Help, is it Cancer?

nhldaughter

Hi, I have been coming to this site for support for my mom's recent non-hodgekin's lymphoma diagnosis (past 6 months). We now discovered my dad has a thyroid mass. So I find myself back here for possibly my dad now. Here is the run-down:

My dad who is 79 years old had some bumps on both arms and one on his right
upper thigh. He saw a general surgeon who assured us that they are all lipomas (just fat),
including the one on his right thigh. Given my mom's recent diagonsis, we
insisted that he evaluate the mass on right groin to confirm. He had an ultrasound and it showed a 7 X 17mm lymph node (to the surgeon's surprise) on
his right thigh as well as 2 other smaller ones along the inguinal area. The
surgeon also discovered that his right thyroid seemed a little large so a
thyroid ultrasound was done which showed large complex nodule measuring 5.2 X
3.7 X 4.2 cm and a large cystic component. A FNA was recommended which he had
done. The biopsy didn't go as well because a hematoma (bleeding) generated at the site and
the radiologist stopped and assured us that the 10cc she aspirated should be
sufficient for cytology. She was not able to take a speciman from the nodular
mass. The pathology report is done and it shows low cellularity with few
aggregates of follicular epithelial cells arragned predominantly in
microfollicules. And the result is labled as "follicular lesion of
undertermined significance" and a repeat FNA is recommended by the radiologist.
The surgeon, however, thinks he should have it surgically removed and biposied.

We have made appts with endorcrinologists and otolaryngologists as people are saying general surgeons are not trushtworthy for such cases.

Please help! Anyone out there recognize those key words on the biopsy report? Please give advice.

Thanks!
Roya

sunnyaz

Is it Cancer
Hi Roya,

I would recommend another FNA before cutting open a 79 year old man. The results are inconclusive but indicate that there might be Follicular cancer cells present in the specimen. Given the other masses, I would see if you can get an ENT or Oncologist to do another FNA to be sure. Is he on blood thinner medication such as Coumadin (Warfarin) or Aspirin? If so, this could have been the cause of the hematoma or they accidentally went into a vein or artery. I am assuming they asked him this before doing the procedure but sometimes this can be overlooked by incompetent doctors. If the specimen was filled with too much blood they wouldn't get an accurate result. Blood thinners (Coumadin, Aspirin, Ibuprofen) should be stopped about five days before this type of procedure but that also has risks as well depending on why a patient is taking them.

Most General surgeons are trustworthy. They do these types of surgeries all day long and are familiar with them. I wouldn't worry too much about that. Just look up the surgeons credentials. I had an ENT (Otolaryngologist)for my Total Thyroidectomy, he did a great job on that surgery but really messed up my Lymphectomy on the second surgery because he just didn't know the nature of how cancer spreads. Any subsequent surgeries involving metastasis should be done by a specialist in cancer.

I hope this helps a little. Your dad is in my prayers.

Blessings,
Julie-SunnyAZ

nhldaughter

sunnyaz said:

Is it Cancer
Hi Roya,

I would recommend another FNA before cutting open a 79 year old man. The results are inconclusive but indicate that there might be Follicular cancer cells present in the specimen. Given the other masses, I would see if you can get an ENT or Oncologist to do another FNA to be sure. Is he on blood thinner medication such as Coumadin (Warfarin) or Aspirin? If so, this could have been the cause of the hematoma or they accidentally went into a vein or artery. I am assuming they asked him this before doing the procedure but sometimes this can be overlooked by incompetent doctors. If the specimen was filled with too much blood they wouldn't get an accurate result. Blood thinners (Coumadin, Aspirin, Ibuprofen) should be stopped about five days before this type of procedure but that also has risks as well depending on why a patient is taking them.

Most General surgeons are trustworthy. They do these types of surgeries all day long and are familiar with them. I wouldn't worry too much about that. Just look up the surgeons credentials. I had an ENT (Otolaryngologist)for my Total Thyroidectomy, he did a great job on that surgery but really messed up my Lymphectomy on the second surgery because he just didn't know the nature of how cancer spreads. Any subsequent surgeries involving metastasis should be done by a specialist in cancer.

I hope this helps a little. Your dad is in my prayers.

Blessings,
Julie-SunnyAZ

Thanks!
Julie, thanks for all the advice! He was on baby aspirin (81 mg) and they never told us to stop it until after the bleeding occurred. I was so mad at the incompetence of the radiologist! We have two appts lined up, one with an endocrinologist and one with an otolaryngologist. I am for another needle biopsy too, but the general surgeon says once follicular cells are seen even with that small speciman why go do the fine needle biopsy again?
I hope the other appts go well. I did look them up and they have pretty decent reviews by patients.
Anyone else, please share your advice...

Roya

Baldy

nhldaughter said:

Thanks!
Julie, thanks for all the advice! He was on baby aspirin (81 mg) and they never told us to stop it until after the bleeding occurred. I was so mad at the incompetence of the radiologist! We have two appts lined up, one with an endocrinologist and one with an otolaryngologist. I am for another needle biopsy too, but the general surgeon says once follicular cells are seen even with that small speciman why go do the fine needle biopsy again?
I hope the other appts go well. I did look them up and they have pretty decent reviews by patients.
Anyone else, please share your advice...

Roya

Neck Lymphadenectomy
Hi Roya,

Perhaps my experience may be helpful. When it was decided I should have a lymph node biopsied, I was sent to a general surgeon. At first he suggested a fine needle aspiration, but then decided I should have a CT scan to get more info. The CT scan revealed the node was cystic. Following this he said forget the aspiration, I should have it removed for analysis. He also said, he didn't want to do the biopsy and referred me to a head and neck surgeon. His reason was, if the biopsy came back positive, more surgery might be necessary and he didn't want to make things more dificult for the head and neck surgeon. So, the head and neck surgeon did both the lymphadenectomy and the total thyroidectomy w/ radical neck dissection.

From my experience, I would suggest you may want to find a head and neck surgeon and you may want to ask that surgeon how much experience he has doing the surgery you need and the surgeries you may need later. Something my internist said regarding slow moving cancers may also be appropriate, the cure may be worse than the cancer for a 79 year old man. Of course you'll want the cancer {if it is cancer} typed and staged before you make that decision.

Good luck to your dad!
Alan