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Have smoked pot. Scan showed swollen lymph node around neck. Is there any risk of cancer?

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ENT Specialist
Practicing since : 2001
Answered : 2349 Questions
i am concerned of a cancer potentially in my throat area under the right tonsil... i have gone to the emergency room several times, I am 30 years old, 198 lbs, very athletic, but have smoked pot and cigarettes on and off, have quit cigarettes for the past 4 years. I was sick for about a month 4 weeks straight, here are some things I can describe to you, my tonsil stopped pushing out little white residue out of it like my left side normally does, I feel a sensation in the top of my right upper lung which can come and go. When it goes it goes away completely, I had an xray and a ct scan done in the emergency room just 2 days ago, and the ct scan showed several swollen lymph nodes around my neck where it is bothering me. The thing that concerns me is that I have looked and the tonsil has gone down substantially but under neath it still hurts and I no longer feel any cold or infection symptoms whatsoever, I guess I would like to speak to a doctor if it is possible. Also I will add that my lung and throat feel better when I smoke pot, for the past 5 months I got back into it and this is what has lead me to start feeling like this, because when i smoke pot my lymphatic system has trouble clearing out the white stuff in my tonsils that comes out as little white lumps that you can just cough up and spit out, they are gross but its like dead white blood cells... well right now the right side is not producing any, but I have stopped smoking pot, and I feel lymph nodes in my neck as if they are doing stuff. There is a red area under the right tonsil that looks like there is a lot of blood flow to it, just 3 days ago I went to the emergency room and had the doctor look into my throat and she she got the info on the ct scan and basically said that I shouldnt worry about a cancer, but the thing is she did refer me to a mouth throat and nose doctor, but the problem is that I dont have health insurance right now and medicaid is in the process of reevaluating my application. So I cant go to a specialist because they need a method of payment to be looked at, so Iam kind of lost in limbo would love some kind of a response today because i will worry and have trouble sleeping.
Posted Tue, 25 Dec 2012 in Ear, Nose and Throat Problems
Answered by Dr. Naveen Kumar 5 hours later

Thanks for the query and a detailed history

I feel the root cause of all your problems is smoking pot. Smoking causes damage to mucosa of the throat making it susceptible to attract infections. Also, constant damage to the mucosa of the throat causes enlargement of the lymphoid follicles in the throat causing grating sensation while swallowing and turning the neck.

Secondly, any acid reflux from the stomach into the esophagus and throat can present with similar complaints which will not respond to antibiotics. Acid when it regurgitates from the stomach into the throat, causes burning of the mucosa of the throat leading to inflammation of the throat. Inflammation of the mucosa in turn induces swelling in the mucosa of the throat giving rise to foreign body sensation.

The causes of reflux of acid are many, medicines, obesity, stress, food habits, smoking, alcohol, etc. Identifying the causative factors and avoiding them can give you relief from this problem.

The cheesy material which comes out of the tonsil is the accumulated food material and the cell debris in the crypts of tonsils; it is not pus. It is not mandatory that the cheesy material should always be present in the tonsils. Also, the regressing tonsils are not the signs of cancer. Smoking pot reduces the pain temporarily because, the immune system contains cannabinoid receptors which may modulate its function and give you relief. But, this does not control the infection.

Lymph nodes in the neck are secondary to recurrent throat infection. Do not worry! These are mere inflammatory lymph nodes and are not the signs of cancer. Presence of active inflammation can cause pain in the neck and upper chest.

Finally, if you can post the photos of the throat I can guide you in a better way.

My advice to you is:
1. Drink plenty of warm water, this keeps the mucosa hydrated as well as improves the blood circulation in the throat thus reducing the discomfort and the chances of infection.
2. Avoid chilled food/beverages, coffee and alcohol.
3. Use povidone iodine throat spray 3-4 times a day after food.
4. Suitable antibiotic such as a combination of amoxycillin and clavulanic acid or cefuroxime.
5. A proton-pump inhibitor such as omeprazole or pantoperazole for controlling silent acid reflux.

With all of the above measures you will definitely be alright.

Hope I have answered your query; I will be available for the follow-up queries.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
Follow-up: Have smoked pot. Scan showed swollen lymph node around neck. Is there any risk of cancer? 4 hours later
what are symptoms i should be afraid for? because i have not smoked pot in 1 month and it still hurts
Answered by Dr. Naveen Kumar 1 hour later

Thanks for writing back

The features of the carcinoma of tonsils are: Sore throat, ear pain, foreign body or mass sensation, and bleeding. The tonsil can enlarge considerably, bulging into empty oral space before it causes alarm to the individual, enlarged and firm neck nodes. It is very unusual to occur in younger individual.

In your case, the problems appear to be more of long term smoking, I doubt any malignancy. Please follow the above advice and you will definitely be alright. Meanwhile, once you get your insurance please consult your specialist for a complete examination of the throat and the neck.

