged in your throat, pain during swallowing, and associated ear symptoms—can be distressing. These symptoms can arise from various conditions, ranging from benign issues like inflammation or infections to more serious concerns, including tumors. The fact that you have undergone multiple examinations and imaging studies is a positive step, as it demonstrates your proactive approach to your health.

The PET scan results indicating a suspicious area in the epiglottis region (or the area around the base of the tongue) warrant further investigation. The recommendation for a biopsy is a common next step in such cases, as it can provide definitive information regarding the nature of the tissue—whether it is benign or malignant. While the prospect of surgery, especially with the associated costs and potential complications, can be daunting, it is crucial to weigh the risks and benefits.
In terms of your concerns about the surgery, it is natural to worry about the implications of a biopsy on swallowing and speaking. Generally, if the procedure is performed by an experienced otolaryngologist (ENT specialist), the risks of significant functional impairment are minimized. However, every surgical procedure carries some risk, and it is essential to have a thorough discussion with your surgeon about these concerns. They can provide insights into what to expect post-operatively and how they plan to manage any potential complications.

If financial constraints are a significant concern, consider discussing this openly with your healthcare provider. Many hospitals have financial assistance programs or can help you explore options for reduced-cost care. Additionally, seeking a second opinion from another ENT specialist can provide you with more options and potentially different perspectives on your treatment plan. In Taipei, there are several reputable hospitals and specialists who can offer a second opinion. Institutions like National Taiwan University Hospital or Taipei Medical University Hospital have experienced ENT departments.

It’s also worth considering the psychological impact of your situation. Chronic health anxiety can exacerbate physical symptoms and create a cycle of worry that can be hard to break. Engaging with a mental health professional, such as a psychologist or counselor, can be beneficial in managing anxiety and coping with the uncertainty surrounding your health.

In summary, while your situation is undoubtedly challenging, there are steps you can take to address your concerns. Seek a second opinion, discuss financial options with your healthcare provider, and consider mental health support to help manage the anxiety that comes with health uncertainties. Remember, you are not alone in this journey, and there are professionals who can help guide you through the process. Your health and well-being are paramount, and taking these steps can help you navigate this difficult time more effectively.

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