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Thread: Cancer in throat that has spread to glands in the neck.

  1. #1
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    Cancer in throat that has spread to glands in the neck.

    Dear Sir,

    I need your kind help regarding my father cancer.

    He has a Cancer in throat that has spread to glands in the neck.

    Which treatment would be better?
    I found some of those below names over internet.

    Cyberknife treatment? or VMAT? or chemoradiation? "Hydrogen Peroxide Cancer Treatment, nitrogen flush" ?"transoral laser microsurgery"? SELECTIVE INTERNAL RADIATION THERAPY (SIRT)? SORAFENIB ? Cetuximab (Erbitux)?
    His body can handle chemo?

    Thank you very much for your time and help.

    Thanks and Regards,
    Naresh

    ==============
    I hope I posted the as much details as possible related with the my father test report for your all advice.

    ==============


    Here is the report for CT SCAN OF THE PNS & NECK DATED 25.10.2016

    Contrast enhanced CT scan of the PNS & neck region has been performed from base of skull till root of neck on a MDCT scanner. This is a case of supraglottis for evaluation. A heterogeneously enhancing mass with necrotic areas within is seen epicentered in pharyngeal surface of epiglottis on right and involving the pharyngo epiglottic fold, reaching upto vallecula and right AE fold, just reaching upto the medial wall of right PFS. Both the free edge and root of epiglottis are involved. There is involvement of the preepiglottic space and right paraglottic spaces with the lesion just reaching upto the level of false vocal cords on right. Base of tongue is free. Posterior pharyngeal wall is free. There is no extension across midline. Laryngeal cartilage framework is intact. The true and false vocal cords and subglottic are spared. It measures about 2.0 x 1.9 cm. Large necrotic nodes with perinodal extension are seen at right level IB, II and III. The largest at right level IB measures 3.0 x 2.6 cm in maximum axial dimensions and compresses the right IJV and abuts the right ICA with loss of planes for an angle of contact of less than 180 degrees. Rest of major vessels appear free and patent. Thyroid appears unremarkable. The oral cavity is unremarkable. Paranasal sinuses and orbits are clear. The parotid & submandibular glands are unremarkable. Visualized lung apices are unremarkable. Visualized bones show degenerative changes. CT study reveals heterogeneously enhancing mass with necrotic areas within epicentered in pharyngeal surface of epiglottis on right with extent and associated metastatic cervical adenopathy as described. Consultant (

    ===============

    At present able to eat near normal food consistencies orally

    OSME - mouth opening good, tongue ROM good

    FOIS - 6

    PSS HNC diet - 90

    100 mL water swallow test - able to swallow well, laryngeal elevation good, pre and post swallow voicing good

    Clinically funtional swallow

    ==============

    RT OPD

    59 yr M, R/o Kolkata k/c/o HTN and DM, PTCA with stent-2011, chronic ghutka chewer

    p/w swelling in Rt lateral neck X 2m
    No h/o dysphagia/Hoarseness/change of voice/aspiration

    O/e at presentataion:
    Proliferative Growth On The RT Side Of Epiglotis With Extn To PE FOLD & AE FOLD Both VC mobile

    CXR-NED

    FOL (26/10/16):
    UPG inv Rt LPW, Rt PE fold and adjoining epiglottis
    Superiorly reaching epiglottis
    Inferiorly upto AE fold
    B/L cords mobile
    B/L PFS clear

    FNAC Rt cervical node-( TMH review-28/10/16) - Met SCC
    CT neck and PNS(2/11/16):
    1. 2X 2cm Mass in Pharyngeal surface of epiglottis on Rt inv PE fold, reaching upto vallecula and Rt AEF just reaching medial wall of Rt PFS
    2. Both free edge and root of epiglottis involved
    3. inv of preepiglottic space and rt paraglottic space with lesion just reaching upto Rt FVC
    4. BOT/PPW/laryngeal cartilage/ B/L TVC and FVC/subglotiis free
    5. Rt level IB, II and III necrotic nodes with PNE - largest 3X 2.6 cm compressing Rt IJV and abutting Rt ICA with loss of planes for angle of contact less than 180n degrees

    O/e:
    Gc fair, KPS 90, Wt-78 kg
    OC : Mo adequate- 4 cm , moderate oral hygeine, dental staining +, no mass seen or felt in oral cavity, BOT felt and free, FOM free
    Hopkins:
    Neck : 4 X 3cm Rt level II node, hard. fixed, non tender with restricted mobility

    Imp : Ca Supraglottis c T3 N 2a M0- SCC

    =============

    DIABETES SINCE 12 YEARS HTN SINCE 6 YEARS PTCA SVD 5 YEARS

    ECOG : 0 - Fully active, able to carry on all predisease performance without restriction.

