Aug 30, 2012 - 2:14 am
(1) Noticed both tonsils slightly inflammed with one on the right bigger than the one on the left like 2 years ago in 2010.
(2) Went to see the physician in Feb 2011 and he said its nothing and everything looked normal to him. One tonsil can be bigger than the other and it can just be an ongoing allergy. He prescribed me some allergic medications and after 2 weeks when I went to see him again, the tonsil had retracted to normal state.
(3) Went to another physician at around March 2012 and he said there is nothing wrong he could see and everything is normal. He felt the nodes on the underside of my neck and did not find anything. Suggested me to go for a Barium - swallowing test which I did not take.
(4) Doc. calls back in and suggests a lymph node needle biopsy on the right side.
(5) Went to the same primary physician again and asked him to refer to another ENT. He checked tonsil again. He still said that he thinks nothing is wrong but just the tonsil area on the right side seems to be red and inflamed. I was referred to another ENT.
(6) ENT sugested right tonsillectomy followed by biopsy of the tonsil. He explained, something is definitely wrong with the tonsil and should be taken out. It can or cannot be malign but that could be figured out after tissue biospy of the tonsil and then the case could be followed up.
(7) Did not get surgery done but went to another ENT surgeon/professor. His resident doctor checked everything and did a physical exam under my armpits but did not find anything. He also said that 1.6 cm of lymph node in that area of the neck can be acceptable.
(8) Senior Dr./professor came and had a look and he suggested me to take aspirator or fine needle lymph node biopsy right then. 2 of his MD docs came and performed the needle biopsy on my lymph node. Both doctors looked the sample under the microscope and declared that it is SCC of tonsil and pointed towards HPV infection.
(9) Detailed report came in later and no HPV was found, however, SCC of tonsil was confirmed. PET scan was done.. Doc calls in the evening and says he doesn't understand the scan very well as several spots lighted up in the entire lymphatic system including tonsils, nodes on neck, armpits, spleen, 3 nodes below liver, groin etc. He says, he is not sure if it is SCC of tonsils (eventhough their tests says so).
(10) He now thinks it can be lymphoma or may be both SCC and lymphoma OR it can be some other infection going on in the system. He called me in for yet another physical exam of my armpits and groin area. I did so and he could not feel any enlarged node in my armpits or groin area. He suggests taking out a lymph node with help of an ultrasound or CAT scan since no node can be felt and then send it for biopsy.
(11) I stand extremely confused now as their own diagnostic tests are contradictory. Firstly I do not exhibit any signs of any serious illness. No fever, weakness, fatigue, weight loss, pain etc. etc. It was only me who pushed for ENT docs to have a look and they are not yet able to reach to a conclusion. I was diagnosed for HPV which came negative after the test. The tests confirmed it is SCC of tonsil but the doctor now says he doesnt think it is SCC and it can be lymphoma instead.
(12) The biopsy of my cervical lymph node and tissue biopsy of my tonsil came out negative for lymphoma but shows SCC with P16 HPV. The aspiration biopsy on lymph node was negative for P16. I have never indulged into random sexual behavior so a possibility of HPV just seems to be impossible. In fact I have been studying all my life and have been in a monogamous relationship with wife only. She is negative for all HPV strains as well. Until the day of biopsy the doctors were absolutely certain that it will come out negative for SCC and it is lymphoma. I was told that just a pea sized tissue will be extracted from inflamed tonsil but they ended up taking out quite a big chunk (1.2 X 0.9 X 0.8 cm). On asking why did they do it, doc said a larger section is required for lymphoma prognosis.
(13) Anyway, the entire tonsil has not yet been removed. I was sent to a surgeon who examined my armpit and groin area where the lymph nodes lit up but he said he could not feel anything and everything seems to be normal. He sent us back and told us that he will talk to the ENT surgeon. They might have discussed and now ENT wants the surgeon to perform a CAT scan on right armpit and surgically remove a lymph node buried deep inside. This lymph node will now be biopsied. He wants to find out if this node shows SCC or lymphoma or is just benign.
(14) I am not agreeing to this plan because I feel it is unnecessary. When the most inflamed part of the lymphatic system - the right tonsil and associated lymph node was negative for lymphoma, is their a need to do such an invasive test, specially when the nodes are not swollen and cant be felt during physical examination ? Even if I believe I have SCC of tonsil and lymph node, does the SCC spread in this fashion that it will be present in the entire lymphatic system without any adverse symptoms in me?
(15) Why is the cervical lymph node not growing in size and in fact has become smaller ? This doesn't seem to be like a typical case of tonsil cancer and neither lymphoma. Is it a possibility that it is just some viral infection that has affected the entire lymphatic system and body is fighting against it? No blood tests have been done so far and the docs think they won't get any information from them. The tonsil basically got inflamed after taking antibiotics (Augmentin) for 2 weeks. Before that the 1st ENT I went to could not even see anything visually until I asked him to feel the tissue on the right tonsil.
(16) As far as I understand, viral infections in tonsil respond to antibiotics and the cancer cells wont. Why did the tonsil respond to antibiotics if it was all SCC. Can the PET-SCAN be a false positive, and should we repeat the scan before going into the body fishing for the lymph nodes ?
(17) Is it SCC everywhere in the lymphatic system, or lymphoma below the head but SCC in the tonsil and neck or its just another infection which mimics cancer ?