Question: I have a rock hard fixed mass/nodule in or around parotid gland. I had a CT scan which showed a "nodule of I think 1.5 cm mass in/near parotid gland. It is rock hard, and immobile. It appears to be fixed to underlying structure. The doctor who gave me the report said that needle aspiration was not possible, a biopsy is the next step and recommended me to the ENT. I am going to go straight to Markey Cancer Center here at University of Kentucky. He said that it being unmovable denotes fixed to underlyng structure in all likelihood is malignant. I am scheduled to have a bunionectomy in 10 days. I've waited a year and a half for this foot surgery. If I have the bunionectomy first, can they within a week or so go into the parotid and do the biopsy, and is there a lot of facial nerve damage risk here?

My question was why FNA was not possible. It is a 1.5 cm nodule, it is fixed to underlying structure. Does that denote malignancy, and the fact that they cannot do a FNA is that also indicative of malignancy. How many weeks or days would I have to wait between procedures.

Thank you,

Dr. XXXXXXX XXXXXXX

Thank you very much for you detailed and informative answers. I appreciate your patience.

As, spoken of before, I will be contacting University of Kentucky's Markey Cancer Center, they are one of the 10 bests in the nation. I am assuming that if there is a malignancy I am facing Chemotherapy, but I understand further test would have to be done to determine metastases of other areas. I'm real nervous about the facial nerve part, more than the Chemo. I think I can handle Chemo, it's the permanent facial paralysis that has me raveled. Silly, I guess. Like you said, there's procedures that could help that, but from what I read, it could be bad. I'm sure technology and medicine has come a long way in regards to that.

Ah, vanity vanity, we middle-aged women have enough of a fight on our hands.

God bless you, and thank you. I'm a reluctant author, trying to do the work of the Kingdom, my real dream is to be an evangelical philanthropist. I want to build dormitories in third world nations for children and group homes for forgotten vets and special needs children and adults. I was hoping the books I've written would be the gateway to that. Those are my dreams.

I've faced the devil constantly in this battle. My husband just got over prostate cancer. Three months post-surgical, and his last PSA was untraceable, which is good, but so is his sexual function, which is bad. Medication only served to make him sick the next day. They say it's too early to even try or hope. It's been a battle here lately. Could turn out that we both had cancer at the same time. A weird twist of fate, huh?

Blessings,
XXXX

Hi Dr. XXXXXXX

Today, I called Markey Cancer Center at University of Kentucky, it's a great place. They told me that I could not go there just for biopsy in the parotid gland, that I had to go to their regular ENT clinic, unless there was a strong indication of malignancy. I tried to book an appointment w/ UK's ENT clinic and they told me I needed a referral. I called my primary care doctor and got a call back from a substituting primary care physician about an hour later. They booked me an appointment this Friday at Markey Cancer Center, with Rony K. Aouad, MD Department/Specialty Head and Neck Cancer Team Otolaryngology, Head and Neck Surgery Thyroid Cancer Team.

When my regular doctor called back after being on vacation, she looked at the CT scan and mentioned something about CT scan not being specific enough about what lymph involvement there is. The Nodule is in the preauricular region right where the top of the parotid is, right next to my ear.

I've noticed if I move it in a certain direction it does move, but it could be the entire lymph node moving. It only moves in one direction and the skin moves freely over it, so, it does appear to be attached to some underlying structure. It has quite a bit of vascular involvement, in other words, in Dr. Marlowe's words, it's getting a pretty good blood supply.

Here is where I'm concerned. Markey Cancer center told me that I could not come there unless there was strong indication of malignancy, or definite one, thus I had to go to the ENT clinic at UK Hospital. My intuition is that my Dr's are not being up front with me, not wanting me to panic. I'd rather be on the safer side of presuming the worse, rather than being hopeful, or optimistic and having the rug pulled out from under me. I know first rule of thumb is that a physician should not let their patient "panic" and diagnose on the safe side until more definitive answers are available.

Do you agree, they must suspect malignancy or they would not have "rushed" me to Markey Cancer Center. When I spoke to my own physician who just got back from vacation she seemed relieved and happy that they were able to get me in as quick as they did. ENT appointment can sometimes take up to a month, but at Markey, I'm assuming if malignancy is indicated especially with lymph node involvement that they are not going to put it off. They do know about my bunionectomy and they say that is not a problem it's only a week away and I can get it done. But, I'm assuming they want this biopsy ASAP.

