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Needle Biospy not performed in 2005 (lump in 2006 was cancer)

PattyNC's picture
PattyNC
Posts: 65
Joined: Oct 2006

Question concerning something that has been really nagging at me ever since my brother Michael's diagnois. He had a lump in his neck and went to ENT in Sav, GA sometime in 2005. He told me he thought it might be ear, tonsil, or tooth related (he did not have the best teeth even prior to rad treatment). At that visit the Dr. prescribed him an antibotic & sent him on his way ... no follow up. When almost a yr pasted, lump started growing so big it became noticeable to his friends. One finally called me & said I needed to prod Mike to return to the doctor. Michael when back in for visit ... doc stuck a needle it it & it came back metastatic squamous cell carcinoma. When he scheduled Mike for surgery on a Monday end of May 2009 --- his doctor phoned me here at my office in Charlotte NC (I had fax'd him requesting a call to discuss my brother's operation the coming Monday since I was driving to Sav on Sat morning & wanted to be as informed as possible). What was so shocking to me was in the phone call that Friday (about 2:30 pm)the doctor was ruffling through my brother's charts and made this comment & I quote verbatim ... "did you know your brother saw me about a year ago for lump in the same area?" I answered "yes, I did." He then says, "Well, I don't find anything in his charts where we stuck a needle in it ... I don't know why we didn't stick a needle it it --- it might have been cancer then, but now we'll never know." I was just astonded & mortified! I wanted to shout at him ... "I bet if it was your family, you'd have stuck a damn need it it & would not be wondering now ... Oh, it could have been cancer then, but now we'll never know." But since this same man was going to be cutting on my brother's neck at 7:30 the coming Monday, I simply sat lisenting in stunned silence while he continued to talk about the operation, etc. Does his comment sound appropriate? Is not doing a needle biopsy fairly common? I still get so angry when I recall his statement. I could hardly believe my ears. Really wish that call had been recorded. Thanks all for letting me finally get this nightmare phone call off my chest ... anybody that knows if needle should have been done as protocol, pls advise. Sorry if I have typos etc .. I'm seething right now just recalling this incident.

Skiffin16's picture
Skiffin16
Posts: 8088
Joined: Sep 2009

I don't really have an answer for the protocol or procedure. I know when I first was diagnosed with possible throat (tonsil) cancer, I also had a tumor pop up. When I first visited the MD he had mentioned that he was removing the tonsils, and doing a needle biopsy on the tumor.

A few days later the tonsils were removed and he did a quick biopsy at the same time (tonsil tissue), confiming that it was SCC. He sent the tissue off to determine if it was HPV+, it was.

Anyways, I had asked him later about the needle biopsy, he said he didn't do it. I asked why, but his explanation, which satisfied me, was there was no need. He already confirmed that I had SCC in the tonsils. Anything else would show up during the PET.

I know that is a different scenario than your brothers in the fact that they didn't diagnose, operate or perform any further treatment at the time for your brother, and that is unfortunate.

All I can really offer at this time is that it has been determined to be cancer now, and that they are planning a treatment stradegy. Be positive and there for your brother.

Unfortunately there's nothing that can now change what has or has not been done. Hoping for the very best for you and your brother in the upcoming weeks and months.

Best,
John

stevenl's picture
stevenl
Posts: 587
Joined: Jan 2010

I went to my primary when I first noticed a small lump in Dec. 09. He gave me antibiotics and said give it 10 days. I think he knew there was a problem because when I told him there was no pain and it was not bothering me at all, he said not good. Told me if it was an infection it would probably be bothering me in some way. But he followed protocol and gave me the antibiotics. But he did want me to return in 10 days. When I returned he sent me for an MRI and CT scan. He got the results in about 3 or 4 days. From that time until April everything was kind of a blur. That is how it happened for me but I've got a real good primary care doc who sent to some of the best doctors anyone could ever hope for.

