Hi everyone, my name is Amanda and I've had a rather stessful summer so far. For some background info: I first noticed a lump to the right of my windpipe on June 16 and later went to the doctor's about it. He prescribed antibiotics and sent me home. Those did not help, and I actually developed another lump to the left of my windpipe (although it's not as hard as the one on the right). So he left my diagnosis for the time being as adenopathy of the anterior cervical lymph nodes. However, I did have a CBC done and an infection was indicated both times (both before and after the antibiotics were administered). So then he decided to send me to an oral surgeon to see if there was a chronic infection in my mouth somewhere that would cause them to swell up (especially since my blood count did look better after the treatment of antibiotics). That particular appointment was yesterday morning, and I was panicking at that point because I noticed about a week ago that I have a...well, lump may not be the best term...but something, in any case, on the floor of my mouth on the right side. I can feel a little bump with my tongue but when I feel with my finger it's like a squishy piece of skin. When I examined this area further and compared it to the other side of my mouth, it seems like I have what feels like a wet sponge or something on the floor of my mouth. It's squishy, not exactly hard, and isn't white or red (looks the same as the other side, except the back appears to be a bit more raised up). And although the oral surgeon said my mouth was perfect and normal, he seemed rushed and I don't know if it really is normal or something is wrong. He did find an impacted wisdom tooth on the bottom right that needs to come out eventually (I only just turned 19 in May, which is making this more stressful for me), but apparently he thinks the rest of my mouth is normal. And now I have an appointment at the end of the month with a hematologist because for some reason my doctor is convinced that if this isn't an infection and is cancer, it's going to be a lymphoma of some sort. So, I'd like to ask a few questions about my situation and your situations as well.

Did anyone diagnosed with oral cancer have no other symptoms other than an invisible lump in the mouth and/or swollen lymph nodes? Am I being too paranoid about this since I am a 19-year-old non-smoker and non-drinker (never have once and never will) with absolutely no chance of having HPV? Could an impacted wisdom tooth on one side of the mouth cause hard, painless, swollen lymph nodes on both sides of the neck? I am just so worried about this, especially since I'm moving back into my dorm in a few weeks and I would much rather be worrying about organic chemistry than cancer. I think what worries me the most other than what I think is a lump in my mouth combined with the swollen lymph nodes is that the area near the lymph nodes feels odd. Where I can feel my windpipe on one side, the other seems to have the lymph node flattening out and extending onto it and after reasearching online, I'm just afraid that this could be cancer from my mouth making its way down into my neck.

Amanda,
for most of us, the cancer was asymptomatic - there was was pain at all. Only a slight horseness and maybe a feeling of something stuck in the throat. I would be encouraged by your bloodwork. My CBC and WBC was completely normal in the the 2 pre Dx tests that I had. It it normal for lymph nodes to swell up when they are busy fighting infection. We a have a general rule that if you don't respond to antibiotics within 2 weeks then you should see an ENT or Head & Neck surgeon. There are exceptions to this rule, 2 of them are possibly a peritonsillar abcess or a crack in a tooth root. These conditions can take months of antibiotics to treat. In the case of a crack in the root of a tooth, the treatment will only be temporary. Impacted wisdom teeth can cause a lot of problems as well and they should removed by an oral surgeon. You are at the perfect age for this.

When the fear level gets up there you will be looking at parts of your anatomy that you have probably never even been aware of. I actually though a normal salivary gland was a new tumor - My H&N surgeon and I had a good laugh over that one (AFTER the fact of course). I wasn't laughing while I was waiting to find out however.

Statistically, your odds of contracting oral cancer, at your age, are very low. You are being a little paranoid but caution and early detection are never a bad thing. Regular doctors, like GP's, oral surgeons and dentists are not the best qualified to rule anything out. The head & neck is a complex area of the body and you should get a referal to a specialist for your own piece of mind.

Thanks for the advice. My dad actually took me to a different doctor for a second opinion and my blood work came back completely normal this time, so he gave me a referral to an ENT (who I will be seeing on Thursday). Apparently when my mom made the appointment, a fine needle aspiration was mentioned. If something does happen to be wrong with me, is this a good way to get diagnosed? Thanks again.

