Happy New Year to all! So happy to hear Dr. Weiss is still with us and hope he can answer this for me.
My sister's fiancé's mother has some type of cancer in the throat. Squamous cell is all she knows and that it is in the larynx and junction that is difficult to reach, affecting mostly wind pipe, voice box and esophagus. I know this is a dire situation as the doctors here have told her that they've never seen this before. She is 80 years old and they haven't completed the diagnosis yet. But they did tell her that they would not do chemo.
Of course in our area there really are no specialists, just those that do different types of cancer. They are consulting with Dana Farber, so that's a good thing. She's also suffering from severe head aches and will have an MRI for her throat and hopefully her brain on Monday.
My thoughts are that they will only do palliative radiation to help reduce the tumor in the throat area and if brain mets, those too. It's also complicated in that she has a hiatal hernia. She's eating baby food and has lost weight obviously It was mentioned about a feeding tube and trach and I'm pretty sure she won't go that route.
I'm very sad for her as she's such a nice lady that has raised a loving family. They all know that this will be her choice and she doesn't want any of them to try to convince her of anything else. I don't see her lasting much longer at this rate though she's still pretty spunky. No other health issues.
I'm sorry to hear this troubling news. I don't have much to add, since it seems that (as I'd expect) you're pretty well informed based on the information currently available about the diagnosis.
One thought is that I hope that chemo has not been rejected solely based on her age, since there is plenty of evidence that a fit 80 year old can do well with such treatment. There may be other reasons (general health, specifics of her cancer, etc.) that argue against giving chemo, but age alone should not be the determining factor.
Thanks Jim. That was my thought also about the chemo, but I didn't mention it to the family. Waiting to see what they find out tomorrow. But would love if Dr. Weiss could chime in with any thoughts.
Take care, Judy
I'll asked Dr. Weiss to comment right now, I was waiting for the end of the weekend. We often don't send out comment requests on weekends anymore especially on holidays. I'm sorry for any inconvenience that's caused. I hope you and yours are doing well and have a great new year.
Janine
I don't really treat head and neck cancer, but I can at least provisionally say that an alternative approach that is more effective than radiation alone is adding Erbitux (cetuximab) to radiation therapy. It also may well be possible to do a sequential approach with radiation and light chemotherapy, since there is a wide spectrum of intensity of chemotherapy. Of course, only someone working directly with her could say what she would be in a position to tolerate.
It's good that her doc(s) can connect with the experts at Dana Farber, where they have plenty of expertise to offer.
I don't know if Dr. Weiss will have additional insights.
Judy, Janine, Jack: I am very sorry for the delay in my response; I'm massively behind on everything and scrambling to catch up; thank you Janine for the reminder. The exact situation doesn't sound clear, so a consultation is a very good idea. If reasonable vis a vis this person's social and personal situation, an in person consult at Dana Farber or another major cancer center might be a good idea. Here's some relevant information that may help based on what you've share:
*Headaches are a common symptom of head/neck cancer. Spread to the brain from head/neck cancer is rare.
*When head/neck cancer has not spread distantly, the standard treatment is radiation (typically 7 weeks) with chemotherapy for big cancers or if nodes are involved.
*The standard chemotherapy is usually cisplatin in high doses. While age alone should not be used to exclude patients, older patients often have reasons why they can't get it (most commonly hearing loss and kidney impairment). That said, that are multiple alternative regimens. Cetuximab is the best validate of these alternatives.
*Hiatal hernias and other abnormal anatomy can complicate radiation delivery. Again, consultation with a disease-specific expert who can review the details of the situation can be a good idea; there are sometimes creative approaches that can be taken.
Dr. Weiss, please don't be sorry for any delay. I know our a very busy doctor and was just happy that you could respond at some point. As well as Dr. West. I think she and her family are trying to avoid chemo and they said something about a pill. I can't imagine with her throat problems that she would be able to swallow a pill as she's eating only baby food and yogurt along with fluids. I'm just happy that DF is being consulted and maybe a plan can be put in place that could help. I don't know of any spread as of yet as she had an MRI on Monday. But nothing showed on a PET scan. Again thank you all for your info and I'll see if anything else comes about. Take care, Judy
Happy New Year to you all!