    Karnofsky : 90% - Able to carry on normal activity; minor signs or symptoms of disease.
    Naresh Agarwal

    ===============

  2. #2
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    Also any home remedies would help? like wheatgrass juice? and organic fruits?

  3. #3
    Super Moderator Top User po18guy's Avatar
    Join Date
    Feb 2012
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    10,209
    Welcome, but very sorry to hear of this. As we are not doctors, we cannot make specific recommendations regarding treatment. Since each case is remarkably different from all others, the doctors who have examined him are best qualified to make those determinations. Have you sought a second opinion at another major cancer facility? Second opinions are always a very good idea.
    05/08-07/08 Tumor appears behind left ear. Followed by serial medical incompetence on the parts of PCP, veteran oncologist and pathologist (misdiagnosis via non-diagnosis). Providential guidance to proper care at an NCI designated comprehensive cancer center.
    07/08 Age 56 DX 1) Peripheral T-Cell Lymphoma-Not Otherwise Specified. Stage IV-B, >50 ("innumerable") tumors, bone marrow involvement.
    08/08-12/08 Four cycles CHOEP14 + four cycles GND (Cyclofosfamide, Doxorubicin, Vincristine, Etoposide, Prednisone & Gemcitabine, Navelbine, Doxil)
    02/09 2) Relapse.
    03/09-06/13 Clinical trial of Romidepsin > long-term study. NED for 64 twenty-eight day cycles, dose tapered.
    07/13 3) Relapse, 4) Suspected Mutation.
    08/13-02/14 Romidepsin increased, stopped for lack of response. Watch & Wait.
    09/14 Relapse/Progression. Visible cervical nodes appear within 4 days of being checked clear.
    10/06/14 One cycle Belinostat. Discontinued to enter second clinical trial.
    10/25/14 Clinical trial of Alisertib/Failed - Progression.
    01/12/15 Belinostat resumed/Failed - Progression. 02/23/15
    02/24/15 Pralatrexate/Failed - Progression. 04/17/15
    04/15 Genomic profiling reveals mutation into PTCL-NOS + AngioImmunoblastic T-Cell Lymphoma. Stage IV-B a second time. Two dozen tumors + small intestine (Ileum) involvement.
    04/22/15 TEC (Bendamustine, Etoposide, Carboplatin). Full response in two cycles. PET/CT both clear. Third cycle followed.
    06/15-07/15 Transplant preparation (X-rays, spinal taps, BMB, blood test, MUGA scan, lung function, CMV screening, C-Diff testing etc. etc. etc.) Intrathecal Methotrexate during spinal tap.
    BMB reveals 5) 26% blast cells of 20q Deletion Myelodysplastic Syndrome MDS), a bone marrow cancer and precursor to Acute Myeloid Leukemia.
    07/11-12/15 Cyclofosfamide + Fludarabine conditioning regimen.
    07/16/15 Total Body Irradiation.
    07/17/15 Moderate intensity Haploidentical Allogeneic Stem Cell Transplant receiving my son's peripheral blood stem cells.
    07/21-22/15 Triple dose Cyclofosfamide + Mesna, followed by immunosuppressants Tacrolimus and Mycophenolate Mofetil.
    07/23-08/03/15 Marrow producing zero blood cells. Fever. Hospitalized two weeks.
    08/04/15 Engraftment occurs, and blood cells are measurable - released from hospital.
    08/13/15 Day 26 - Marrow is 100% donor cells. Platelets climbing steadily, red cells follow.
    09/21/15 Acute skin Graft versus Host Disease arrives.
    DEXA scan reveals Osteoporosis.
    09/26/-11/03/15 Prednisone to control skin GvHD.
    11/2015 Acute GvHD re-classified to Chronic Graft versus Host Disease.
    05/2016 Tacrolimus stopped. Prednisone from 30-90mg daily tried. Sirolimus begun. Narrow-band UV-B therapy started, but discontinued for lack of response. One treatment of P-UVAreceived, but halted due to medication reaction.
    09/16/16 Three skin punch biopsies.
    11/04/16 GvHD clinical trial of Ofatumumab (Arzerra) + Prednisone + Methylprednisolone begun.
    12/16 Type II Diabetes, Hypertension - both treatment-related.
    05/17 Extracorporeal Photopheresis (ECP) begun in attempt to control chronic Graft-versus-Host-Disease (cGvHD. 8 year old Power Port removed and replaced with Vortex (Smart) Port for ECP.
    05/2017 Chronic anemia (low hematocrit). Chronic kidney disease. Cataracts from radiation and steroids.
    06/17 Trying various antibiotics in a search for tolerable prophylaxis.
    08/17 Bone marrow biopsy reveals the presence of 2% cells with 20q Deletion Myelodysplastic Syndrome, considered to be Minimum Residual Disease.
    12/17 Bone marrow biopsy reveals no abnormalities in the marrow - MDS eradicated. The steroid taper continues.
    01/18 Consented for Kadmon clinical trial.
    03/18 Began 400mg daily of KD025, a rho-Associated Coiled-coil Kinase 2 Inhibitor (ROCK2).
    09/18 Due to refractory GvHD, Extracorporeal Photopheresis halted after 15 months ue to lack of additional benefit.
    10/18 I was withdrawn from the Kadmon KD025 clinical trial due to increasing fatigue/lack of benefit.
    11/18 Began therapy with Ruxolitinib (Jakafi), a JAK 1&2 inhibitor class drug. Started at half-dose due to concerns with drug interactions.