Do you agree with my assumptions.

Thank you XXXXXXX

Hi Dr. XXXXXXX

Twice now I've send a follow up question and it doesn't show up when I come to the page, which is why you are not answering it. I don't know why. I hit the submit button. Anyway, I went to Markey Cancer Center today, of course the best of the best in this area is there. He called in a pathologist who performed a FNA. The first two passes were tolerable as far as pain. She was able to extract fluid. I think she did dry smear, then she took it up stairs for initial preview. The liquid appeared clear, not pasty, white or chocolate brown as in a Wharthin's tumor.

She came back down saying that she did not get enough epithelial cells and had to go in two more times, deeper to get more of the tumor, and she reaspirated, very deep inside. I imagine looking for Mucoepidermoid Carcinoma, This I believe will be the Romanowsky Staining.


I'm sure I do not have to tell you how much those hurt. Let's just say it was like getting a root-canal without Novocaine. She went in very deep. This I believe will be the Romanowsky Staining.

The nodule was 1.2 cm in the preauricular region and I noticed after the first two passes, it seemed to have shrunk, but then after the 3rd and 4th, by the time we left the office, it was even bigger than when I came in this morning. I'm assuming because of it's cystic characteristics? No lymphocytes were seen, I was told. I'm guessing rather hoping for low grade MEC, if not pleomorphic adenoma

He scheduled a complete parotidectomy for July 28. Here are my questions and concerns.

At first Dr. Auoud manner was chipper and calming and reassuring. When he came back in after the 4th pass, he seemed more serious and somber. Maybe I'm reading more into this than I should.

I asked him if it being cystic was a good sign and he mumbled something about differential in carcinomas and different kinds of cystic carcinomas. After he left and I had scheduled the surgery the nurse three times looked me in the eye, specifically and said, "Now have a good weekend, really, I mean it. Relax and don't think about it," I found that amusing as she said it three times.

I'm a very upbeat person, normally, so I chuckled at her attempt to get me to remain calm. Because they came back for 2 more passes, does that indicate that they're was suspicious for MEC. I'm a research junkie, I love reading medical reports and journals, along w/textbooks.

So here's my conclusion, because he scheduled a total parotidectomy, that is indicative of a MEC, or some other malignancy, but of course, he can't be sure until pathology 24-48 hours.

There were two things I observed about nerve involvement. They did a typical exam, squeezing my eyes shut asking about any difficulty in swallowing, and he gagged me w/that nasty mirror. He didn't ask me to smile for any length of time, and I never thought to mention that my face twitches if I try to hold a smile. I'm going to assume that to be facial weakness. I've had that for at least two years. I thought I was getting old.

Life's been rough here so, I've not practiced smiling or laughing much, but I find it difficult to hold a smile for a picture. No, I did not tell him that, because he did not ask. I noticed it in my research. I also remembered that I had a fast growing cervical dysplasia in the severe category 23 years ago. I had forgotten. The GYN used cryosurgery to remove it. Hence, my bodies propensity to make pre-cancerous cell changes. I've had clean pap smears ever since.

Of course it's Friday, so I can't tell Dr. Auoud these things until Monday, and by then the report should be in. He asked us to call on Tuesday, but I imagine that's neither here nor there at this point.
Tuesday is my bunionectomy.

I understand there could be facial weakness w/ both but it is more prevalent in malignancies. I never even told my husband, as I felt it was from my not smiling much these last few years, thus using those muscles. (It's been one trial after another.)

Again, I'm not freaked, I'm not even scared. I know in Whose Hands I am in, Job 14:5. A man's days are determined his months are decreed. God has set limits he cannot exceed, likewise Psalm 139:16, "all the days of my life were ordained before one of them came to be."

My question to you, is do I sound like I'm off my rocker, or do you agree?
Is Chemo a likely treatment. I imagine they'll be further tests to see if there is metastases. Is a parotidectomy enough?

I'm ready to undergo whatever the Lord has ordained, as it will only make my ministry to the suffering in the future that much more credible and weighty.

I'm a reluctant author with a dream, I told you, and the dream is outlined on my author page, if you want to check it out. http://www XXXXXXX com/dp/B00GP26WZE God has a plan for me, and I'm ready to walk whatever path I need to, in order to "grow-up."

Thank you for your time, talent and patience with my wordiness. We authors with ADHD tend to get a little wordy.

Blessings
XXXX