And Dr. Weiss, have you set a date yet or did you already tie the knot???
There are pills that can be used in the treatment of cancer. In regards to head/neck cancer, there's one called xeloda. It's not typically used as part of curative therapy, but can be used as part of palliative care. However, xeloda is not less toxic than IV chemo; if anything, it's very slightly more toxic than the similar IV drug (called 5-FU). When it's the right thing to do, xeloda can be dissolved in water and put down a feeding tube (not advocating for this, just saying that it's mechanically possible and appropriate in certain situations).
As far as getting married, I did that three years ago and am very happily married, even more so with the birth of our twin girls Betty and Dina nine months ago.
I am not a moderator Dr., but I am a 6 year survivor of oral cancer. I was treated with IMRT (radiation) and Cisplatin chemo. I will tell you it is not a fun treatment and there are long term side effects. I also had referral ear pain and at times major headaches prior to dx. Dana Farber is a great cancer center.
Dr.Weiss, wow how did I miss that you were married already and now have twin daughters, how wonderful! Congrats to you and your wife! Guess we all get busy!
The latest info is that an artery is involved, and my thought is that it's the carotid artery. I can imagine this complicates her situation even more. As for the pill, no one knows what it is but thought it was an immunotherapy drug. Do they have any immune drugs in pill form? Only ever seen IV.
This does not necessarily need to be answered by Dr. Weiss.
Take care, Judy
walknlite: I couldn't agree more. I have a love/hate relationship with the combination of radiation and cisplatin. I love that it when it cures people. But, I couldn't agree more that both short term and long term side effects can be awful. I'm about to open a trial of pembrolizumab (an immunotherapy drug) together with radiation for curative treatment of head/neck cancer. Of course, curing more people is a major goal of the trial. My other goal is to make cisplatin obsolete and replace it with something much less toxic like immunotherapy. I've dreamed of doing a trial like this for years; now I finally have a drug that I have sufficient confidence/excitement about to try.
Judy: Thanks! Involvement of the carotid makes surgery more challenging and often not possible. Radiation is typically possible in this situation. As catdander said, the dominant immunotherapies with the best data for head/neck are all IV at the moment.
walknlite: Most importantly, I hope the you never have a recurrence! I should clarify that this study is first line and for cure, so it's only for people who have never had a treatment before. We and others have many promising studies for patients with recurrences, but better yet, please don't ever have one!
Dr. Weiss, they have decided to go with pembrolizumab. My guess is this must be off-label since it's not FDA approved for H&N. No mention of radiation. I've heard that with the immunotherapy drugs, that many tumors swell which looks like pseudo-progression before they start to shrink. Wouldn't this be troublesome for someone with throat cancer? And no steroidal use due to the immunotherapy.
Take care, Judy
Reply # - January 1, 2016, 04:58 PM
Yes on both counts Judy. Dr.
Yes on both counts Judy. Dr. Weiss is still volunteering and on the board.
Happy New Year!
Janine
Reply # - January 2, 2016, 05:56 PM
Happy New Year to all! So
Happy New Year to all! So happy to hear Dr. Weiss is still with us and hope he can answer this for me.
My sister's fiancé's mother has some type of cancer in the throat. Squamous cell is all she knows and that it is in the larynx and junction that is difficult to reach, affecting mostly wind pipe, voice box and esophagus. I know this is a dire situation as the doctors here have told her that they've never seen this before. She is 80 years old and they haven't completed the diagnosis yet. But they did tell her that they would not do chemo.
Of course in our area there really are no specialists, just those that do different types of cancer. They are consulting with Dana Farber, so that's a good thing. She's also suffering from severe head aches and will have an MRI for her throat and hopefully her brain on Monday.
My thoughts are that they will only do palliative radiation to help reduce the tumor in the throat area and if brain mets, those too. It's also complicated in that she has a hiatal hernia. She's eating baby food and has lost weight obviously It was mentioned about a feeding tube and trach and I'm pretty sure she won't go that route.
