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I had radiation to my head and neck as a child. Consequently…

I had radiation to...

I had radiation to my head and neck as a child. Consequently I developed thyroid disease, had a total thyroidectomy and also developed a brain stem schwannoma which was surgically removed. Also a meningioma. I have been advised to avoid any x-rays including dental x-rays but I developed a small lump on my face. Saw Chief of Head and Neck today. He is almost certain it is benign but wants to do a CT scan to be sure. Should I do this, given the warnings against additional radiation to my head? Thank you.

Doctor's Assistant: How long have you been dealing with this issue? Any other skin concerns?

No, nothing.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Excellent health. Thank you.

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3/22/2018
Dr Uzair
Dr Uzair, Doctor
Category: Medical
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Experience: MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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Customer reply replied 5 months ago
Thank you. I'm not sure I'm logged in correctly but will pay for good answer.

If the lump is visible and its extent is evident on clinical exam, then it can be removed without any additional imaging. However, if the lump involves a structure of the face such as the parotid gland or is near the orbit and there is a possibility of extension into the orbit, then a CT scan is mandatory.

The risk to benefit ratio of the background radiation will tilt more in favor of getting the scan done in the latter case.

Of course, whether you have a history of radiation-induced tumors or not, getting an unjustified CT scan done is not something that is defensible.

I suggest that you discuss your concern with your Head and Neck doctor and ask him if the CT scan will influence his management plan in any way. If not, then you can go ahead and opt for surgical removal without a scan.

I sincerely ***** ***** I have helped you and that I have earned my 5-star rating today! Please remember to rate my service by selecting the 5-stars at the top of the screen (rating me now does not close your question). We can continue here until you are satisfied, simply use the reply box and let me know. Thank you!

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Customer reply replied 5 months ago
Thank you. The lump does not involve the parotid gland and is not hear the eye. It is on the cheekbone. It is not disfiguring and if I were sure it was benign, I wouldn't have surgery. The doctor thinks it is benign but wants the scan to be absolutely sure. I'm afraid the issue of additional radiation will always pose a problem for me. I am in excellent health and take good care of myself but one after the other the radiation I had as a child causes tumors. My primary is away; there isn't anyone else I can ask.
Customer reply replied 5 months ago
Is there anything else you can add? I'm afraid I am just asking for reassurance that I am not causing additional harm to myself.

Imaging a lump does not verify that it is benign. Getting a CT scan done to see if a lump is benign is a far shot.

The most important factors that verify that a lump is benign or malignant are the course of the disease (history), for example, its symptoms and growth pattern. How long a lump has been there, does it hurt, the physical examination - is it fixed or mobile, hard or soft etc. The most definitive investigation to prove the nature of a lump is a biopsy - a fine needle aspiration cytology is perhaps the most minimally invasive way to do that.

Again a CT scan does not prove if a lump is benign or malignant - yes it can give us clues, but that's what they are, clues.

A biopsy is definitive. Surgeons do CT scans to see the extent of the disease and lymph node involvement.

I sincerely ***** ***** I have helped you and that I have earned my 5-star rating today! Please remember to rate my service by selecting the 5-stars at the top of the screen (rating me now does not close your question). We can continue here until you are satisfied, simply use the reply box and let me know. Thank you!

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