3 Month Follow-up - ENT

Well, my three month follow-ups are here which will be with my ENT, oncologist and radiation oncologist.  Today I had my appointment with my ENT but I have to preface this with what happened the middle of last month.

When I had my appointment with my ENT back in March he gave me an order for a CT scan with and without contrast.  Well last month I called to schedule the appointment and the imaging department ran it by insurance.  Insurance denied it because it was with and without contrast and they would only approve one.  So the radiation department called me and told me it was denied and to speak with my oncologist to see if he could get it approved.

So I did just that.  However my oncologist called me back and gave me some news that really surprised me.  He told me that he doesn't recommend follow-up scans for me.  He told me that they can generate false positives which cause unnecessary biopsies and surgeries pursuing something that's not there and can actually do more harm than good.  He said he basically relies on physical exams to check on recurrence.  All this time I was under the impression that periodic scans were the norm.

I passed this information onto the radiology department and, long story short, my radiation oncologist submitted the order just with contrast and got it approved.  So this last Tuesday I went in and had my CT scan done.

Today I was eager to discuss this scan/no scan business with my ENT as well as my general progress.  I got there and he immediately scoped my mouth and throat.  He mentioned he could still see some sores on the right side of my mouth that haven't healed yet.  Down in my throat he saw what looked like a fungal infection going on.

After scoping me he gave me the news that the radiologist found a 17 mm mass in the images.  My ENT said he doesn't think it's anything to worry about.  The radiologist only looks at the images and doesn't see the patient.  He said it's probably either the fungal infection or scarring.

I told him about what my oncologist said about not doing scans.  My ENT thought that was strange and said that it's usually the oncologists that are ordering scans and the ENTs that are relying on physical exams because they have the tools to look inside the mouth, nose and throat and oncologists don't.  He posed the question, "Then how are they supposed to know if a cancer returns or spreads?"  I said that was a good question.

After a moments though he said that maybe because my cancer was caught at such an early stage, T1N1, that maybe my oncologist thought that I wasn't a high risk for recurrence.  Could be.  That's a question I'll have to ask when I see him next week.

My ENT said that now that we have this CT scan as a baseline he'll do another physical exam in a couple months and then decide if we need to do another CT or other modality scan a month after that.  Then we'll be able to compare what they saw in this scan to see if that mass has grown or stayed the same and that will tell us if it's something to be concerned about.

He prescribed lozenges for the fungal infection and I scheduled my appointment for two months out.

Discussing this with my wife while leaving the office she reminded me that this may be exactly why my oncologist recommended against doing any scans; false positives.  Makes sense.  I sure feel like I'm putting a whole lot of trust in my doctors and for a person with trust issues, that's saying a lot.

I'm not too worried about this right now.  Another thing to consider is that I had my other tumors for more than 5 months and they were less than a centimeter.  Now, I just went through all this radiation and chemo and 3 months later something that wasn't there is now showing as 1.7 centimeters big.  Pretty unlikely that a cancerous tumor just showed up out of nowhere after radiation and is that big.  Make more sense that it's a fungal infection or scar tissue.

I have appointments with two of my other doctors next week so I'll see what they have to say.  Just trying to stay positive and focus on being healthy.