    To date: 1 cancer, relapse, second relapse/mutation into 2 cancers, then 3 cancers simultaneously, 20 chemotherapy/GVHD drugs in 11 regimens (4 of them at least twice), 5 salvage regimens, 4 clinical trials, 5 post-transplant immuno-suppressant/modulatory drugs, the equivalent of 1,000 years of background radiation from 40+ CT series scans and about 24 PET scans.
    Both lymphoid and myeloid malignancies lend a certain symmetry to the hematological journey.

    Believing in the redemptive value of suffering makes all the difference.

  4. #4
    Newbie New User
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    Nov 2016
    Posts
    3
    Doctors are recommended below treatments, which one should we go with?

    1) radiation therapy + chemotherapy with cisplatin.

    2) radiation + cetuximab

    3) VMAT radiation therapy with concomitant cetuximab (erbitux)

    4) VMAT radiation therapy with cisplatin intravenously weekly

    ===============
    And below natural stuff:

    1) Resveratrol

    2) Wheat Grass Juice with Ocimum tenuiflorum known as Ocimum sanctum/holy basil/or tulsi.

  5. #5
    Super Moderator Top User po18guy's Avatar
    Join Date
    Feb 2012
    Posts
    10,209
    The problem is that making a choice will eliminate the other choices. It cannot be known which choice will be best and there is no way of knowing, once a choice has been made, if it was the correct choice. Each of those treatments has advantages and disadvantages, which must be carefully considered. At this point it is best to consult with research doctors about the specifics of your father's case, and make your decision based on the best evidence and their suggestions.
    05/08-07/08 Tumor appears behind left ear. Followed by serial medical incompetence on the parts of PCP, veteran oncologist and pathologist (misdiagnosis via non-diagnosis). Providential guidance to proper care at an NCI designated comprehensive cancer center.
    07/08 Age 56 DX 1) Peripheral T-Cell Lymphoma-Not Otherwise Specified. Stage IV-B, >50 ("innumerable") tumors, bone marrow involvement.
    08/08-12/08 Four cycles CHOEP14 + four cycles GND (Cyclofosfamide, Doxorubicin, Vincristine, Etoposide, Prednisone & Gemcitabine, Navelbine, Doxil)
    02/09 2) Relapse.
    03/09-06/13 Clinical trial of Romidepsin > long-term study. NED for 64 twenty-eight day cycles, dose tapered.
    07/13 3) Relapse, 4) Suspected Mutation.
    08/13-02/14 Romidepsin increased, stopped for lack of response. Watch & Wait.
    09/14 Relapse/Progression. Visible cervical nodes appear within 4 days of being checked clear.
    10/06/14 One cycle Belinostat. Discontinued to enter second clinical trial.
    10/25/14 Clinical trial of Alisertib/Failed - Progression.
    01/12/15 Belinostat resumed/Failed - Progression. 02/23/15
    02/24/15 Pralatrexate/Failed - Progression. 04/17/15
    04/15 Genomic profiling reveals mutation into PTCL-NOS + AngioImmunoblastic T-Cell Lymphoma. Stage IV-B a second time. Two dozen tumors + small intestine (Ileum) involvement.
    04/22/15 TEC (Bendamustine, Etoposide, Carboplatin). Full response in two cycles. PET/CT both clear. Third cycle followed.
    06/15-07/15 Transplant preparation (X-rays, spinal taps, BMB, blood test, MUGA scan, lung function, CMV screening, C-Diff testing etc. etc. etc.) Intrathecal Methotrexate during spinal tap.
    BMB reveals 5) 26% blast cells of 20q Deletion Myelodysplastic Syndrome MDS), a bone marrow cancer and precursor to Acute Myeloid Leukemia.
    07/11-12/15 Cyclofosfamide + Fludarabine conditioning regimen.
    07/16/15 Total Body Irradiation.
    07/17/15 Moderate intensity Haploidentical Allogeneic Stem Cell Transplant receiving my son's peripheral blood stem cells.
    07/21-22/15 Triple dose Cyclofosfamide + Mesna, followed by immunosuppressants Tacrolimus and Mycophenolate Mofetil.
    07/23-08/03/15 Marrow producing zero blood cells. Fever. Hospitalized two weeks.
    08/04/15 Engraftment occurs, and blood cells are measurable - released from hospital.