Best,
Steve

Kimba1505's picture
Kimba1505
Posts: 557
Joined: Apr 2010

Steve reports the best case scenerio. My partner, Mark, pictured to the left, had a lump in his neck for several years. He also has two other lumps on his body which are fatty deposits. When he first had the docs check his neck, he was told it was the same thing he had on his arm and torso. In January of 2010 he began having ear and throat pain, went to the doc, he was put on anti-biotics. Pain did not go away. He returned...he was put on stronger anti-biotics, pain did not go away. He returned again and he was put on strong anti-biotics for a longer period of time and was told if this did not take care of the problem he was to get a CT scan. Needless to say, I would not be writing this if that 3rd round of anti-biotics did the trick.
He was diagnosed on April 13th 2010 with SCC left tonsil, stage IV. Yikes!!
Many were appalled at the primary physician's continuation of anti-biotics and late CT scan. I had a hard talk with the ENT who did his surgery...he felt 3 months is the acceptable time frame for a primary physician to pick up on cancer with presenting symptoms like Mark's. He felt a law suit for Mark would be a lot of work and no guarenteed outcome. He thought it could be 50/50. Mark was interested in another kind of fight...a fight for his life. We are not pursuing anything.
Steve's doctor seemed to, not only be right on target, but ahead in the game. (Steve, your primary is a keeper).
Patty, your anger is justified. Mark's advanced stage of disease would not have been so andvanced had this been picked up on sooner...he probably would not have had to have the radical neck dissection which has altered his appearance. May be less noticable when he gains some weight back.
What you want to do with your anger is entirely up to you. You may have a malpractice law suit worth pursuing. The doctor will never admit that he said what he said to you, but the record shows your brother presented with symptoms a year ago. But after the anti-biotics your brother did not return, so the doctor could have the position that the anti-biotics worked. In PA, a malpractice attorney will review a case for free to see if it has merit. Again, it is how you decide to direct your energy at this time. I know I had no energy for a law suit, I let other family members carry that anger, and it subsided for everyone as Mark got into surgery and treatment.
Patty, cancer just sucks, and we want something to do with our anger and our helplessness. Talk things out here on these boards. It helps tremendously.
My Best to your brother, you and all the wonderful people you will encounter here,
Kim

Hal61's picture
Hal61
Posts: 656
Joined: Dec 2009

Hello Patty, I can see why the doctor's seemingly off-the-cuff remark bothered you. It would me too, but I would've done the same, given the doc was scheduled to perform the surgery. Can't really speculate on his/her awkward attempt to diffuse a situation that might become an issue at a later date . . .

John is on the mark though. Your admirable restraint shows that you're already aware that the primary concern now is your brother's treatment and recovery.

best to both of you, Hal

PattyNC's picture
PattyNC
Posts: 65
Joined: Oct 2006

thanks all ... really appreciate the thoughts and support

soccerfreaks's picture
soccerfreaks
Posts: 2801
Joined: Sep 2006

Like others, I went to my family doctor with rather non-alarming symptoms, in my case a rather persistent sore throat. Like others, I was given a prescription for antibiotics. When they didn't work, I went back to doc and was given a stronger antibiotic.

Finally, when I called him indicating the sore throat remained and that I was even having problems eating because of a 'bump' on my tongue, he advised me to head straight to the ER, where he would meet me. There, a biopsy was done (they CAN be invasive!), and the squamous cell carcinoma was revealed.

Your brother's choice not to report back to his doctor for more than a year frankly puts the burden directly at his own feet and leaves the doctor blameless in my opinion. As others have reported as well, the doctor is typically going to rule out other possibilities with antibiotics and other measures before ramping it up to test for the big C, for a number of reasons, including cost, inconvenience, and, in many cases, the invasiveness of the procedures required.

I am glad to see that you are working on the anger thing :). At this point the best thing is to move forward, as others have also said. Cancer does not have to be a death sentence, as so many follks on this board and elsewhere can testify.

Best wishes to your brother and his family.

Take care,

Joe

micktissue's picture
micktissue
Posts: 432
Joined: Dec 2009

Exactly what happened to me. The Dr was not concerned with the lump in spite of a family history that included lymphoma. He sent me away with antibiotics which had no effect on the lump. It was 6 months of me worrying about it before he finally agreed to a biopsy which, after 2 failed tries, came back as SCC about 9 months after I found the lump.

