Dr. Weiss Throat Cancer Questions - 1260735

Hi Judy, I'm so sorry your cousin has these problems. They sound just awful. I'll contact Dr. Weiss for input.

How are you? My husband and I are doing well and plan on a good day tomorrow as we have so much to be thankful for.

Happy Thanksgiving and Hanukkah...Thanksgivukkah (I hope that isn't impolite),
Janine

Dr. Weiss may well be out celebrating for a few days, so please don't be put off if he doesn't respond for a while.

-Dr. West

Judy,

I'm sorry for what your cousin is going through. Chemoradiation to the head and neck or esophagus can be very rough, with enduring side effects. As a clarifying point, your cousin may have had esophageal cancer as opposed to head/neck cancer; while adenocarcinoma of the head/neck happens, it's fairly rare. If it was adenocarcinoma of the head/neck, these cancers are a bit harder to cure, so your cousin may have needed particularly intense therapy, which would help explain particularly bad side effects.

Taste buds typically return by a year. 8 weeks of radiation is longer than standard for most head/neck or esophageal cancers, so it's possible that your cousin received a higher than typical dose. Poor dentition is common after radiation that affects the mouth; the radiation oncologists have all kinds of dental protocols to try to prevent and minimize this, but even normal teeth have poor tolerance for radiation. The healthy swallowing muscles can be affected by radiation; for the average patient this improves with time, but it sounds like your cousin, in general, has had a hard time of it. Some patients will be helped by swallowing rehab, but there's a real rate of permanently needing a feeding tube. The normal salivary glands really hate radiation and loss of salivary function is very common after radiation; there are a variety of artificial salivas that can help; this loss of salivary function is also a key part of the cavity problem as saliva helps prevents cavities.

The bottom line is that your cousin's side effects, while worse in severity than typical, are all classic problems with radiation to the head/neck or esophagus. In seeking a second opinion for her, you might consider a good radiation oncologist with head/neck expertise. While palliation of these kinds of things isn't formally their specialty, many have learned tons of helpful tricks that can help. Finally, it's worth noting that there are (...to be cont for a last line or two...)

(this is why I don't tweet...hard to be brief!) It's worth noting that there are all kind of new techniques in radiation oncology to try to avoid these problems. For example, for HPV+ cancers (which are easier to cure) there are studies looking at lower doses of radiation. Newer radiation plans avoid the salivary glands when it's safe to do so. While thus far they've all failed, we've studied new medicines to protect healthy (noncancerous) tissue from radiation or help it recover after. Finally, less morbid surgeries (particularly transoral robotic and transoral laser) are challenging both old-school surgery and radiation in certain circumstances as less morbid (particularly with regard to speech and swallowing).