Suffering From Difficulty In Breathing, Hoarseness Of Voice And Difficult In Swallowing. Suggest?

Posted on Tue, 24 Sep 2013

Question: Hi,
My father has been past 45days suffering from difficulty in breathing,hoareness of voice and difficult in swallowing.
He was undergone 6 cycles of CT and 32 days of RT 2 years ago for laryngal carocima.

45 days back doctor has asked for PET-CT scan and report as below:
Here is the PET-CT scan report :

CT-Findings:

Brain : normal

Neck :

-- Mild thickening of soft tissues of larynx and ary-epiglottic fold noted .. ? RT changes

-- Eccentric focal soft tissue noted on left side in supra glottis with asymmetry- ? Recurrence(for PET correlation)
-- Few small volume (4-7mm)bilateral level II and III nodes noted
-- Rest of Neck structure appear normal

CHEST:
-- Atelectasis in right middle lobe
-- Small 5mm nodule

PET Findings :

-- Normal physiological F-FDG tracer uptake is seen in brain.pharyngeal tonsils ,vocal cords, myocardium, liver, gut, kidney and urinary bladder
-- Heterogeneous, asymmetrically increased F-FDG tracer uptake is noted in left in left supraglattic & left vocal cords regions in larynx, corresponding to suspicious thickening described in CT(SUVmax=7.9)
-- Heterogeneously increased metabolic activity in left vocal cord & supra-glottic region with eccentric soft tissue in left supra-glottic area as described -? Recurrent.
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Here is the FL scope done 30days back and report as follows
Edematous arytemoids,edematous epiglottis,narrowed subglattis-normal,post cricoid region-slough+.

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Please provide your advice , we stay in Hyderbad,India

Thanks in advance.

Answered by Dr. Sriram Nathan (3 hours later)

Hello welcome to XXXXXXX

Thanks for writing back.

I am Dr Sriram Nathan and I am an ENT and head and Neck surgeon who has treated cases relating to the throat including malignancy or cancer.

I have understood your concern regarding the findings in both CT and PET scan done.

The findings in both the cases states and means that there is a suspicious swelling in CT and also there is increased uptake in PET. This implies that there is a doubt that there may be a recurrence of cancer or even that there may be a new growth or cancer in the same field or area. The findings of slough in the area also points out to the same. The findings of nodes in the neck and also foci in the lung point out to a recurrence of the growth.

Most of the time though since your father has undergone RT and CT such findings can be still seen due to the effects of radiation.
Unfortunately the only way to confirm at this stage is to take a small tissue from the said area and send it for pathological examination.
This type of study has to be done in anaesthesia by a procedure called DL Scopy and Biopsy.

You need to consult and ENT surgeon who is well versed in the said procedure (you may consult the doctor in nizam hospitals in Hyderabad for the same)
I usually start most of my post RT patients on tablet Pantoprazole 40mg twice daily before food for two weeks since even reflux can cause such changes or aggravate the same. Your doctor will know about this.

Hope I have cleared your doubts. I would be more than happy to answer any more.

Take care and do not worry. Laryngeal cancers are usually very amenable to teatment and have a good prognosis

Dr Sriram Nathan

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Raju A.T