    08/13/15 Day 26 - Marrow is 100% donor cells. Platelets climbing steadily, red cells follow.
    09/21/15 Acute skin Graft versus Host Disease arrives.
    DEXA scan reveals Osteoporosis.
    09/26/-11/03/15 Prednisone to control skin GvHD.
    11/2015 Acute GvHD re-classified to Chronic Graft versus Host Disease.
    05/2016 Tacrolimus stopped. Prednisone from 30-90mg daily tried. Sirolimus begun. Narrow-band UV-B therapy started, but discontinued for lack of response. One treatment of P-UVAreceived, but halted due to medication reaction.
    09/16/16 Three skin punch biopsies.
    11/04/16 GvHD clinical trial of Ofatumumab (Arzerra) + Prednisone + Methylprednisolone begun.
    12/16 Type II Diabetes, Hypertension - both treatment-related.
    05/17 Extracorporeal Photopheresis (ECP) begun in attempt to control chronic Graft-versus-Host-Disease (cGvHD. 8 year old Power Port removed and replaced with Vortex (Smart) Port for ECP.
    05/2017 Chronic anemia (low hematocrit). Chronic kidney disease. Cataracts from radiation and steroids.
    06/17 Trying various antibiotics in a search for tolerable prophylaxis.
    08/17 Bone marrow biopsy reveals the presence of 2% cells with 20q Deletion Myelodysplastic Syndrome, considered to be Minimum Residual Disease.
    12/17 Bone marrow biopsy reveals no abnormalities in the marrow - MDS eradicated. The steroid taper continues.
    01/18 Consented for Kadmon clinical trial.
    03/18 Began 400mg daily of KD025, a rho-Associated Coiled-coil Kinase 2 Inhibitor (ROCK2).
    09/18 Due to refractory GvHD, Extracorporeal Photopheresis halted after 15 months ue to lack of additional benefit.
    10/18 I was withdrawn from the Kadmon KD025 clinical trial due to increasing fatigue/lack of benefit.
    11/18 Began therapy with Ruxolitinib (Jakafi), a JAK 1&2 inhibitor class drug. Started at half-dose due to concerns with drug interactions.

    To date: 1 cancer, relapse, second relapse/mutation into 2 cancers, then 3 cancers simultaneously, 20 chemotherapy/GVHD drugs in 11 regimens (4 of them at least twice), 5 salvage regimens, 4 clinical trials, 5 post-transplant immuno-suppressant/modulatory drugs, the equivalent of 1,000 years of background radiation from 40+ CT series scans and about 24 PET scans.
    Both lymphoid and myeloid malignancies lend a certain symmetry to the hematological journey.

    Believing in the redemptive value of suffering makes all the difference.

  6. #6
    Moderator Senior User IndyLou's Avatar
    Join Date
    Jan 2014
    Posts
    452
    Hello, agnaresh--I'm very sorry to hear about your father. This type of cancer is very similar to what I had. I am not a doctor, but I can tell you that I was treated with IMRT (a highly-precise radiation therapy, similar in effect as VMAT) and a weekly dose of cetuximab. I've had no evidence of disease in over three years, so I'm happy to say that it looks like my treatment worked very well.

    There are some side-effects from the above treatment, but I think they were relatively mild compared to side effects from platinum-based chemos like cisplatin. Regardless of which chemo or targeted therapy you choose, you won't be able to get around the effects of radiation therapy. Because your father's cancer is metastatic, they will likely treat his entire throat (the orpharyngeal cavity) and likely the lower mandible.

    It will be difficult for your father to eat and drink, and you may want to consider a feeding tube to supplement his nutrition. There will likely be enough pain to require narcotic pain relievers, so be prepared for that.

    As for your questions about home remedies, please keep in mind that none of those you mentioned are proven to specifically help cancer patients. If they're supplements that aid in his well-being and the doctor is OK with them, by all means, please give them a try.

    I wish you and your father well. Don't hesitate to come back with other questions.
    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

 

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