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Thread: throat cancer and outdoor work after treatment

  1. #1
    Newbie New User
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    Jul 2016

    throat cancer and outdoor work after treatment

    I work on the railroad in a really humid enviroment...I dig, climb, lift and get much exposure to sun...after 35 radiation treatments and chemo...what am I to expect returning to work...we have no light duty

    I have squamous cell carcinoma to the oropharynx ...im 58 years old ...do i need to look at medical retirement ?

  2. #2
    Administrator Top User Kermica's Avatar
    Join Date
    Jul 2009
    Hi rremt and welcome, though I am sorry you have reason to be here of course. I don't know that anyone is going to be able to answer your question any better than you can after you return to work. If you find that you cannot deal with the work environment then you will need to talk with your care team regarding your choices.

    Do this very carefully. It is important to protect one's options and choices when considering a disability claim. Be sure that you are following the work rules as you proceed in order to not inadvertently give up something that cannot be recovered. Since you work for the railroad, I suspect you are in a union. If so, a conversation with lyour union rep regarding your options and how best to protect them would be in ordder. Good luck to you and keep us posted.

    Good health,

    When the world says, "Give up," Hope whispers, "Try it one more time."
    ~Author Unknown

    Age 67
    Follicular lymphoma diagnosed August 08, Stage 1
    2 cycles (20 treatments each) localized radiation to tumor sites. Remission confirmed July 09
    Restaged to Stage 3 May 2010
    Recurrence confirmed May 2010 - Watch and Wait commenced - multiple scans with minimal progression.
    Cutaneous Squamous Cell Carcinoma diagnosed September 2012. Mohs surgical excision 09/2012. Successful, clean edges all around.
    Significant progression detected in PET scan - December 2012
    Biopsy to check for transformation 1/18/2013 - negative for that but full of lymphoma, of course.
    July 2013 - Rescan due to progression shows one tumor (among many) very suspect for transformation, another biopsy 8/12/13.
    August 2013 - No evidence of transformation, 6 courses of B+R commence 8/29 due to "extensive, systemic disease".
    February 2014 - Diagnostic PET scan states: Negative PET scan. Previous noted hypermetabolic cervical, axillary, iliac and inguinal lymphadenopathy has resolved. Doctor confirms full remission.
    June 2014 - started 2 year maintenance Rituxan, 1 infusion every 3 months. Doctor confirms lump under right arm are "suspicious" for recurrent disease, deferring scans for now.
    February 2015 - Doc and I agreed to stop R maintenance as it is depressing my immune system too much.
    June 2015 - Confirm that the beast is back by physical exam, will scan in August after esophageal issues settle down so we can get a clear view.
    August 2015 - physical exam in error, PET/CT shows no evidence of disease. Remission continues well into second year!
    December 2015 - Cardiologist tells me I have plaque buildup growing at an alarming rate. Stent or bypass down the road but not yet...
    March 2016 - new tumor below the jaw so remission is over. Back to active surveillance until treatment is needed.
    June 2016 - C/T scan indicates presence of multiple lesions in iliac chain.
    August 2016 - PET/CT shows multiple areas of lymphoma as expected plus new areas of concern in bowel.
    January 2017 - C/T scan shows significant progression in cervical and inguinal lymph chains, largest tumor is impacting hearing, measures 2.1x4.6 cm. 4 to 8 cycles of R-CVP, 1x3weeks to commence 2/6/17.
    April 2017 - Mid treatment scan shows about 1/3 reduction in multiple tumors. Also shows abdominal aortic aneurysm with peripheral thrombus. Cardiologist changed meds, spoke of need for surgical repair down the road.
    September 2017 - finished 10 rounds of R-CP, V was stopped due to neuropathy in feet. No further treatment planned at this time, at least 10 tumors can be felt which seem to be growing again.
    December 2017 - Biopsy of external iliac node with SUV of 13.1 shows no transformation! However, the FL grade is now 3A instead of Gr 1-2. Will start indefinite protocol using Copanlisib, one of the new targeted therapies. I remain hopeful.
    March 2018 - Copanlisib failed, treatment stopped 3/28. New plan is to go to Dana Farber on 4/16 for case review and treatment recommendation.

    May 2018 - did not qualify for clinical trials at Dana Farber. Tumors need to get larger to be considered. On consultation w/Dr. Armand at DF and my onc, have decided to take a break from cancer treatments. Will have a biopsy of the mass in my sinus discovered in scan at DF and to get the aneurysm repaired as it has developed a potentially catastrophic penetrating ulcer. Surgery scheduled for 7/12.

    September 2018 - biopsy of mass in nose shows transformed DLBCL throughout. Assessing options for this negative development.

    October 2018 - started 6 to 8 cycles of R-CHOP. Goal is to get to full remission to open up other options.

    February/March 2019 - PET shows four hot spots following R-CHOP. referred to Dana Farber for stem cell transplant. Pre testing all good, accepted for Auto Transplant. Will begin inpatient process about April 1.

  3. #3
    Moderator Senior User IndyLou's Avatar
    Join Date
    Jan 2014
    Hello, rremt. I had the same kind of cancer...it's been over 3 years now since my treatment ended, and I'd have to say that life is going pretty well.

    If you have not started treatments--let me give you a little background on what I experienced. Every cancer patient deals with their cancer and treatments a little differently, but here's what happened to me.

