Hello,
My mother (age 59) was diagnosed with Stage IV Adenocarcinoma and tested positive for EGFR Mutation. She has been on Tarceva 150mg for 6 weeks today and symptomatically she has had a generally positive response - her cough has come down significantly (say by 50% or more) and a tumor in the supraclavicular region seems to be reducing in size when we feel it with our fingers. She has also experienced a grade 2/3 rash, fatigue, loss of appetite, and minor shortening of breath, but nothing to be concerned about per our Oncologist.
As of last week, she has been experiencing a change in voice (usually after waking up or after a nap) that comes and goes. A visit to an ENT specialist confirmed partial paralysis of the right vocal cord. Most of her tumors are in the right lung, but given the otherwise positive symptoms we have three key questions:
1. Is it possible that a reduction in tumor size could be affecting the vocal cord nerve and causing the change in voice?
2. Given the change in voice, would you recommend that we expedite a CT/PET scan or give Tarceva some more time to work? (the next scan is currently scheduled ~6 weeks from today)
3. Is it possible that the vocal cord will "fix itself" or does the change in voice mean that some permanent damage has already been done?
Appreciate your thoughts very much,
Varun
Reply # - December 31, 2013, 09:58 AM
Reply To: Can reduction in tumor size cause a change in voice?
Hi Varun, I'm sorry your mom is going through this. I know it's terrible for the family as well. The link below is to a blog post on the subject of hoarseness. It's such a common problem in lung cancer that it would be impossible to know the cause from an online discussion but yes shrinking of the tumor can cause this. This blog doesn't talk about tarceva specifically but tarceva can cause post nasal drip which in turn can cause hoarseness. Cancer can do just about anything, it's a wild disease as I'm sure you're learning.
http://cancergrace.org/cancer-treatments/2011/04/16/hoarseness/
On a side effect note
I don't know if she or you have searched this site for info on caring for the rash and other issues but there is a ton of info on the subject. For example, http://cancergrace.org/cancer-treatments/files/2011/09/dr-lacouture-on-…
We have a forum just for EGFR inhibitors, http://cancergrace.org/forum/cancer-treatments-symptom-management/egfr-…
I hope this helps,
Janine
Reply # - December 31, 2013, 11:57 PM
Reply To: Can reduction in tumor size cause a change in voice?
Varun,
I think the link to the discussion of hoarseness will be the most useful resource, as I really haven't encountered this in my own patients and don't think there is any well described experience with this issue. I would consider this symptom to be inconclusive enough that it wouldn't lead me to move up a scan, particularly a PET/CT, which has been identified as one of the most over-ordered tests in cancer care compared with a standard chest CT scan, the later almost always being able to clarify whether disease is responding well or progressing significantly.
I also agree with Janine's point that cancer can do just about anything, including a pattern of hoarseness improve after worsening previously. Not knowing what is the cause of the hoarseness, I couldn't speculate about what is most likely to happen in the future.
Good luck.
-Dr. West