Since there have been several posts on this list in the past few days
regarding head and neck cancers, particularly tonsillar cancer, let me gain
share my experiences with the interested persons.
Head and Neck cancers are curable if detected fairly early and if there is
no significant lymph node involvement. The standard treatment has been
surgery followed by radiation (usually 5 to 7 weeks), radiation alone, or
radiation followed by surgery. If there is significant lymph node
involvement the latest protocols call for combining chemotherapy with
radiation--usually Taxotere, 5FU, and cisplatin. Radiation and
chemotherapy can often spare one from disfiguring surgery.
For the gentleman starting radiation it is important that you be properly
evaluated by a dentist trained in maxillofacial prosthodontics and that you
wear flouride trays every night for 10-15 minutes. Since permanent
reduction in saliva usually results from radiation of the head and neck,
you might ask your radiation oncologist to prescribe salagen (works best if
started before treatment begins). Ethyol (amifostine) administered prior
to radiation has been shown, in a recent Duke Univ. study, to reduce the
severity of xerostomia (dry mouth). Be sure to use the recommended baking
soda and salt rinse to help with mouth sores, and if these get too bad then
there is Miles magic mouthwash, and one to one to one (benadryl,lidocaine,
and maalox). The latter helps numb your mouth so you can eat and swallow
with less pain. Its very important to fuel up on high calorie high protein
shakes etc. because as the radiation progresses, you might experience moree
difficulty eating. A friend of mine who had tonsillar cancer lost so much
weight that she had to have a feeding tube. She is doing very well and is
approaching her two year mark. Her staging of the primary tumor and lymph
node involvement was less than mine.
Usually if one makes it to the two year mark with no recurrence or distant
metastasis, one is usually "cured". Five years is of course the official
period. There are numerous trials using accutane (cis-retinoiic acid) to
prevent recurrence of H&N cancers. The results have been mixed.
In my case, my tonsillar cancer took a long time to diagnose. I kept on
complaining of a sore throat and of being dry. My GP and I thought that I
had a virus--I had had several positive tests to the EBV virus. Also
because I never smoked, exercised daily, had an excellent diet and good
oral hygeine the thought of cancer never entered our minds. If when the
digastric lymph node on the right started enlarging we thought it was due
to a viral infection because it was still soft. But then it started
getting hard and larger and I was sick of going to the Dr. and just ignored
it and put it off for a while. When I was finally diagnosed by an ENT
surgeon my staging was T2N3a. Since the lymph node was large I had seven
weeks of radiation first followed by a modified radical neck dissection.
The pathology report showed no positive lymph nodes in the neck and I was
giuven a fairly gooid prognosis (70%).
I was followed up every month for the first year, every second
month for the second etc. (some ENT surgeons follow-up every 3 mnths).
The follow up exam usually involves visual examination of the oral cavity
and manual examination of the neck and face. Every second month the first
year my ENT surgeon used a flexible nasolaryngoscope. All my monthly exams
were fine and a CAt scan of the head and neck area taken 9 months after
surgery was also fine. I was almost back to normal--exercising every day
etc., etc.
One year after surgery a routine chest x-ray showed some thickening in
the hilum. A CAt scan of my chest was recommended at it revealed several
enlarged lymph nodes in the hilar area and several small nodules on both
lungs. A biopsy of one of the lymph nodes indicated squamous cell
carcinoma. My onclogist suggested waiting four weeks and doing a repeat
scan toi see how fast the cancer was growing. In 4 weeks one of the lymph
nodes had doubled in size. Within days I started chemotherapy-Taxotere for
one hour followed by 5FU and Cisplatin 24 hrs for five days. After thge
second treatment there was a very significant reduction in the size of the
nodes and nodules. After the fourth treatment all the enlarged lymph nodes
had disappeared and only twoi very small spots were left on my lungs. My
radiation oncologist called it a phenomenal response. I had one more chemo
treatment in November 1997 for insurance. This week I had a repeat CAt
scan and was shocked to find that the cancer is back --two new lymph nodes
and several spots on both lungs. The oncologists had hoped for a longer
reprieve. There are really very few options left--radiation might buy some
time and then more chemotherapy.
The important lesson is that if the primary tumor is large and there is
significant lymph node involvement or one large lymph node, chemotherapy
should be combined with the radiation, even though CAt scans show no
metastasis to the chest or brain (head and neck cancers usually travel
up to the brain or down to the chest). My brain scans and chest scans were
normal when I was first diagnosed. So was a follow-up chest x-ray before
surgery. What I had was micro-metastasis. I was told at M.D. Anderson
that chemotherapy at the time of radiation might have prevented the distant
metastasis.
A very good resource for people with Oral and Head and Neck cancers is S.P.
O.H.N.C. Nancy Leupold who runs this puts out a Newsletter that has all
the latest information on new treatment protocals. Check it out: http://
www.spohnc.org. Good luck. If anybody knows of new treatments or clinical
trials for metastatic head and neck cancer do let me know.
Klaus de Albuquerque albuquerque@cofc.edu
Professor Office: (803) 953-8183
Sociology and Anthropology Home: (803) 723-7770
College of Charleston FAX: (803) 953-5824
66 George St.
Charleston, SC 29424
USA
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