    I received a weekly infusion of cetuximab, also known as Erbitux. This is a targeted, monoclonal antibody, so it's not like traditional chemotherapies. There is no nausea, no hair loss, no nerve or other organ damage. It does dry the skin out a bit, so your fingers, mouth, nostrils, and toes can become irritated. You usually also develop a skin rash on the torso, that can extend to the face and scalp. Most of the side effects can be managed, and they're not too debilitating.

    The second week after the cetuximab started, I began a 35-day regimen of IMRT for the SCC in my oropharynx region. Each session of RT started with a CT-scan of the next area so the radiation oncologist could precisely direct the treatment. Then, each dose of radiation took about 6 minutes to administer. From a daily standpoint, you really don't "feel" anything as far as the radiation goes, at least not at first.

    The radiation effects are cumulative. By about the second full week of treatments, my throat began to get a little horse. After the third week, I had visible signs of mucositis--inflamed gums, tongue, and hard palate. My appetite had been gradually waning, and despite the feeding tube I had inserted, I took less and less nutrition. That was a mistake.

    By the fourth week, I started to dehydrate, and the IV insertion became more challenging. I probably dropped 10 pounds of weight before I was halfway through my treatments, and that left me weakened. At that point, I worked in the mornings, and received my radiation treatment in the early afternoon. Although most of my work is in the office, I did little after my treatments--all I wanted to do was to go home and sleep.

    Getting nutrition was the most challenging part for me. When I was halfway through the treatments, there was very little I could eat. I started using these cartons of liquid nutrition, designed to be used with feeding tubes. Still, I could take about a maximum of 6 cartons per day--about 2100 calories. Some days, I only took 5 cartons. My mouth and throat became so fried, I had little interest in eating--by definition, I was probably slightly anorexic. That reduction in my nutrition did a lot of short-term damage in terms of my ability to perform physical tasks because my body was so weak and atrophied.

    Within a month or two following the treatment, while I still wasn't able to eat regularly, I slowly gained back some of the energy I had lost. My diet mostly consisted of what I took in through my feeding tube, and what little else I was able to nibble on to supplement my energy needs. I spent a weekend in NYC that summer, and walking a couple dozen blocks around the city definitely tired me out, though I was only two months beyond treatment.

    By six months however, I would say that while I couldn't eat everything, I was mostly back to my normal self. It took a good 4-6 months for the hoarseness in my throat to clear, but physically, I felt normal. I don't know if your medical retirement is a permanent thing, or a temporary status. If you have the option of taking a medical leave, that seems more suitable, because you will heal It'll probably take more time than you might think (months, rather than days or weeks.) It's likely that there will be a period of time in which you will physically be unable to perform tasks that require body strength, especially if you lose a lot of weight during your treatment.

    As for the other environmental conditions, there's nothing that prevents you from being in a humid environment, though that can sap your energy even more. Once your radiation treatments are finished--about two weeks afterward, you might notice that your neck is sunburned--even second-degree burns. This is your skin finally having a chance to do what it's supposed to do, but the point is, you should probably protect your skin from sun--ultraviolet radiation. You don't want to develop a nasty burn, or worse, skin cancer.

    I've gone through a lot of what I experienced, I hope you find it useful. Feel free to ask any other questions, but remember, each cancer patient may encounter symptoms less or worse than others. Best of luck with your treatments--the prognosis for this type of cancer is pretty good, and it's very likely you will resume a productive and normal life in a relatively short time afterward.
    Age 52 Male
    early Feb, 2013 - Noticed almond-sized lump in shaving area, right side of neck. No other "classic" cancer symptoms
    late Feb, 2013 - Visited PCP for check-up, PCP advised as lymphoma. Did blood work, orders for CT-scan, referred to ENT
    3/7/13 - CT-scan inconclusive, endoscopy negative
    3/9/13 - FNA of neck mass
    3/14/13 - Received dx of squamous-cell carcinoma, unknown primary
    3/25/13 - CT-PET scan reveals no other active tumors
    3/26/13 - work/up for IMRT
    4/1/13 - W1, D1 of weekly cetuximab
    4/8/13 - W1, D1 of IMRT
    5/20/13 - complete 8 week regimen of weekly cetuximab
    5/24/13 - Complete 35-day regimen of daily IMRT
    mid-July 2013 - CT-PET scan reveals no active tumors, but shows necrotic tissue at site of original tumor
    early Sept 2013 - partial neck dissection to remove necrotic tissue. Assay shows no cancer present.
    Spring 2014 - No signs of cancer
    Spring 2015 - NED
    Spring 2016 - NED
    Spring 2017 - NED
    Spring 2018 - NED
    Spring 2019 - NED

  4. #4
    Newbie New User
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    Jul 2017
    Quote Originally Posted by rremt View Post
    I work on the railroad in a really humid enviroment...I dig, climb, lift and get much exposure to sun...after 35 radiation treatments and chemo...what am I to expect returning to work...we have no light duty

    I have squamous cell carcinoma to the oropharynx ...im 58 years old ...do i need to look at medical retirement ?
    Thyroid cancer has a specific listing in the Social Security “Blue Book” And based on what I remember you have to meet the requirements of this specific listing, you must show that you have Carcinoma and Medullary carcinoma that has spread beyond the lymph nodes near the thyroid gland. I remembered our doctor issued a medical retirement for my uncle.
    Last edited by lisa1962; 07-03-2017 at 01:03 PM. Reason: link deleted per forum rules

  5. #5
    Administrator Top User lisa1962's Avatar
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    Jan 2013

    This thread is a year old and OP has not returned to forum since that time. I closing thread to avoid confusion. It should also be noted that this is an international site not just a US site so circumstances regarding insurance and treatment may not apply to others.



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