Radiation Consult

Tuesday, March 24, 2009 Mom met with Dr Geiver, a Radiologist at the Tri-Cities Cancer Center. Below are the notes of the consult: First this type of cancer is not common - not unheard of, just not common.

After finding the mass, the first step was to see what type of mass we are dealing with. When Dr Swartz removed the tonsil and the mass, his goal was not to remove the cancer but the mass and find out what type of cancer. Now that they have identified the cancer as Squamous Cell Carcinoma and we know that not all the cancer was removed there are different ways to approach treatment.

The first step is to see where else the cancer is. A PET scan is used to identify cancer in the throat, neck, lungs and bones. After PET scan, they will be able to know fully how to proceed. Even if the PET scan does not find that the cancer is outside the throat region there are choices that need to be made.

1. Major operation to remove part of the jaw bone, neck and something else (sorry couldn’t keep up). This is a major and invasive operation and Dr Geiver did not recommend she go in this direction.
2. The second approach is 7-weeks of radiation Monday-Friday. There are many side effects from this (listed below). The objective of the radiation is to damage the DNA of the bad cells (cancer cells) so that they can not reproduce. In accomplishing this, other DNA cells are affected
3. The third approach is to have radiation and chemotherapy at the same time. The doctor suggested that Mom consult with an oncologist about this. There is a specific chemotherapy drug called Herbitux that has been found (in conjunction with radiation) to be effective to improve the result by 5-6% for Mom’s type of cancer. Short Term Side

Effects from the radiation:

1. Fatigue, she will feel run down and will need to rest more (the good news no nausea)
2. Sore throat and mouth. The doctor stated that if you think of the worse sore throat you’d ever had, this will be even worse. He said to consider the experience an “investment in misery” to get well.
3. Will loose all taste buds (temporarily) until approximately two to four weeks after treatment is finished. All food will taste like cardboard and tin foil
4. Dry mouth – the radiation will kill the glands that produce salvia
5. Sunburn like on the face and neck, which may blister
6. Hair loss in zoned patches on the back of the ear and head. It may come back in thin, different texture and/or color. Most likely her hair will come back thinner then now
7. Nutrition issues which are caused by all the mouth soreness and lack of taste. The options here are to make a diligent effort to eat even when it seems impossible or to have a stomach feeding tube inserted.
8. The gums will get very sore and receed. A few weeks into radiation she will stop using her dentures all together – just too painful. She will eventually, six months after the end of treatment need to be refitted for new dentures.

Long Term Side Effects from Radiation:

1. Neck will be thicker
2. Checks firmer
3. TMJ issues – jaw will be stiffer and may continue to be sore and not go away. She will need to work throughout radiation treatment to keep her jaw opening and closing as wide as possible
4. Internal sores that may not heal. Not as common but may result
5. Continued dry mouth. There are pills to help with this, but it will not return to normal.
6. May be some scaring in the in the lungs.
   

Options that required discussions (other then to do radiation)

1. If she wants to have the feeding tube or tough it out. The doctor’s recommendation is to have the feeding tube. There is less chance of being admitted in the emergency room for dehydration and nutrition issues. Monitoring her nutrition and weight as closely will not be necessary. However she will still need to actively swallow 2-3 times daily, which will be challenging.
2. If she wants to take the drug that helps maintain the salvia glands. However there are side effects from this drug. They include dizziness, allergies, and rashes. The drug takes 1.5 hours to administer (by shot) and will add an hour and a half to the daily regimen. It can be started and if the side effects become present, she can stop it. The drug is done by the oncologist that will do the chemotherapy so it could be one stop shopping for her.
   
   
   Mom asked if she will be able to continue to drive. The doctor said that she must monitor herself and know when she is not safe to drive. If her neck becomes too sore for her head to have full range of motion making it hard to look over her shoulder and if her fatigue is to a point that it will affect her reaction time.
   
   Over all her prognosis is very good and he feels that she can over come the cancer. It will be a very uncomfortable seven weeks and he reminded her that it will be an investment in misery.