I'm very sad for her as she's such a nice lady that has raised a loving family. They all know that this will be her choice and she doesn't want any of them to try to convince her of anything else. I don't see her lasting much longer at this rate though she's still pretty spunky. No other health issues.
Take care, Judy
Reply # - January 3, 2016, 07:36 AM
Hi Judy,
Hi Judy,
I'm sorry to hear this troubling news. I don't have much to add, since it seems that (as I'd expect) you're pretty well informed based on the information currently available about the diagnosis.
One thought is that I hope that chemo has not been rejected solely based on her age, since there is plenty of evidence that a fit 80 year old can do well with such treatment. There may be other reasons (general health, specifics of her cancer, etc.) that argue against giving chemo, but age alone should not be the determining factor.
JimC
Forum moderator
Reply # - January 3, 2016, 05:42 PM
Thanks Jim. That was my
Thanks Jim. That was my thought also about the chemo, but I didn't mention it to the family. Waiting to see what they find out tomorrow. But would love if Dr. Weiss could chime in with any thoughts.
Take care, Judy
Reply # - January 3, 2016, 07:58 PM
I'll asked Dr. Weiss to
I'll asked Dr. Weiss to comment right now, I was waiting for the end of the weekend. We often don't send out comment requests on weekends anymore especially on holidays. I'm sorry for any inconvenience that's caused. I hope you and yours are doing well and have a great new year.
Janine
Reply # - January 4, 2016, 07:22 AM
NP Janine, I didn't expect an
NP Janine, I didn't expect an answer over the weekend but very nice of both you and Jim to chime in! I can wait! Happy New Year!
Take care, Judy
Reply # - January 7, 2016, 04:32 PM
Any luck yet Janine? Thanks &
Any luck yet Janine? Thanks & Take care, Judy
Reply # - January 7, 2016, 08:44 PM
I don't really treat head and
I don't really treat head and neck cancer, but I can at least provisionally say that an alternative approach that is more effective than radiation alone is adding Erbitux (cetuximab) to radiation therapy. It also may well be possible to do a sequential approach with radiation and light chemotherapy, since there is a wide spectrum of intensity of chemotherapy. Of course, only someone working directly with her could say what she would be in a position to tolerate.
It's good that her doc(s) can connect with the experts at Dana Farber, where they have plenty of expertise to offer.
I don't know if Dr. Weiss will have additional insights.
Good luck to her.
-Dr. West
Reply # - January 8, 2016, 06:56 AM
Judy, Janine, Jack: I am very
Judy, Janine, Jack: I am very sorry for the delay in my response; I'm massively behind on everything and scrambling to catch up; thank you Janine for the reminder. The exact situation doesn't sound clear, so a consultation is a very good idea. If reasonable vis a vis this person's social and personal situation, an in person consult at Dana Farber or another major cancer center might be a good idea. Here's some relevant information that may help based on what you've share:
*Headaches are a common symptom of head/neck cancer. Spread to the brain from head/neck cancer is rare.
*When head/neck cancer has not spread distantly, the standard treatment is radiation (typically 7 weeks) with chemotherapy for big cancers or if nodes are involved.
*The standard chemotherapy is usually cisplatin in high doses. While age alone should not be used to exclude patients, older patients often have reasons why they can't get it (most commonly hearing loss and kidney impairment). That said, that are multiple alternative regimens. Cetuximab is the best validate of these alternatives.
*Hiatal hernias and other abnormal anatomy can complicate radiation delivery. Again, consultation with a disease-specific expert who can review the details of the situation can be a good idea; there are sometimes creative approaches that can be taken.
Best of luck,
Dr. Weiss
Reply # - January 8, 2016, 08:23 AM
Dr. Weiss, please don't be
Dr. Weiss, please don't be sorry for any delay. I know our a very busy doctor and was just happy that you could respond at some point. As well as Dr. West. I think she and her family are trying to avoid chemo and they said something about a pill. I can't imagine with her throat problems that she would be able to swallow a pill as she's eating only baby food and yogurt along with fluids. I'm just happy that DF is being consulted and maybe a plan can be put in place that could help. I don't know of any spread as of yet as she had an MRI on Monday. But nothing showed on a PET scan. Again thank you all for your info and I'll see if anything else comes about. Take care, Judy
Happy New Year to you all!
