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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10341
Experience:  14 years as clinician in the field of Family Practice
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My ESR was 2 and my Full Blood Count test was 'excellent'

Customer Question

My ESR was 2 and my Full Blood Count test was 'excellent' according to my doctor because i coughed abit of blood ( happened 4-5 times ) over 3 months and he did those 2 tests. I am a smoker and sometimes there are pink thread like particles in my cough and thus i have a fear of throat cancer.Can those 2 tests rule out cancer?I am a 20 year old male,smoking for 1 year now.I do not have any other symptoms like trouble talking or swallowing, my cough is only there once in awhile,not chronic coughing,my sore throat is kinda persistent, it gets better with antibiotics and cough mixtures but comes back after 2-3 weeks.Please advice.Thanks
Submitted: 8 years ago.
Category: Health
Expert:  Anthony Bray, MD replied 8 years ago.


These two blood tests do practically nothing to say that you might not have cancer. At

your age however it is almost unheard of for lung or larygeal cancer. If you have a first-degree relative with one of these cancers then your risk of developing cancer in your lifetime would be 50% higher relative risk for lung cancer. (I'm not sure of the statistical difference for laryngeal cancer.) The more likely source of some blood tinged mucous as you describe would by far by infections of the bronchi or sinuses with post-nasal drainage. If you cough up more blood or this is a more recurrent pattern then that would be a more concerning pattern. A full workup to rule out laryngeal and/or lung cancer would include a chest CT, a bronchoscopy and a larygoscopy. I do not think these tests are needed at this time mainly because of your age. These cancers are more of a risk as you get older and have a 20 plus pack-year history of smoking. The main thing that you can do to your benefit now would be to quit smoking. This for one would reduce your average respiratory infections per year in half (on average). If you continue to smoke then your lifetime risk of lung cancer will approach 10% while if you quit your risk will drop to less than 0.5% . I hope this info helps. Follow up questions are welcome if you have any.

If my answers have been helpful and to your satisfaction then please press the "ACCEPT" button so that I may get paid for my work. Thank You and Best Regards,

Anthony Bray MD

Customer: replied 8 years ago.
Why is it that those 2 tests do not say anything in regards ***** *****? wont your red blood cells level and white blood cells level have 'strange' readings if you have throat cancer?

Can an inner cheek biopsy rule out throat cancer?

Patients with throat cancer-how is their cough like? is it there 24/7 even at night or stops at times?

what are the earlier signs of throat cancer?

how long does throat cancer take to get from the 1st stage to last stage?

Thank you very much.
Expert:  Anthony Bray, MD replied 8 years ago.

Hello again!

The blood tests are a matter of degree in terms of what you can determine from them. If you had a sed rate of 2 and normal blood counts then I would interpret that as meaning that nothing of major metabolic or immunologic significance is going on at that time. I have seen patients where the first clue to a malignancy was an elevated sed rate and /or high white count for example. The normal values to my interpretation safely say that you do not have a malignancy of any significant size; but do not mean that you couldn't possibly have some pea-sized group of abnormal cells somewhere. The inner cheek biopsy must have been to evaluate a suspicious looking area. The biopsy tells only what is going on at that spot and can't determine the health of the tissue throughout your body. Symptoms of larygeal cancer are usually a change in voice, chronic hoarseness, a chronic feeling that you need to clear your throat, a "frog in the throat" type of sensation. An ENT can directly visualize your vocal cords with a laryngoscope and this may have been done if an ENT did your cheek biopsy.

With regard to the symptom of cough; many smokers will develop chronic bronchitis due to chronic irritation of the airways. This is the most common cause of cough day in and day out in smokers. Smokers are more susceptible to lower respiratory infections and this is more likely to cause a more severe cough, one that is more likely to keep you up at night and one that is more likely to produce a yellowish productive sputum. With lung cancers; their association with the symptom of cough may depend on their location. Those cancers that start out near the chest wall may not be associated with much cough until they are advanced. Those that start or involve a bronchus are more likely to be associated with a cough. Coughing up bright red blood even in relatively small amounts is potentially a very concerning symptom. If erosion of a bronchus is associated with an infection then this is more likely to be assciated with streaks of blood within a yellowish sputum or a rusty colored sputum.

