Surgery Trip Report (Part I): Diagnosis -- Thyroid Cancer (Long)

[colgin]

I was diagnosed with papillary thyroid cancer on July 21.

I had been at the gym in late January or early February when I twisted my neck, which caused a slight pain on the right side of my neck. As I rubbed it I noticed a slightly rounded bump towards the bottom of the right side of my neck. The bump was neither tender nor painful. I later mentioned this to my wife. While she did not think she had noticed it before I thought that the bump had been there for a long time. In fact, since my veins tend to be large and visible I assumed that it was a slightly large vein in my neck that had always been there. My wife said a number of times that I should have it looked at but I was dismissive as I convinced myself that it had always been like that and I felt fine.

A few weeks later I was having a drink with my best friend and he asked me, “What is that on your neck?” I told him that I thought it was a vein and that, in any event, it had been there for a long time. He told me that he doubted it was a vein, but that it definitely had not been there a long time as he would have noticed it before. We both have the same internist and he told me that I needed to go have it checked out. So, in late February or early March I went to my physician for a checkup. He told me that the bump was an enlarged lymph node. Lymph nodes throughout the body can become enlarged for a wide variety of reasons, particularly in children (who get sick frequently), and there was no need to necessarily be alarmed. I had had a bad bacterial infection in January so it was possibly related to that. He said he would take a blood sample and see if that told us anything.

At the end of the week, he called me and said that the blood test did not show anything alarming. My white cell count was fine although my red cell count was very slightly elevated, which could be the sign of an infection. He told me to let him know if the lymph node got any larger or failed to fade away after a while. I did not ask him how long a “while” was, although I probably should have.

April came and went and in May my wife and I went to France for a week and a half. When we returned I decided that I needed to call my internist again since the lymph node had not gone away (nor had it gotten any larger). When we talked, I told him that I should probably see a specialist although I had no idea what kind that should be. My internist gave me the names of two ear, nose & throat doctors on my health plan. One could take me in about two weeks and the other in three. Since this didn’t seem urgent I did not look around any further.

I first saw the ENT doctor on June 29. He reiterated that it was an enlarged lymph node and that while I should not be alarmed or worried, we needed to get to the bottom of the cause since it had been there for a while. He said that he was going to need to go in there with a needle to get a sample but that he wanted me to go for a CAT scan first so he could have a better idea what he was dealing with before we underwent any kind of surgical procedure.

On July 3 I went for the CAT scan. I had never had one before in my life, so I was a little nervous going in. Unlike an MRI, a CAT scan is not an enclosed machine so there is no risk of suffering from claustrophobia. For the CAT scan I was hooked up to an IV which would shoot iodine through my veins to provide contrast for the scan. The technician said that I might have a slight metallic taste in my mouth and it might make me feel a little warm, but nothing unpleasant. While I did feel some kind of sensation going through my body it was hard to characterize it, although I would say a slight buzzing sensation that was over quickly.

The following week I returned to the ENT doctor with my wife. He said that the CAT scan said that I had four “poorly enhancing lymph nodes” on the right side of my neck in addition to the “superficial” one that was visible. This in and of itself did not tell us much. Before taking a sample of the lymph node (which I suppose is a form of biopsy but not a full fledged one in which they would need to surgically remove the entire node) he took a look down my throat and at my vocal cords. This involved putting a topical anaesthetic up my nose with a long Q-Tip, which was quite unpleasant). Then, a viewer is put in my nose and bends to go down partially into my throat. The doc told me that I had allergies, which, of course, I already knew. The doctor then took an aspiration needle and put it in the lymph node in order to get a sample of what was in there. This was uncomfortable but not terribly painful. The procedure was over quickly. The ENT doctor told me that the lymph node was cystic but that the sample needed to be tested at the lab in order to know the cause.

The following week I returned to the ENT doctor for the results. My wife insisted on coming with me, which I thought was unnecessary because I was certain that the doctor told me that everything was OK. We were told that the lab results on the prior sample were inconclusive, probably because of the buildup of fluid in the lymph node. So, the doctor took another sample from my already sore neck. Rather than waiting another week for the results he suggested that if we have time we take the sample directly to a local pathology lab. This way, if this sample was also inconclusive, the pathologist could continue to probe and poke with the needle until he could find a good one. We proceeded to the eye and ear infirmary near my apartment and met with the director of pathology. He examined and we discussed the medical background relating to the enlarged lymph node and then he looked at the sample the ENT doctor had taken under a microscope.