I did some research on this and found a research paper that said this is a fairly common approach (antibiotics and no biopsy) but the procedure of giving antibiotics was unfounded. I am looking for that paper and will put it somewhere for you (and anyone else) to download. I sent my Dr (now former Dr) a nasty gram and gave him the paper as well. He has not responded. Jerk.

this is why I am so for advocating. It is always wise to bring someone with you who can talk when you cannot, listen when you're overwhelmed, and drive when you cannot see through your tears. Drs don't get it so they need to be told.

Best,

Mick

RushFan's picture
RushFan
Posts: 218
Joined: Aug 2010

Patty, so sorry to read about your experience, very tough to read.

Like many here, I had a lymphnode that was "giving me trouble". In Nov. of 2009 I noticed a swollen LN on the right side of my neck. My sister in law (reseach RN) was visiting from California and I showed it to her. We both mumbled that I should get it checked out.

I went to an ENT (December)with a sinus infection and my swollen LN. Antibiotics prescibed. No change in node, infection gone. He was concerned, one more round of AB's and then "we need to watch that LN". After second round of AB's, no change in node. He wanted to CT scan right away. I spoke with a Orthopedic Surgeon friend of the family, and was refered to an ENT he knows / trusts etc. I told him the story so far and he wanted a scan to rule out C. I started to get concerned. Forward to January 2010. Had a CT scan. Inconclusive. Next ultrasound needle biopsy. Rulled out Lymphoma, but no conclusive I.D. of C. So my new ENT says..."that thing needs to come out". So it did. Local path couldn't positively I.D. which cancer it was, but it was cancer. Slides sent to Mayo Clinic, I.D. squamous cell carcinoma. My ENT referred me to MDA. After CT scan at MD Anderson...unknown primary, no tumor found.

So...2/19/10 surgery / biopsies...no primary found
3/15/10 started treatment
4/30/10 finished treatment

Again, sorry and best wishes to your brother.
Chuck.

PattyNC's picture
PattyNC
Posts: 65
Joined: Oct 2006

FYI Mikey did have tumor ... occult origin. Never did find out source so like yours, his primary remains a mystery. Also, when Mikey read my post last night ... he pointed out typo on date he had his operation (my subject line is correct for May 2006 but my post says May 2009.

guess people can connect the dots and realize my error -- I'm new at these boards & not sure what I'm doing, just trying to learn

Also, last night I asked Mike (as I have asked him many times before) ... "why in the world did you wait so long to tell the doctor it never went away and was (in fact) growing." He mumbled that a good friend of his had a lump for years on the same side bigger as his and it was a benign cyst. Mike said he had a cyst before and it was benign so he thought for sure this one was too. WRONG

Chuck, thanks again to you and to all the othes for your well wishes. It means the world. Same back at you! I'll be praying for you to make a full, complete & lasting recovery!

PattyNC's picture
PattyNC
Posts: 65
Joined: Oct 2006

thanks so much Mick

if you find that paper pls give me a link or post so I can take a look too

hope you have good friends & family to take care of you during this difficult journey

your online friends will keep sending prayers your way

take care & let's all hope today is a good day !!

debbiejeanne's picture
debbiejeanne
Posts: 2454
Joined: Jan 2010

Patty, that is aweful and totally unacceptable. It absolutely blows my mind to see how doctors truly DON'T CARE!!! I'll bet they'd be upset had that been thir loved one. I am very sorry and definitley understand why you need to vent. I would do the same if it was my brother. I keep telling my bros and sisters they must take control of their health, ask questions and get mad if that is what's it takes. We can insist they do this test or that test. Patty, I will put your family in my prayers. My heart and best wishes go out to you now. Take care and try to calm down. Your brother is really gonna need you now.
God bless you,
debbie

PattyNC's picture
PattyNC
Posts: 65
Joined: Oct 2006

thanks a million ... hope I am replying correctly (still stumbling around learning the ropes)