With laryngeal cancers cough is not typically a primary symptom but may be common in this patient group. As with all cancers , the earlier the detection and treatment then the better the results tend to be. At your age and after only one year of smoking then your risk of either larygeal or lung cancer would be extremely unlikely at this time. I think you are probably becoming overly alarmed about this as a possibilty when in reality it is very unlikely to be connected to your symptoms. That being said perhaps your current fear may be used to the positive to help motivate you to quit smoking before these serious conditions do become a threat. I hope this helps and further follow up questions are welcome if you have any.Oh and it would typically take years for an early cancer to metastasize but this can vary quite a bit.

Best regards, ***** ***** MD

Customer: replied 8 years ago.
Hi Dr Bray,sorry for the long reply.

Just some other questions that i have that i hope you wont mind answering.

I was going through the symptoms of throat cancer and i found the following symptoms:

* Abnormal (high-pitched) breathing sounds
* Cough
* Coughing up blood
* Difficulty swallowing
* Hoarseness that does not resolve in 1 to 2 weeks
* Neck pain
* Sore throat that does not resolve in 1 to 2 weeks, even with antibiotics
* Swelling in the neck
* Unintentional weight loss

I do have cough,neck pain ive had for 2 weeks but it has it is arlight now,in fact i've gained weight,no abnormal breathing sounds,doctor said neck pain was due muscle spasms after he physically examined my neck by pressing it,no lymph nodes,no difficulty in swallowing and there is hoarseness but that is when i feel there is phlegm in my throat,after i cough out the phlegm and spit it out,there is no hoarseness.

My questions are:

Based on what i have written above,does it seem like i have throat cancer?

Is my hoarseness the same as that which is experienced by throat cancer patients?

How common is it to see people of my age getting throat cancer?

When i cough out phlegm,it is usually clear with yellowish dots that i know are caused by smoking,the red threads appear like 2-3 times per day,pinkish red.Is it possible that those threads can be caused by inhaling of fabrics,because i just noticed 5mins ago that my blanket is made of the thread like material and has red/pink threads.
I did not use that blanket yesterday but i still had pinkish threads today but very less compared to yesterday.Could it be caused by that?

I am sorry sir for troubling you but i am just very worried and i hope you understand my situation and answer all of my questions asked.Thank you very much and i sincerely ***** ***** help.
Customer: replied 8 years ago.
sorry sir,another thing i wanna ask.

what are the earliest of symptoms for throat cancer? how long is the earliest time taken for the symptoms to appear? lets say for 3-4 mths i have no symptoms like i read from the net,sld i be fine? thanks!
Expert:  Anthony Bray, MD replied 8 years ago.


Well, I think it is VERY unlikely that you have throat cancer based on your age. Also it is not like you've been smoking since you were 5 years old. Also keep in mind that a cancer does not just get better so symptoms from it do not come and go; they come on and gradually get worse. So hoarseness that comes and goes would not be consistent with a cancer.An early symptom of throat cancer might be a "frog in the throat " feeling or a tickle type cough or hoarseness. Swelling of the throat, coughing up blood, weight loss, neck pain, trouble swallowing would more likely be late type symptoms. I think you are fine. The red threads you have noticed are probably just an artifact from inhaled dust from the sounds of it. I hope this helps.

Good Luck, Anthony Bray MD

Customer: replied 8 years ago.
Thank you sir for your reply.

What do you mean by 'frog in the throat'?. Can you kindly please elaborate more about the earlier symptoms? And you also said that the symptoms get worst on and stuff? How do i know if the bleeding is from my my throat and not from the respiratory areas?

Just how long later do symptoms like weight loss,neck pain ( all the late symptoms ) appear since the diesease started? few months? i heard from some that throat cancer and oral cancer grow very fast and takes just 6 months to reach its last stages,is that true?

Thank you very much sir.
Expert:  Anthony Bray, MD replied 8 years ago.

