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Throat pain, unable to swallow, pain on biting, chewing, white patches on tonsils. On amoxicillin. History of throat and esophageal cancer. Causes for pain?

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ENT Specialist
Practicing since : 1991
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hi doctor....I am 48, 3 and half months ago I had very severe pain started my right side throat. I can eat, drink and can not swallow my saliva. I consulted with a doctor, he prescribed pencicillin tablets that was not helping to settle the pain. Then next week I seen another doctor, he advised me to drink plenty water It should be viral. After one week again I fealt more pain then I approached another doctor he checked whole my body and nothing wrong any unusual symptoms, he prescribed amoxicillin 500mg cap. for one week. Then I had been pain till 5th week, after that it slowely settled. I never had this type of pain and I am always having problem with my throat from my young stage.
After this incidence still I am feeling slight pain and throat discomfort always.
Three weeks ago I noticed my right tonsil had a changes, and when I open, biting, chewing, my mouth was painfull. Then I seen again doctor, he prescribed 56 penicillin tablets for 14 days. Now the mouth pain settled. But one white patch on the middle of right tonsil still have without pain and slowely enlarging. After the two weeks antibiotics I seen again doctor, he refered to ENT specialist. And still he saying nothing wrong with my tonsil. I have two family history about throat and easofage cancer. I am bit worried. Please reply soon for me.....
Posted Sat, 21 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 36 minutes later

Thank you for your query.

1. When in doubt, you should insist on a small biopsy from the edge of the enlarging white patch on the right tonsil. Tonsil biopsy is not a common procedure and is usually a XXXXXXX biopsy is avoided due to excessive bleeding at times. Esophageal biopsies require endoscopy.

2. Requirement for biopsies is especially indicated if there is exposure to tobacco and alcohol. You may also insist on a test for HPV (Human Papilloma Virus) in the sample. Presence of HPV is associated with higher risk of oro-pharyngeal cancers, depending on the sub-type.

3. Tonsil and esophageal cancers are rare. A negative biopsy should be sufficient to put any immediate fears to rest.

4. Local control of tonsillar and esophageal cancers is good if caught early. Distant spread is difficult to control. New investigations such a PET (Postiron Emission Tomogram) Scans can help here.

5. Oropharyngeal cancer is rarely painful in the early stages. In your case the following conditions should be ruled out:
a. Glossopharyngeal neuralgia
b. Eagle's Syndrome due to an elongated styloid process.
c. Hyoid bursitis
d. Acid reflux which includes GERD (Gastro Esophageal Reflux Disease) and LPR (Laryngo Pharyngeal Reflux)
As I believe that more information helps a physician arrive at an accurate diagnosis, I would request you to answer the following questions:

1.     Do you have any difficulty swallowing?
2.     Do you have any history of change in voice?
3.     Any history of blood stained expectoration?

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

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