Pam M's picture
Pam M
Posts: 2194
Joined: Nov 2009

Patty,
It was a young dr. who prescribed antibiotics for me and said to see my primary if it didn't get better (the huge lymph node sticking out of my neck) in a month. But I was told to have it re-checked if it didn't go down. My primary (probably mid forties) said we had to have it checked right away, and that "until you know it's not cancer, act like it could be".

delnative's picture
delnative
Posts: 452
Joined: Aug 2009

... this doctor was negligent. Negligent, as in open to a whopping big lawsuit. At least he was honest enough (foolish enough?) to admit it, but that doesn't make him any less culpable.

--Jim in Delaware

PattyNC's picture
PattyNC
Posts: 65
Joined: Oct 2006

Yes ... I often wonder if he recalls & regrets saying that to me. It is exactly what he stated and like I said, I was absolutley speechless. He was telling me even he couldn't understand why he "didn't stick a needle it in." But I bet he would recall it differently, it money became involved.

thanks Jim for your input & support

Patty

rozaroo
Posts: 667
Joined: Apr 2010

I discovered a lump on the side of my neck & thought it was an infection from a molar that was giving me trouble. I made an appointment & went to see my dental surgeon. He proceeded to tell me that it was a bacterial infection & as soon as we pulled the molar out my troubles would be over. So I trusted him & waited & finally found a Dr. who referred me to an ENT who ran tests & discovered that it was stage 4 cancer of the toncil. Yes I was angry, but thought about my girlfriend who just lost her 29 year old son to cancer of the tongue.She tried to hire a lawyer in our city but no one would touch her case. She finally found one from out of town & the max payout is $90,000 & after paying out lawyer's fees & their cost's there would be nothing left. Therefor I decided that I had enough of a battle to fight & to focus on my health & my family.But I do make sure to mention to anyone requiring a dentist never to go to him. That is my revenge.

Hondo's picture
Hondo
Posts: 5812
Joined: Apr 2009

Good reason to be angry at the doctor but I find most of the doctors these days miss the mark on a first time diagnose, that is why I always like a second opinion. How is he doing after the surgery

PattyNC's picture
PattyNC
Posts: 65
Joined: Oct 2006

He is doing well (or so it seems). Even prior to losing his job, Michael's employer canceled their BCBS coverage for all their employees (that happened Mar 1st of this year I believe, then he was terminated July 27 (had been with them since 1998 & before them worked for same company since he was 18 so he has been working steady for 35 yrs .... until being terminated on July 27.

Several other employees where he worked also had cancer ... including the owner's wife & the office manager who are both breat cancer survivors. I guess the owner could afford private coverage for his family. Not sure what we will be doing about Michael getting check-ups now. My husband has rhumatoid arthritis & he has BCBS but even his co-pays & meds take a bite out of our budget. Michael did physical labor and only weights in at 125 lbs now. I am going to help Mikey file for disability (hoping that at least he will be checked by a physician to see if he qualifies--- best case scenario is they will order a PET but that might not be how this procedure works at all .... it is all new to me, so I'm not sure what will happen. If Michael's health is good enough that he can't get disability, he would love to be employed ... however, in this economy & with him being frail, not sure what in the world we will do then. To be honest, I believe his not having teeth or dentures would be a great challenge to his finding a job when there are so many, many healthy applicants for them to choose from. But then I could be wrong about that too. So just taking it a day at a time --- this site is very helpful in so many ways, so I'm glad I finally started to utilize it.

Scambuster's picture
Scambuster
Posts: 975
Joined: Nov 2009

Hi Patty,

I understand your anger & frustration and this is a common scenario for many people health issues, not just Cancer sufferers. Dealing with the anger is important and you need to purge and move in on as anger is NOT GOOD for us. It is good you have brought it to the surface - now let the good sun shine on it and heal the wound that has festered away for so long.