Hello again;

Well, the "frog in the throat " sensation is a common expression for a feeling that you need to clear your throat , but then your clear your throat and it does not improve. It is the sensation associated with swelling of the vocal cords. It is a common sensation that most people experience on occasion . It is generally associated with a cold and resolves in a couple of days. If you should ever have a throat cancer, we are mainly referring to cancer of the vocal cords because this tissue undergoes at lot of damamge and repair over the years. If a cancer involves the vocal cords then it typically causes an alteration of the voice or hoarseness that would not go away. It may cause ulcerations of tissue that will not heal and so coughing up blood becomes a chronic thing. Difficulty swallowing is a common red flag symptom. This may include aspirating fluid into the windpipe or simply having trouble swallowing food. Cancers that start in the vocal cords may have different patterns of spreading to local tissues and may vary greatly in how rapidly they progress. Some people will stay in denial or avoid treatment for as long as they can which adds to the variable presentation when people are first diagnosed and the estimate of how fast they progress. As for bleeding from the throat vs other areas. A common scenario that many people may have from time to time is an upper respiratory infection which irritates sinus tissues and causes some blood streaked mucous that drains to the back of the throat and may be coughed forward. If you have any ongoing production of blood then it should be checked out. A sinus infection would be limited in time and any streaking of blood would clear up. I hope this helps clear it up for you.

Best Regards, ***** ***** MD

Customer: replied 8 years ago.
i am sorry sir for wasting your time again. Lets say i am able to eat fine without any problems swallowing food or drinking water but have red dots in phlegm now and then,i dont have high pitch breathing sounds and i dont have hoarseness,am i considered fine?

Also,i was crying heavily just now to due a tragedy in the family.While i was crying,there was something kinda poking in my throat,that kinda sensation.I also coughed violently and hardly a few times but there was no blood at all,just the red small thread (twice).Is that a good thing?How much blood in phlegm indicates cancer of throat?

i just stopped smoking last night.Been 21 hours since i last touched a stick.Do cigarettes also cause the throat to bleed when you smoke during an already occuring sore throat?If lets say my problem is caused by smoking,when can i see the difference of the throat healing after qutting smoking? Basically,after how long of not smoking can i see my throat healing?
Expert:  Anthony Bray, MD replied 8 years ago.


Yes, I think you are fine. After quitting smoking you may have about 6 weeks of an increased cough because cilia that move stuff out of your airways are being repaired and the mechanism to keep your airways clear is getting back on track. After that you will experience less cough and probably feel an improved sense of energy. Except for the occasional cold that anyone may get, I think your throat will be fine.

Best Regards, ***** ***** MD

Customer: replied 8 years ago.
is it also possible that the threads that i see are that of nictoine/tar or cigarette content? there are black threads in phlegm but only when they are red/pink/reddish purple do i get worried because i think that my throat is bleeding and that scares me with the thought of cancer.

i really wanna thank you for your time sir,i also suffer from hypochondriasis that you wld had probably guessed by now and i would be greatful to you if you just say any words of encouragement for me regarding my fears,stuff that can make me feel better because i just cannot stop worrying and i spent the whole night sitting awake.
Expert:  Anthony Bray, MD replied 8 years ago.

Hello again!

Yes, I gathered that you had become obsessed with worry over a condition that you had no realistic chance of having at this stage of your life. You need to stop examining every bit of spit with a magnifying glass or a microscope or whatever you are doing! You may have an anxiety disorder such as obsessive compulsive disorder. You might consider seeing a physician who deals with OCD and/or anxiety disorders in general. There is nothing that I can say that is likely to free you from your tendancy to worry. Sometimes our thought process gets sort of stuck in a particular cycle. I kind of like to think of it as similar to a glitch in a computer program. I suggest that you seek help with regard to this problem and it will probably help you temendously if you can hook up with a good psychiatrist . I think you may fit more into the OCD category and not the hypochondriasis category. I hope this helps to point you in the right direction.

Good Luck To You! And if you would please hit the "ACCEPT" button and I would greatly appreciate it! Thank You, ***** ***** MD

Customer: replied 8 years ago.
Hi,upon your advice i arranged to see an ENT specialist. He put a tube through my nose and i thought it was larnygoscopy but i just found out after reading from the net that it was actually endoscopy.

He told me that 'everything is normal'.Can it diagnose throat cancer/larnx cancer as well? I am getting worried again after just a day of happiness.Please advice me as soon as possible.

PS-He sprayed something through my nose and after 10mins,put a tube with a camera and light through my nose and everything was reflected onto a tv screen and he took 4 pictures.How do i know if it was direct optic larnygoscopy or endoscopy? Can you provide photos of both and show me so that i can know what scope he did for me?It would put my mind at ease.Or was it nasal endoscopy?

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