Patient's Query
Hello doctor,
I have had two biopsies on my vocal cord. The first result showed high-grade dysplasia. Because the surgeon was concerned about cancer, they performed a second procedure two weeks later: microtherapeutic endoscopic extirpation of the lesion and biopsy.
I had a follow-up two weeks after the procedure. The surgeon said it came back again as severe dysplasia. He confirmed twice that it was not cancer and asked if I wanted to have a deeper excision (because he wanted to be sure they got everything) or follow up in six weeks. They had an MDT meeting, and the decision was surveillance. I chose to monitor it.
I was shocked when I saw this in the report he sent to my GP:
Right vocal cord: at least high-grade dysplasia with areas suspicious but not definitive for invasive squamous cell carcinoma.
Am I right to be concerned that he said nothing about the areas being suspicious but not definitive for invasive squamous cell carcinoma?
Please advise.
Thank you.
Hello,
Welcome to icliniq.com.
Thank you so much for sharing your concern with me.
Based on the information provided, you have high-grade vocal cord dysplasia (a precancerous condition), with histology describing areas suspicious for invasive squamous cell carcinoma, but not definitive. This means cancer has not been confirmed, but there are concerning features that require careful follow-up, as small invasive areas can sometimes be missed on biopsy.
This is why your surgeon and MDT (multidisciplinary team) recommended either close surveillance or a deeper excision; both are medically appropriate options. Your concern is completely understandable, and this wording definitely warrants further clarification.
To better assess your situation, please clarify: your age and sex; whether you currently have symptoms like hoarseness, pain, or difficulty swallowing, and how long they have been present; your smoking history; whether you have had similar lesions before; and any imaging results (computed tomography or magnetic resonance imaging).
Also, please upload, if available, your blood tests (complete blood count, biochemistry) and discharge summaries. Additionally, describe your full medical timeline in detail (how it started, symptom progression, procedures, and outcomes), as this will help determine the most appropriate next steps.
Hope I have addressed all of your queries and concerns. Do follow up whenever needed.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
All he told me was that it is not cancer. I only found this out by chance, and I have been worried since then. Do you think it is okay to wait until my follow-up in six weeks, and is it reassuring that two biopsies have not found definitive cancer?
The last procedure involved the complete removal of the lesion. I have not had any lesions before. I am a 42-year-old female, and I do not smoke or drink. I first saw the ENT last year because of persistent hoarseness that had been present for a few months.
A month back, I was referred to the hospital, where they performed a nasal endoscopy and found some white swellings on my right vocal cord. I had the MLB, and the result showed severe dysplasia of the right vocal cord.
I was immediately referred to a larger teaching hospital and a top consultant. After the scope, he told me that he believed it was cancer and booked me in to remove the entire lesion with another biopsy. I underwent this procedure two weeks after the first biopsy.
I had a follow-up last week, where the surgeon was very relaxed and told me on two occasions that it was not cancer. He said he was not sure if they had removed everything and asked whether I wanted to monitor it or have another operation.
I was surprised he was leaving the decision up to me, but I was just very happy he said it was not cancer. We agreed to have another follow-up in six weeks, when my vocal cords would have healed properly.
Later that day, I saw the report he sent to my GP, which is the same one you saw. My blood results are normal. No scans have been done.
Please advise.
Hello,
Welcome back to icliniq.com.
Based on the information you have provided, your situation appears relatively controlled: you have had two biopsies, and neither confirmed cancer, which is an important and reassuring factor. Additionally, your last procedure involved the complete removal of the lesion, and you do not have typical risk factors (such as smoking or alcohol use), and this is your first occurrence.
The phrase “suspicious but not definitive” means the pathologist saw changes that could resemble early invasion, but there was not enough evidence to diagnose cancer. This is why a surveillance approach is considered acceptable, and a short follow-up interval (four to six weeks) is commonly used to reassess healing and ensure there is no residual or progressing disease.
Yes, waiting six weeks is generally considered safe in this context, especially after complete excision and two biopsies without confirmed cancer. This is indeed reassuring. However, it is important to monitor your symptoms closely: if you notice worsening hoarseness, pain, difficulty swallowing, or breathing issues, you should seek earlier review.
If possible, also clarify with your doctor whether the surgical margins were clear and whether a repeat biopsy might be needed at follow-up. Overall, your current management plan is reasonable but requires careful follow-up.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
Hello,
Welcome back to icliniq.com.
Thank you for reaching out.
If you have any further questions or receive any new test results, please do not hesitate to contact me. I will be happy to help.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
One more thing: I had stopped experiencing pain, but it returned last week on the side that was operated on. I did some singing last week, so I am unsure whether that could have caused the pain.
My last surgery was three weeks ago, and my last scope was one week ago.
Please advise.
Hello,
Welcome back to icliniq.com.
The return of pain three weeks after surgery can still be part of the healing process, especially if you recently strained your voice (singing places significant stress on the vocal cords). At this stage, the tissues are not fully healed yet, so irritation or overuse can trigger pain on the operated side; this is quite common.
The fact that the pain appeared after voice use and had previously improved suggests mechanical irritation rather than something more concerning. Also, your last scope was just one week ago; if no concerning findings were noted then, that is reassuring.
That said, it is important to monitor how things evolve: if the pain does not improve over a few days with voice rest, or if it worsens, or if you develop persistent hoarseness, difficulty swallowing, or other symptoms, you should seek an earlier review rather than waiting.
For now, I would recommend strict voice rest (avoid singing and loud speaking), good hydration, and a gentle regimen.
I hope this helps you.
Thank you.
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Answered byDr. Tkhir Ihor Ihorovych
Medically reviewed byiCliniq medical review team
Same symptoms don't mean you have the same problem. Consult a doctor now!
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