I wish you good health.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
Follow-up: Have smoked pot. Scan showed swollen lymph node around neck. Is there any risk of cancer? 4 days later
ok so since you have already been on top of my topic I want to add the following informational to the case, so the one side (right side) of my tonsil that was hurting so much for over a week after being sick for a month which led me to believe that I may have cancer has gotten better, but a day after it got better my other tonsil began to hurt, like some infection spread to it, so I am now convinced its an infection of sorts instead of some kind of a cancer. As I have said I was tested for HIV, for MONO, and for strep throat, all came back negative, just 2 weeks ago. I noticed that there are strange kind of small sores on the tonsils and I do not know the root cause of it, but it is very disturbing. The doctors always put my diagnosis as pharyngitis when i went to visit them. Now as I have said I have no health insurance. I do not have a runny nose. I do not have any sort of a cough, and the pain I am experiencing is strictly on the areas of the tonsils where you can see the small sores and the little dark areas. I am still trying to figure out what might be the cause of this, I did start dating a new girl and I did perform oral sex on her about 2 months ago, and we have not been active for the past 3 weeks. She has no symptoms of anything, and I was wondering if this can be a primary HPV infection symptom, or what else it might be I am starting to think its viral and not bacterial. Please advise I am attaching a few photos. In the morning when I wake up I blow my nose and i have a small signature of yellow mucus, otherwise no runny nose all day, no head aches, no rashes, no fatigue, actually no other abnormal symptoms, maybe a small amount of mucus cough up from the throat itself not the lungs, but very very small at different times through out the day, I have completely stopped smoking pot for the past 2 months. I am very frustrated because I have had a sore throat now goin on 2 months, and it was a common cold at first, for the first 3 weeks, then I took antibiotics which helped significantly, then for the past 2 weeks its been this odd symptoms no cold symptoms but tonsil related pain, and it moved from one tonsil to the other but still remains. and in fact now i realize that the pain is the same on the new tonsil as it was on the previous one when i thought it might be cancer related just in a different zone.
Answered by Dr. Naveen Kumar 24 hours later

Thanks for writing back and posting the images.

I have examined the images thoroughly; following are the features which I noticed:
1. The tonsils are perfectly normal; the sore areas over the tonsils are nothing but the normal crypts of the tonsils.
2. The whitish spot on the left tonsil is the obliterated crypt of the tonsil with deposits of food and dead cell debris; keratosis.
3. The flap like structures on the either side and behind the tonsils is the posterior tonsillar pillars. As they appear more prominent, the tonsils appear to be atrophic; but, it is perfectly normal.
4. The most problematic area which I noticed appeared to be the posterior pharyngeal wall (back of the throat). The area is swollen along with post nasal drip.
5. Finally, the uvula seems to be swollen, secondary to recurrent throat infection.

To sum it up, there appears to be more of sinus related problem rather than tonsillar or cancer related problems. Post nasal discharge and the swollen pharyngeal wall is giving rise to recurrent throat discomfort. Please follow the advice 1-4 as mentioned in the previous post and also try taking a mucolytic (such as ambroxol or bromhexine), you will definitely be alright and recover completely.

I wish u good health and good luck.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
Follow-up: Have smoked pot. Scan showed swollen lymph node around neck. Is there any risk of cancer? 22 hours later
I have uploaded an image to show you where on my tonsil it hurts to show the area of concern and where the sore is.
Answered by Dr. Naveen Kumar 17 hours later

Welcome back

I have examined the updated image; there appears to be an ulcer in that area. It is a harmless aphthous ulcer.

Aphthous ulcer or stress ulcer is a painful, temporary sore that may occur anywhere in the mouth. The sores can occur one at a time or as a group. Stress, smoking, alcohol, certain medications, vitamin deficiency, etc. can cause these sort of ulcers.

The treatment of this lesion is the same as I had mentioned before. Along with those medications you can try using oral steroid preparation such as Triamcinolone Acetonide. Triamcinolone Acetonide is a synthetic corticosteroid which possesses anti-inflammatory, antipruritic, and antiallergic action. With these medications your problems will definitely subside.

I wish you good health.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
Follow-up: Have smoked pot. Scan showed swollen lymph node around neck. Is there any risk of cancer? 18 hours later
there is no progress and the visual of my throat is gettin worse, I have a feeling of pain in my right upper lung, and also a more agressive pain on the right tonsil and the ulcer on the left side has gotten bigger, I am at a loss and do not know how to proceed it seems that internally something is destroying my body and I do not know what kind of an agressive infection it oculd be, could it be tiberculosis or hpv, what should I do i do not see any progress and this has been on going for over a month and a half now and the progress is slow and not showing any progress actually.
Answered by Dr. Naveen Kumar 10 hours later

Welcome back

If you are not feeling better, you can try taking a short course of low dose oral steroids. Oral steroids are power anti-inflammatory agents; it will take care of the recurrent pain not subsiding to normal antibiotics in the absence of infection.

Pain radiating from the tonsils towards the upper part of the neck is because of the same innervations.

HPV is not an easy virus to meaningfully test for. Just finding HPV DNA in samples from a mouth swab does not necessarily mean that individuals will develop cancer. For tuberculosis, you will have to get necessary blood investigations such as ESR, complete blood count, interferon-γ release assays, Nucleic acid amplification tests (NAAT).

There is not much difference between the old and new images. Please, follow my advice, you will definitely recover. Also, allow sometime for the epithelium to heal by itself.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
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