topic Re: Head and Neck Cancer and ENT’s in I've just been diagnosed

Head and Neck Cancer and ENT’s

Mumto4 — Tue, 08 Jan 2019 00:54:23 GMT

Hi there. I haven’t been diagnosed but have been referred and have a few questions regarding the diagnostic process for head and neck cancers. My GP has referred me to a private ENT as she feels I need to be seen quickly and the public system will take too long. She seemed to think that a private ENT would still be able to refer me to the public system and potentially get a scope, biopsy etc done quicker that way.

Has anyone else gone through this way? I’m concerned that seeing the private ENT for an initial consultation will mean I will end up needing to go through the scope and everything privately and I’m not sure I can afford that. I do have private health insurance but I expect it would still be a huge out of pocket expense.

I assumed that a potential cancer referral through the public system would be seen quickly but my GP seemed to think it would still take months. I’m feeling a bit confused and overwhelmed by everything and very concerned about the cost (but I also don’t want to wait for months if it IS cancer). Does this sound like the normal process?

Re: Head and Neck Cancer and ENT’s

nosfalamos — Sun, 06 Jan 2019 09:33:18 GMT

Hi mumto4,

This must be a very difficult time for you, having a potential diagnosis looming and also trying to navigate our difficult health system.

The way public health works with referrals is through a triage process or "categorisation". When the relevent department receives your GPs referral, a doctor will categorise it in terms of its urgency. Many potential cancer related referrals are categorised highly and are seen quicker, however it does depend on a few factors including your complaint and how well your GP has written the referral (ie the key information they have provided). It can't hurt asking your GP to put in a public referral as well and seeing how they categorise it. I know in Qld, if it is categorised as a 1, you will be seen in 30 days.

Hope this helps, and all the best on your journey.

Re: Head and Neck Cancer and ENT’s

Mumto4 — Sun, 06 Jan 2019 23:21:29 GMT

Thanks Nosfalamos. I just rang the private ENT she referred me to and they can’t see me for 9 weeks (but they didn’t ask for any details or a copy of the referral). I’m not sure if it’s worth ringing them back and giving them more information or seeing the GP again and asking for a referral to the public system.

My concern is that I’m worried about oral HPV as I had CIN3-precancerous cells removed from my cervix 15 years ago, caused by HPV. That progressed from CIN1 to CIN3 to precancerous in less than a month and my gyn told me if I had left it another two weeks, it would have been even worse so I’m not sure I’m comfortable waiting another two months. But at the same time, I don’t want to overreact and be a drama queen because statistically speaking, it’s unlikely to be anything sinister.

Re: Head and Neck Cancer and ENT’s

nosfalamos — Mon, 07 Jan 2019 20:58:40 GMT

I’d ring them back. Maybe though that’s their wait time for their most urgent cases? You could ask them how they categorise their referrals. Give them your details, and if it is truely 9 weeks then get your referral sent elsewhere. The health system is full of obstacles, both public and private! Given your history, it would be wise to act fast.

Re: Head and Neck Cancer and ENT’s

Colt45 — Thu, 04 Jun 2020 07:20:50 GMT

Hey MUMTO4,

I found out 4 weeks ago that I have head and neck cancer I was refereed by my Doctor to ENT and within 8 days I was called by ENT at RPH within 5 days I had PET and I am having Biopsy next Thursday so all happening pretty quick have not paid a cent and I was going to go private but was told it would take longer and cost heaps so glad I didn't. I hope you are going ok it is a lot to take in and go through I also have 2 young children.I am waiting on PET scan results and then I guess I will know where I am at.What Cancer do you have?

Re: Head and Neck Cancer and ENT’s

CaptainAustrali — Sun, 21 Jun 2020 13:31:14 GMT

Sorry, I realise this comment is late - but I think your GP made a really bad call. If you were referred into the public system, cancer is always looked at on a high-risk basis. Even in the middle of all this COVID fun & games, you would have been seen pretty promptly I reckon (unless you live on a cattle station or something).

In my experience, the public system is great, and probably even more accessible and quicker than a private doctor, who deals with scheduling and whatnot based on their own criteria. (Honestly, my personal opinion is that your GP might be some kind of an idiot - and gave you horrible advice - you should have immediately been referred to your local metro hospital ENT clinic for urgent diagnosis).

The public system is good, and part of the reason is the triage / duty of care mandate - cancer is life threatening, so it jumps the queue over a lot of chronic, even very serious, respiratory issues.

But yeah, further - your GP can order a biopsy - without knowing the details, they can refer you to one of the imaging clinics (many of which provide bulk billable services). In my case I was referred for a fine needle aspiration / biopsy by my local GP, which he did concurrent to referring me to the hospital ENT clinic.

It's all situational, so I may be unfair not knowing the detail - but let's say the suspicious symptoms were fatigue and a swelling in the lymph node on the left side of your neck .. doctor could have referred you for urgent ENT evaluation in the hospital system while concurrently obtaining a biopsy. That's what happened for me, anyway.

Sorry, no two ways around it, I personally think your GP screwed up. I think they made a bad call. Sure, it's just my two cents, and maybe completely unfair, but I really don't think the course of action they suggested is sound or prudent, as a person who's gone through all this stuff from a patient's point of view. It was further delinquent of them not to take into account your resources and any limitations in that regard - what the hell is the point of pressing you toward a private clinic if you are worried about being able to pay for the consult, let alone subsequent bills ?

Further, not every private ENT is going to be highly competent with the oncology stuff. Sure they'll know all about it no doubt, but some ENTs might have more of a surgical background than diagnostic, who knows - they're just one person, whereas in the hospital system it'll be the ENT clinic and a team of doctors, so you can be pretty comfortable one of the attending physicians looks at suspicioius oncology stuff every day.

The major metro hospitals will have a multi-disciplinary approach with initial cancer diagnostics & treatment plans - you get looked at by a few ENTs, radiation oncologists, chemo oncologists, they look at the scans, discuss your case - having an outside ENT involved or steering is probably even non-viable (and likely pretty bloody expensive)

Maybe you're in an area where the local hospital service is very limited, and they have more insight into that than I do - so take my remarks with a grain of salt ..... BUT .... whether it's Cairns Base Hospital or Brisbane Metro's RBWH, they'll take a potential cancer prognosis seriously and prioritise accordingly. Maybe you're in a black spot area or something .. but if you're in one of the major cities, I'd take a very long look at your GP.

Let us know how you went - hopefully no cancer (but hey, in my experience where there is smoke there's fire). If you did get diagnosed with cancer, I hope the prognosis is good, and treatment is already underway. It's outside my experience whether a few weeks can make a trajectory difference for whatever class of cancer (mine was tonsil), but hopefully everything is on track, even if you got off to a shaky start.

Sorry if this reads a bit ranty - I guess I am a little angry about the advice you got, it really seems to me to fall so clearly and notable in the "BAD" column.

Hope it's all worked out, let us know your situation if you are so inclined ?

Re: Head and Neck Cancer and ENT’s

Andz — Thu, 10 Sep 2020 03:03:06 GMT

I have a private ENT that specialises in cancer removal in the throat with a TORS machine. The public sector hospitals do not allow usage of the TORS for ENT. Paid a bit to use it in a private hospital as the costs of the Tors lies outside Medicare.

Unfortunately the cancer has re-occurred in the other tonsil so I requested a referral to the public cancer center for radiation/ Chemo treatment. I need more support this time that private doesn't give without mortgaging your house. Got a call back after 1 day and seeing the radiation oncologist next Tuesday. Not having an op this time as the cancer is a bugger and we don't think having another op will totally remove the cancer.