Amanda,
an FNA would be the beginning. There many tests and scans ahead if they really suspect cancer.
If it is lymphoma, as you mentioned in your original post, that's pretty treatable with a relatively mild form of chemotherapy.

None of us had "invisible lumps", they were usually in the neck area and quite palpable. Typically more than 1 cm (1/2 inch) in diameter. This refering to enlarged nodes. The actual tumor I had was slightly larger than a golf ball.

You are wise to see an ENT and find out for certain, but we don't see many 19 year olds here - so think positive and don't let fear drive you crazy in the meantime.

What I meant by "invisible lump" is that although there is a big, squishy lump on the floor of my mouth, I can only feel it, not see anything noticeably different in my mouth when I look. Sorry about not being clear. And I do have one large lymph node in the left side of my neck as well as one slightly smaller in the right side of my neck. Plus I've noticed three small red bumps to the left of my left tonsil, but they came up within a matter of days, so I hope they're nothing to be concerned about. I think what bothers me the most is that I don't have any symptoms besides these lumps. I don't have ear pain or the feeling of something stuck in my throat, and I haven't been hoarse at all. There's just these lumps that won't go away. If you wouldn't mind my asking, do you know how fast it typically spreads(since I have found the one lymph node in my neck in mid-June it feels only slightly bigger, but not drastically, and the lymph node in the left side of my neck popped up literally over night and doesn't appear to feel any bigger at all)? If there is something in my mouth and it has spread to the lymph nodes on both sides of my necks, wouldn't I be having some sort of symptoms by now? And for anyone that has had lymph node involvement, do they grow fairly rapidly or take months and months? I'm trying not to stress out before I see the ENT, but I'm still worried.

There is a large salivary gland under the tongue, in the floor of the mouth, that feels "squishy". I don't know how you can possibly "see" your tonsils as it requires special mirrors and techniques or a nasolaryngoscope that only an ENT can do. The tonsils reside in the far back of the throat sandwiched next to the side of the base of the tongue. Even dentists and hygenists cannot visualize that part of the throat. When they palpate that area on me (which requires placing a gloved finger all the way to the base of the tongue they are looking to feel something that is hard. Most oral cancers have been there for some time before thay are detected (in my case 2 years) it is unlikely that red bumps occuring suddenly would be cancerous. There are many things it could be besides cancer. Lymph nodes are supposed to swell up to fight infections and they will naturally become tender or painful. You need to take a deep breath and break the lock of fear that has settled upon you. It's been said many times here that "it ain't cancer until the pathology report says it is". It is well for you to definiteively determine the cause of your pain for your own peace of mind and an ENT or head & neck surgeon, with cancer experience, should be able to make a quick determination as to the cause.

Now I feel all embarrased. I always thought that the two little brain-like things to the right and left of the uvula were the tonsils. Sorry. =/

I'm really not all that worried about it, because I haven't had any pain at all and I tend to to associate bad things with pain (although that isn't always the case), but I just don't want to be nastily surprised if I go to the ENT and something does turn out to be wrong. But thank you so much for the info on the salivary gland. At least now I know that it's supposed to be there.

Hi Amanda,
Don't feel embarrassed as the objects you mentioned are indeed the tonsils. When our tonsils are infected or invaded by cancerous cells, they are often enlarged. The ENT may not be sure if there is the tumor in the tonsil or it is just tonsillite until he takes out some tissue for biopsy. In my case, I could see the swollen tonsils easily when I opened my mouth,as you describe, brain-like things.I had my left 'brain' much larger than the right one because my tumor was on the left. Of course for a healthy person, he won't notice where their tonsils are.

Karen

Amanda,

Don't feel embarrased. I can see the tonsils of many of my patients and others have some that are so small, that they cannot be seen.

I'm sure that you are looking at your tonsils if they look "Brain-like", as that is what tonsils look like.

Jerry

Actually Karen and Jerry are right so I'm the one who should be embarrassed! I keep forgetting that mine melted away during the radiation so they actually have to dig deep to find the original tumor bed for the followup exams. When my tumor got large enough I was able to easily visualize it - but it was a big tan rubbery thing, and not "brain-like".

I have to admit I never looked much in the back of my mouth before I got cancer.