It turns out that this sample was also no good. The pathologist went back into the same spot with another needle and got in there good (not fun for me). He then took it to the lab. About twenty minutes later he came back and told us: “This is difficult to say. . . . When I looked at your sample under the microscope I had the technician doublecheck the slides because I thought it must be a mistake and we had the wrong sample. But we doublechecked all the slides and it was yours. The sample from your lymph node appears to have thyroid cells in them. That’s why I doublechecked to make sure we had the correct slide. Those cells shouldn’t be there. While there is some chance there will be another explanation for this, I think it is about 80% likely that you have papillary thyroid cancer.” He then remarked that even if that was the case, which we were not yet absolutely certain, this form of cancer was 100% curable, although it would require surgery and post-operative treatment.

Since his best ultrasound technician was in for the day, we then proceeded to have my thyroid gland scanned to look for tumors. At first they could not find anything and the pathologist remarked that he was not used to “seeing” healthy thyroid glands. But then sure enough they found a tiny nodule, only about 4 centimeters in length. The pathologist said that it was tiny enough that many doctors wouldn’t try to biopsy it, but that he thought he could get in there and get a sample. The thyroid gland is a butterfly shaped gland at the base of the neck. He approached from the right side of my neck and dug the needle in what seemed to me incredibly deep, but probably was not. It was not incredibly painful but was terribly uncomfortable. With the aid of the ultrasound monitor and technician he found the nodule and was able to get a sample.

We waited for another 20 minutes or so. The upshot was that the pathologist still thought it was likely to be cancer but that he needed to run more slides with the tiny sample he had, but that we might need to come back again. He asked us to check in with him in two days. After two days, he said he still did not have anything definitive. There were some cells that appeared to be papillary thyroid cancer cells, but there were so few that 9 out of 10 pathologists would not make a positive diagnosis. Since in his practice he was used to small samples he believed it would turn out to be cancer. But he needed more information before he could make a final diagnosis.

We ended up having to go back the following week. With the benefit of our actual CAT scan results and the ultrasound he was able to locate a different enlarged lymph node that was under the skin and not visible to the eye. Once again, the needle. This time he got a good sample. I could see that it was a discolored light brown and the doctor noted that the discoloration was not blood. We knew that was not good.

After twenty minutes he came for us in the waiting room and took us to his office. He told us that unfortunately he was correct and it was papillary thyroid cancer. By this point we had been bracing for this and so it came as less of a shock than when it had first been mentioned a week earlier. He reminded us that it was completely treatable and that even though it had metastasized (in that it had spread to the lymph nodes) my overall prognosis should be quite good. Surgery would be required. My entire thyroid gland would need to be removed as well as any tissue in the right side of my neck containing cancerous lymph nodes. We thanked the pathologist for being so aggressive in pursuing the diagnosis and went home to start researching surgeons.

Coming in Part II: Picking a surgeon.

[El Diablo]

c,

"100% curable"

Cool.

[astroglide]

stories like this remind the rest of us how much we take our health for granted. thanks, and good luck.

[z28dreams]

Wow, very scary situation, but glad to hear that you have a curable form of cancer.

Every time I see something like this happen to my friends or family it really makes me reassess what's important in my life.

Good luck picking a surgeon - I'm sure everything will work out for you. Keep a positive attitude - it makes a huge difference in recovery.

-Z

[Dominic]

good luck! It's never fun to hear those words, "cancer," from your doctor (I know), but it looks like they caught it early and you should be right as rain in no time. Looking forward to the next installement...

[mmbt0ne]

Thyroid cancer cases are on the rise in the US recently. Luckily, that's because they've gotten much better at detecting it early or at all.

[TiK]

Good luck to you.

[spentrent]

cliff notes?

[Evan]

[ QUOTE ]
cliff notes?

[/ QUOTE ]
The cliff notes are that you shouldn't open a thread with "cancer" and "long" in the title if you're not willing to spend a few minutes reading it.

[spentrent]

Well EXCUSE ME for thinking it was about astrology.