Having already recently gone through a CT scan with contrast, I wasn’t overly apprehensive about the PET/CT scan. In fact, the biggest issue for me was not being able to drink anything other than water until after the procedure that was scheduled for late in the morning. Being an avid coffee drinker, this was quite stressful! I was brought to a room where the radioactive injection was administered and then waited approximately an hour for the drug to circulate before being scanned. This was a much longer procedure than the original CT scan and took around 2-hours total. By now, I was familiar with the online patient portal that provided very quick results from imaging studies performed at St. Mary’s. By mid-afternoon I was able to read the radiology report online. The report indicated that the cancer likely originated in my right tonsil and had spread to nearby lymph nodes.
This is the point where having a background in oncology is both a blessing and a curse. I knew that “staging” describes the severity of a person’s cancer based on the size and/or extent (reach) of the original (primary) tumor and whether or not cancer has spread in the body¹. This is important for several reasons:
- Staging helps the doctor plan the appropriate treatment.
- Cancer stage can be used in estimating a person’s prognosis.
- Knowing the stage of cancer is important in identifying clinical trials that may be a suitable treatment option for a patient.
- Staging helps health care providers and researchers exchange information about patients; it also gives them a common terminology for evaluating the results of clinical trials and comparing the results of different trials.
As a tumor grows, it can invade nearby tissues and organs. Cancer cells can also break away from a tumor and enter the bloodstream or the lymphatic system. By moving through the bloodstream or lymphatic system, cancer cells can spread from the primary site to lymph nodes or to other organs, where they may form new tumors. The spread of cancer is called metastasis. In view of the fact that my cancer originated in the right tonsil, I knew that based on the PET/CT imaging results it had already spread from the primary site to the lymph nodes (not good).
Using the oral and oropharyngeal cancer staging criteria for tumor (T), node (N), and metastasis (M), also known as TNM, I had stage IVA cancer of the tonsil due to the fact that the enlarged lymph node measured more than 3cm and/or may be in more than one lymph node².
¹ National Cancer Institute
This afternoon, I received a call from my ENT confirming what I had already known or suspected – based on the biopsy results I had cancer. In particular, squamous cell carcinoma. Doctors describe cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade can help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade (such as G1 or G2), the better the prognosis. In my case, unfortunately the cells were poorly differentiated (G3 or G4).
The cancer was in the enlarged lymph node, but that was only one of the locations where it had spread. We needed to know where the cancer originated. Based upon a review of the various markers evidenced in the pathology report, I grew increasingly concerned that the cancer started in my lungs. The next step was to perform a PET/CT scan to reveal the primary source of the disease.
It was the day before Thanksgiving and I was waiting for the water to heat up before getting into the shower. Glancing at my reflection in the mirror, I noticed that the right side of my neck looked a bit larger than the other side. Placing my hand on my neck, I could easily feel an unusual lump just under my jaw line that clearly wasn’t there the day before. It was a solid mass and wasn’t sore at all to the touch. A quick search on Google made me nervous enough to reach out to my general physician and they were kind enough to get me in that afternoon. I’m not generally a pessimistic person, but I had already prepared myself for either lymphoma or head/neck cancer.
Remarking that he could sense the level of concern on our faces, the physician suggested that the lump was a blocked salivary gland and that such a condition could be either painful or not. He prescribed an antibiotic (levofloxacin, 500mg) and stated that the lump should decrease after a few days unless there was a stone or other obstruction causing the blockage. In any event, I was to follow-up with him around Monday unless there was severe pain or discomfort in which case I could consider going to the emergency room over the weekend. In the back of my mind, I was still convinced we were dealing with something different. As stated in the peer-reviewed literature, “More than 75% of lateral neck masses in patients older than 40 years are caused by malignant tumours, and the incidence of neoplastic cervical adenopathy continues to increase with age.”¹
¹ Gleeson M, Herbert A, Richards A. Management of lateral neck masses in adults. BMJ : British Medical Journal. 2000;320(7248):1521-1524.