And Dr. Weiss, have you set a date yet or did you already tie the knot???
Reply # - January 8, 2016, 09:17 AM
There are pills that can be
There are pills that can be used in the treatment of cancer. In regards to head/neck cancer, there's one called xeloda. It's not typically used as part of curative therapy, but can be used as part of palliative care. However, xeloda is not less toxic than IV chemo; if anything, it's very slightly more toxic than the similar IV drug (called 5-FU). When it's the right thing to do, xeloda can be dissolved in water and put down a feeding tube (not advocating for this, just saying that it's mechanically possible and appropriate in certain situations).
As far as getting married, I did that three years ago and am very happily married, even more so with the birth of our twin girls Betty and Dina nine months ago.
Reply # - January 9, 2016, 06:05 PM
I am not a moderator Dr., but
I am not a moderator Dr., but I am a 6 year survivor of oral cancer. I was treated with IMRT (radiation) and Cisplatin chemo. I will tell you it is not a fun treatment and there are long term side effects. I also had referral ear pain and at times major headaches prior to dx. Dana Farber is a great cancer center.
Reply # - January 14, 2016, 03:07 PM
Dr.Weiss, wow how did I miss
Dr.Weiss, wow how did I miss that you were married already and now have twin daughters, how wonderful! Congrats to you and your wife! Guess we all get busy!
The latest info is that an artery is involved, and my thought is that it's the carotid artery. I can imagine this complicates her situation even more. As for the pill, no one knows what it is but thought it was an immunotherapy drug. Do they have any immune drugs in pill form? Only ever seen IV.
This does not necessarily need to be answered by Dr. Weiss.
Take care, Judy
Reply # - January 14, 2016, 04:42 PM
Right Judy, At the moment at
Right Judy, At the moment at least immunotherapies are given only intravenously.
Reply # - January 15, 2016, 06:37 AM
walknlite: I couldn't agree
walknlite: I couldn't agree more. I have a love/hate relationship with the combination of radiation and cisplatin. I love that it when it cures people. But, I couldn't agree more that both short term and long term side effects can be awful. I'm about to open a trial of pembrolizumab (an immunotherapy drug) together with radiation for curative treatment of head/neck cancer. Of course, curing more people is a major goal of the trial. My other goal is to make cisplatin obsolete and replace it with something much less toxic like immunotherapy. I've dreamed of doing a trial like this for years; now I finally have a drug that I have sufficient confidence/excitement about to try.
Judy: Thanks! Involvement of the carotid makes surgery more challenging and often not possible. Radiation is typically possible in this situation. As catdander said, the dominant immunotherapies with the best data for head/neck are all IV at the moment.
Reply # - January 15, 2016, 11:36 AM
Dr. Weiss
Dr. Weiss
If I ever have a recurrence I would be interested in that trial.
Reply # - January 15, 2016, 01:17 PM
walknlite: Most importantly,
walknlite: Most importantly, I hope the you never have a recurrence! I should clarify that this study is first line and for cure, so it's only for people who have never had a treatment before. We and others have many promising studies for patients with recurrences, but better yet, please don't ever have one!
Reply # - January 20, 2016, 02:41 PM
Dr. Weiss, they have decided
Dr. Weiss, they have decided to go with pembrolizumab. My guess is this must be off-label since it's not FDA approved for H&N. No mention of radiation. I've heard that with the immunotherapy drugs, that many tumors swell which looks like pseudo-progression before they start to shrink. Wouldn't this be troublesome for someone with throat cancer? And no steroidal use due to the immunotherapy.
Take care, Judy
Reply # - January 21, 2016, 08:53 AM
Judy,
Judy,
It can be, but most apparent progression (growth) on PD1 agents in head/neck (and lung) is real, not pseudo-progression.