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Thread: Aunt diagnosed with neck cancer

  1. #1
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    Aunt diagnosed with neck cancer

    My aunt is 70 and was diagnosed with neck cancer after noticing a lump on the left side of her neck. The primary is unknown and diagnosis says metastatic moderately differentiated focally Keratinizing squamous cell Carcinoma. She is supposed to do 30 days of radiation and 6 weeks of chemo. No pet scan yet. Does anyone know what to expect?

  2. #2
    Moderator Senior User IndyLou's Avatar
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    Hello, Tampa-

    I faced a similar diagnosis and treatment, though I was better than 20 years younger than your aunt when diagnosed and treated. When detected early--as it appears your aunt's cancer was--the prognosis is generally very good. I will be very honest though, the treatment can be brutal. It can be managed, but it can be painful, and some side effects long-lasting.

    When you say that she'll be "treated with chemo," do you know specifically what kind of chemo? The reason I ask is that many people lump together anything that will be given by port or IV as "chemo," when in fact, there are big differences between traditional, platinum-based chemotherapies, targeted therapies such as Erbitux (cetuximab), and even some of the new immuno-therapies like Keytruda (pembrolizumab) that are available.

    In any case, treatment for head and neck cancer causes numerous issues because of it's location in the body. While radiation therapy is very effective, and generally more precise today, it can cause some nasty side effects when given over six weeks. The radiation oncology will want to hit all the areas of where they expect cancer to reside. Over the course of treatment, the mouth, jaw area, neck and upper esophagus will all be exposed. In a week or two, the gums, tongue, hard and soft palates, and back of the throat will become reddened and inflamed. That will likely continue throughout the treatment.

    Because of the impact to the mouth and throat, eating will become challenging. The salivary glands will eventually cease to function at full capacity. Oral mucositis may set in, which can bring about a nasty, filmy, soreness to the tongue. The mouth and throat may hurt to the point of needing opioid pain medicines, and that should not be neglected.

    One of the biggest issues is taking in nutrition...eating and drinking. Not only is your mouth and throat sore, but food stops tasting good. Your ability to swallow atrophies; your interest in eating declines, and it's a vicious cycle. My radiation oncologist recommended a PEG feeding tube (through my stomach wall), and was a life-saver. Despite that, I lost weight--about 12% of my body weight. That weight loss will bottom out as the eating function returns, and the patient is able to eat regular foods again.

    The reason I asked about the kind of chemo, is that the more traditional chemos have some additional side effects--the kind that cause nausea, vomiting, hair loss, and other side effects. Those can be managed, but it's just more to have to worry about for an already challenged patient.

    I can go into a lot more suggestions if you want. I'm not sure where your aunt is in her work-up process. It would be very helpful if she had a friend or family member accompany her to appointments, just to be a second set of ears and maybe to write down notes. The patient is already dealing with a lot.

    Please post more questions, or PM me directly.

    Best wishes.

    p.s. Does your nickname imply that you are from Tampa? If your aunt also lives there, the Moffitt Center is very good!
    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

  3. #3
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    Thank you so much for getting back to me. I am from Tampa, but she is being treated on Florida Cancer Specialists. She is getting Cisplatin chemo. She just found a large lump right below her knee. Her pcp said it is more than likely just soft tissue, but wanted an ultrasound. I contacted the oncologist and we now have a pet scan scheduled on Saturday. Just hoping for the best

  4. #4
    Moderator Senior User IndyLou's Avatar
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    I'd venture to guess the lump on the knee is something different, unrelated to the head and neck cancer. When metastases occurs in head & neck, it usually goes to the chest or possibly brain.

    The cisplatin is effective, but it is a platinum-based chemo, and can cause some side effects that may exacerbate the effects of the radiation; i.e., mouth sores, loss of taste, etc. It can also cause nausea, though this can be managed, and potentially some hair loss.

    As I said in my first post, I think the most challenging thing to manage in a head & neck cancer patient is the nutritional intake. It may become difficult for your aunt to take in calories, and she'll need that energy to heal from her treatments. It's not that they don't want to eat, it's just very difficult. Over time, eating becomes less enjoyable. Your aunt's radiation/oncologist should be able to connect her with a dietitian if needed.

    PET scans are pretty mild, and it sounds like your aunt will receive a full-body scan. She'll be somewhat enclosed, so hopefully, she's not too claustrophobic.

    It's likely that she'll be fitted for a face mask for her radiation soon, too. I found the face mask to be much more restrictive, and in 35 days' worth of treatments, never really cared for it much. You get kind of tired over time, and then it just becomes something you do.
    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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