Remember also we are all very well informed in 'hindsight' in such cases. A doctor is presented with a case which could be caused by a multitude of things. These are especially difficult if they not epithelial tumors, which are far easier to suspect than those imbedded in several layers of tissue. He is not immediately thinking 'Cancer !!" like we do now. If any of us see someone with a lump on their neck we all 100% would say "Get it biospsied NOW". Saying that, he possibly should have done the needle biopsy at that earlier point and has honestly admitted that - but it sounds more as a 'comment' rather than 'remorse' which is perhaps what triggers a reaction of anger. Almost as if he was discussing an obvious word he had missed in a crossword puzzle at the time."Damn, that was 'dumb', ...next.."

I remember as a kid we would be constantly embarrassed by my father who would stop people in the street and tell them to 'get that mole looked at NOW'. He had recently had a Melanoma successfully removed. That was in the early '70s

I think it is important you somehow deal properly with the anger, forgive and move on. Letting the jerk Doctor know would be a benefit to future patients, but don't beat yourself up over it. A legal battle has no real winner unless you are the lawyers I'm afraid.

I was fortunate to have an early diagnosis. My biopsy was done 2 minutes after I sat down in the ENT guys chair 3 hours after my first Doctor appraisal and I had surgery 4 days later only because the weekend fell where it did - other wise it would have been the next day. I did suffer some terrible pain and unnecessary procedures and maybe even Chemo due to one Doctors negligence and misguided persistence or self interest. I have let it go as there is no benefit to 'me' to be upset any longer because 'I' am the important one in this whole series of events involving all those people.

Looking Up and forward.

Scam

PattyNC's picture
PattyNC
Posts: 65
Joined: Oct 2006

I chuckled reading the part about your Dad stopping strangers & telling them to get their mole checked! My husband has 2 older sisters and both had been diagnosed with maglignant melanoma. They both had surgeries (one sister back in the 80's & the other sometime in the 90's). Both are OK now as far as we can tell. My husband's mother lost 3 brothers to this disease & I believe it was in the 70's. My husband goes annually for a check-up. Now that this suject came up ... it is time to schedule his appt. Thanks again to all for your thoughts, guidance and perspective --- people who have already walked the path, can make our own journey safer. Your Dad was actively alerting people to possible danger. Better safe than sorry.

D Lewis's picture
D Lewis
Posts: 1533
Joined: Jan 2010

PattyNC,

I sympathize with your anger and distress. I was treated at two promptcares for a lingering sinus infection/bronchitis and put on antibiotics both times. After three or four months of a persistent inflamed lymph node, I took myself to an ENT specialist. He sent me directly to a pathologist for a fine needle aspirate biopsy. The pathologist got inconclusive results and told me to get treated with a stronger antibiotic. My ENT was sufficiently concerned about the four month duration of the node and the fact that it was 3 cm in size. He admitted that protocol would be to put me on antibiotics again, but told me that he wanted to surgically remove it instead. Glad he did. That was how we found the SCC. Doctors, ENT's and pathologists seem to be all over the map on this one.

Deb

Kimba1505's picture
Kimba1505
Posts: 557
Joined: Apr 2010

These H&N cancers are also beginning to appear in a very new population: young, healthy, and no risk factors. Primary care physicians may not be up on this new "trend" for quick diagnosis. The silver lining in this is perhaps your brother's doctor, Mark's too, will pick up on this earlier in someone else.

PattyNC's picture
PattyNC
Posts: 65
Joined: Oct 2006

Yes ... let's hope someone benefits from what happened. Michael's doctor really seemed puzzled & confused when he couldn't find in the chart that he ordered a needle biopsy. I am thinking he usually would have done that & that is why he made his unplanned & very honest comment to me about now we would never know if it had been cancer back then, etc (which caught me completely off guard). He knew Michael was a smoker, a drinker, and worked as a sander since he was 18 & didn't wear protective mask. Had all the markers for being at risk. But even today, Mike seems to be in denial that he ever had the big C. Seems to think he is invincible. Positive thinking is a great benefit, so I'm hoping he is reaping some rewards from still being in denial. His Oct 2009 PET was clean but I'm trying now to figure out how we can get him a checkup now that he has no health insurance and no job (and very little put aside for this rainy day).

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