Report:
CT of the neck
Clinical History: pain in angle of mandible/left neck pain prior hx of melanoma
Technique: 2 mm axial CT images of neck were obtained after IV contrast administration. Coronal and sagittal reconstructed images were also obtained.
Findings:
Moderate soft tissue thickening in the posterior nasopharynx. Nodular soft tissue thickening in the left side of the
oropharynx. Mildly prominent soft tissue thickening in the right side of the tongue base. The epiglottis is normal in configuration. The bilateral pyriform sinuses and aryepiglottic folds are grossly symmetric. The vocal cords are grossly symmetric. There is no subglottic mass. The bilateral parotid glands and submandibular glands are grossly symmetric, without evidence of discrete mass. The thyroid gland is unremarkable.
There are multiple lymph nodes in bilateral neck, measuring up to 1.1 x 0.6 cm in the right level 2 area a 1.3 x 0.7 cm in the left
level 2 area.
Mural calcification in bilateral carotid bulbs and proximal ICAs
are present, but no significant stenosis. There are mucosal thickening and retention cysts in bilateral maxillary sinuses.
There are dense bony protuberance arising from the hard palate at the midline, likely representing a torus palatinus.
There are small sclerotic focus in the posterior process of C7 and in the posterior portion of the left first rib. There are mild degenerative changes of the cervical spine. Impression:
1. Soft tissue thickening in the posterior nasopharynx and in the left side of the oropharynx. Mild soft tissue thickening in the right side of the tongue base. Direct inspection is suggested.
2. Multiple lymph nodes in bilateral neck, measuring up to 1.1 x 0.6 cm in the right level 2 area and 1.3 x 0.7 cm in the left
level 2 area.
3. Paranasal sinus disease. 4. Torus palatinus.
5. Sclerotic foci in C7 and left first rib. These could represent small bone islands, although other possibilities cannot be excluded. Nuclear bone scan may be helpful for further evaluation.
Primary Diagnostic Code: ABNORMALITY, ATTN. NEEDED Secondary Diagnostic Codes:
NEEDS FOLLOWUP..... ...I will be going to a new doctor (ENT) on the 16th. and a bone scan on the 24th of April . Thank you for any help.......Nick ( pappy5454)

Welcome to OCF! Unfortunately none of us here are physicians or even employed in the medical field. OCFs members are made up of oral cancer patients and caregivers. Some members may be better at interpreting reports than others. Im sorry but I can make out some of the report but not enough to be able to explain it to you in detail. Best thing I can tell you is to have an in depth conversation with the doctor who ordered your tests.

Best wishes!

I like to tell him thank you and I appreciate that help

Hi - this definitely needs follow up do you have an appointment with someone? An ENT? Take care

Thanks Cheryl , and yes I do on Wednesday with the ENT. But I'm out fishing for more information to educate myself when I go to that appointment. This is all I have from the CT scan and a GP Doctor telling me that is this is not good. And I'm a little spoon because of it.

Most of what is on this report is not consequential. The guys that read these things are obligated to comment on EVERYTHING regardless of significance. It is all about covering the asses in case of a law suit if they miss something. So even the most common thing like a palatine torus which half the American population has, and is nothing but a boney growth that you may have had all your life, is mentioned. That you have a thickening of the tissues of your sinus and simultaneously some enlarged nodes in your neck are tied together. That doesn't mean cancer for sure, it could be any infectious process impacting your sinus and draining to the nodes which is the way it is supposed to work. Degenerative spinal issues, again common as people age. Mine is trashed from a life of playing hard and working hard and I always have the same findings.

I wouldn't trust a GP to take this any further, and the one you have telling you this is not good, isn't helpful, nor possibly even accurate. So when you pick your ENT be sure to get one that does head and neck surgery. There are 4 year ENT's who see mostly kids with strep throat and ear aches, and you have 6 year ENT's that go on with a couple years more of education, and a couple of internship to become head and neck surgeons. The second is they type you need to see, they see lots of oropharyngeal cancers. A phone call to the office should establish which you have. You need to have him do a simple fine needle biopsy of the enlarged nodes. This is to determine what is in them that is making them swell, it could be nothing more than the detritus of an infection or something worse like a metastasis of a cancer starting on the base of your tongue. From this scan it is impossible to know. But it is a simple process. If you can feel those enlarged nodes in your neck yourself, determine if they are tender (sensitive or painful) to the touch. That will tell you a lot. A surgical ENT can also take a small biopsy of the tissue on the base of your tongue and get a pathologist to look at it. This is to eliminate or confirm a cancer forming there. Again this is a simple procedure and you will get back a gold standard, black and white answer as to what this is.

The only thing in the whole deal that I would want to know more about is the thickening on the base of your tongue and the thickening, probably real near it in your oropharynx, likely right next to that. Have you had any difficulty swallowing, or the sensation that things are sticking in your throat when you swallow? Is swallowing painful at all, have you have any chronic sore throat, or hoarseness? Have you had an ear ache on that same side for a while? These are all symptoms that you should comment on to your new doctor.

Also you don't comment on how long you have had these symptoms, and what took you to the doctor in the first place. What brought this to your attention enough to go have things checked out? Good luck on the 16th, hope this give you some things to think about and ask the doc about.

Brian is right he definitely knows his stuff, I would find it what kind of ENT you are seeing before Wednesday - I say this because it will save you time if you have to see someone else. As Brian said it could be other things - but you should be scoped and possibly biopsied to make sure.

Take care

Thank you to Brian & Cherly for getting back to me and yes I checked out the doctor and he is an ENT in surgery and cancer. And yes I do have difficulty swallowing, and a sensation that things are sticking in your throat. Been like that for a while. And I went to the doctor because it was time for my 6 mo checkup with my GP (she is part of my melanoma team) and I told her about being sore on the bottom of my left ear and I could feel my nodes and she told me that she was going to send me out for a CT Scan because of Melanoma and a bone scan. My medical team keep a close eye on me when it comes to the melanoma I go to appointment every 4 to 6 months with one or more of my five doctors. I will be going out for my ENT doctor Wednesday the 16th and the bone scan on the 24th of April. All of this because of my history with my melanoma.
And with that I would just like to tell you both thank you.
Nick

Thanks for the clarification. Good job of using your previous experience to make great decisions this time around.

You have some of the warning signs of a base of tongue cancer occurring. For sure these could mean other things, but in a differential diagnosis the first rule of thumb is to rule out the biggest risk item, in this case cancer.

I hope that you do not need us in the future, because of a non-cancer finding. But if you do, this board is full of knowledgeable people that have gone through this before you who are very caring, and will be able to give you a heads up to things to watch for, and work arounds for problems. We all wish you the best possible outcome from your diagnostic visit with the ENT.

Thank you very much for your time
! Nick