swollen neck - 1250665

Hi Penny, I'm sorry there are complications with your father. Cancer is such an awful disease.
I'll ask our Head and Neck specialist to comment on your post.

I hope he is doing better soon,
Janine

Penny,

The swelling may well be from inflammation related to the radiation, though there may possibly be an infection there. It's not possible to say without being directly involved and able to examine him.

You generally don't feel anything from diminished kidney function, unless/until the kidneys are pretty much failing. But they process a lot of the toxins in the body, so when the kidneys aren't functioning properly, you can see severe dysregulation of the delicate balance of salts, minerals and various metabolic processes in the body. It's also very common to need to discontinue or at least significantly change chemotherapy to accommodate the potential dangers of chemotherapy not being metabolized properly if the kidneys are important in that function for a particular chemotherapy agent.

The PET scan is a test to show where there is high metabolic activity in the body, so where it lights up often but not always corresponds to where there is cancer. But infection and inflammation can also light up on a PET scan as well. The people who read PET scans can often give a good sense of the probability that a particular area lighting up on a PET scan represents cancer vs. some other process.

-Dr. West

Unknown primary head/neck cancer is common. There is a primary in these cases, but it's too small to identify. In almost every other cancer, failure to find the primary means worse prognosis, but in head/neck cancer, the opposite is true--for a comparable nodal stage, the prognosis is better for not finding the primary, than if you can find it after appropriate investigation. The reason is that the primary tumor's stage is very small, which is better. The major problem with treating unknown primary is that because you don't know where the primary tumor is (and you need radiation to cover it in order to kill it) the radiation fields are large, which can increase both short term and long term side effects.
Swelling can be one of these. Swelling can occur from inflammation from the radiation itself, but it can also be concerning for tumor growth (rare during radiation) or infection. A PET will not distinguish between these as both will be hot. The CT portion of a combined PET/CT however, might be helpful. Other signs of infection include fever and a high white blood cell count (although the latter can go up with any inflammation, including cancer and its treatment, so it's not too specific for infection).
In my practice, for both my own thinking and for counseling patients, I distinguish between "laboratory problems" and "human problems." A "laboratory problem" is something that you can't feel and that doesn't hurt you. A "human problem" is something that either causes suffering or at least causes some real threat to a person. The test for kidney function is called creatinine (or sometimes, a measure calculated from it called "GFR"; I actually prefer this formula strongly in my practice). Cisplatin is rough on the kidneys. In my practice, I try to prevent kidney problems by giving fluid before and after cisplatin and with a drug called mannitol; these practices are standard in most oncology offices. (to be continued)....

... (continued)

Despite precautions, elevations in creatinine are common. Most commonly, they come down some over time. It is generally wise to avoid contrast and other drugs that are rough on the kidneys when the #s are high--the doctor here is usually trying to avoid the laboratory problem becoming a human problem. Long term, the side effect of elevated creatinine does happen. The major consequences of this are needing to monitor kidney function with lab tests, adjusting the doses of certain medicines, and avoiding certain medicines. The side effect of long term kidney failure is very rare. Kidney failure (a human problem) means that the kidney doesn't do its jobs such as regulating fluid balance, eliminating certain toxins, and regulating levels of salts in the blood. In this case, dialysis is needed. One other important negative consequence of elevated creatinine in the treatment of head/neck cancer could be the need to delay, dose-reduce or skip doses of chemotherapy that would otherwise be helpful in curing the cancer. However, in this case, it's important to know that the most important cycle of chemo is the 1st one, the 2nd most important is the 2nd and the least important is the third. While our data does tell us that the third cycle helps, it's not tragic when it needs to be delayed, dose-reduced, or skipped.

yes it's common to have a rise in blood test for the kidneys but should also return to normal after eliminating the culprit drug.

Dr. West stated in a previous post, "My practice is to routinely split the cisplatin over two days in order to reduce the nausea and renal toxicity. There isn’t an extensive amount of study, but that’s in part because cisplatin is a 40 year old drug, so no company is incentivized to study the best way to administer it. The available evidence strongly suggests that cisplatin given in lower doses more frequently is not less effective in any way, and if anything it may be more effective, but it’s fairer to say it hasn’t been exhaustively studied. What I can say is that cisplatin given as one big slug is quite toxic to many people, and I would argue that cisplatin is only a valuable addition if you can administer it without causing terrible renal failure."
Here is a link to that thread and the rest of the post, http://cancergrace.org/topic/nsclc-cisplatin-nephrotoxicity

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Janine