Sorry I have not written to keep you guys updated on my friend. Things have been so hectic. Anyway, he is starting his 4th week of radiation this week. The tumor has gone down and his lymph nodes went down a great deal. He asked the doctor how much the tumor went down and the doc replied right now it's just a number.Not sure what that means, can anyone help? Also is it possible to get rid of all the cancer without surgery, or is surgery always followed by chemo and radiation? He will have his second round of 3 rounds of chemo. How do the doctors know the cancer is gone from lymph nodes without surgery? Sorry for all the questions, I am just learning. Good health to all of you and God bless!Thanks, Maureen

Hello Maureen

You could ask your friend's doctor to explain. Meanwhile:
It appears to me that what the doc means is that it is too early to say, and anything that he says would not have real meaning at this time.
The choice of treatment is dictated by the cost (in terms of morbidity i.e. quality of life etc) and benefit ( percentage chance of total elimination of the cancer). Surgery is the choice when the cancer is accessible and if it leaves the patient reasonably well off. Radiotherapy (in combination with chemo) is used when surgery can't be done, or is too risky, or after surgery.

The doctors will assume they have been successful when the scans show up negative and when there is no recurrence.

Hope that helps.

Best wishes
Vinod

This message has been edited. Last edited by: Dr Vinod K Joshi,

Dr. Vinod,

Thanks for your reply and I am sorry to bother you again, but just a few more questions. When will the doctors do the scans, is it after the whole 7 weeks of radiation? And what happens if the cancer is not all gone at that time? Do they do more rad? And how does the body handle that? Also is it possible for this chemo and rad. that he is having now to get rid of all the cancer or is that wishful thinking? I am sorry for all the questions, i am just looking for something positive to hold on to. Also, since the lymph nodes went down a great deal in his neck, does that mean anything at all? Does it mean they are responding to treatment? Thank you so much for your time. I am worried greatly about my friend, these last weeks have been toture. God bless all of you you have gone through this and still continue to do so.

Hi Maureen

The lymph nodes going down a great deal in your friend's neck can only be a good sign. There are limits to how much radiotherapy the body can take at a time! Your friend's radiation oncologist will be the expert on this.

Be positive and do the best you can in the circumstances. We have to then leave the rest to destiny.

Best wishes
Vinod :coffee:

A full-body Positron Emission Tomography (PET) scan may be beneficial after cancer treatment. Investigators found a PET scan done six weeks after completing a combined treatment of radiation and chemotherapy reliably identified residual cancer and distant metastases or secondary tumors in patients with advanced-stage head and neck cancer. This result, researchers say, has a direct influence on health management decisions.

According to the article, PET has been widely used for follow-up exams of patients with head and neck cancer. However, the scan is usually performed in studies when recurrent disease was clinically suspected.

Link: PET Scan Finds Cancer After Treatment
SOURCE: Archives of Otolaryngology -- Head & Neck Surgery, 2004;130:105-109

HI Maur, I think it varies from one end of the Country to the other.
I had 36 session of Radiotheraphy straight after my operation """to get rid of stray Cancer cells""" I was told.
I do not know how your friend is coping but for me it was worse than the actual operation.
I had a PET scan 2 years after my surgery and it showed signs so they did a biopsy in my throat just incase, Think that was the 4 th last year.
Let us know how your friends getting on,
does he/she have a name?
all the best to both of you and you certainly seem a power of strengh to your mate.

Paul

Paul,

Thanks for the info! My friends name is Rod. He is starting his 4th week of radiation. He had 1 round of chemotherapy which left him very sick for about 3 days. He does okay with the radiation, his mouth is dry, and his skin is burnt and he is tired but other than that is is doing okay with that. He seems really depressed and I don't know what else to do to help him. His family is not very suportive so his real source of strength has to come from me. I am struggling lately.I guess I just wondered what happens after he is done with the 7 weeks of radiation. How do they check the lymph nodes for any remaining cancer? I guess I am just anxious for this to be over and hope all is okay w/ him.I will continue to pray,thanks again Paul&God bless!

Hi

The side effects of the radiotherapy cause much discomfort in the mouth due to mouth ulcers developing, and discomfort in eating and swallowing. Perhaps board members can remember what they found helpful in coping with these side-effects. Your advice may be of some help to Maureen's friend.

Maur, have a look at Helpful Tips too.

Best wishes
Vinod :coffee:

Hey guys,

It's me again! I have a couple more questions concerning my friend Rod. He had to have another mask made the other day because of the tumor shrinking???( I guess) Is this routine or is it a good sign? Also if the tumor shrinks away and he does not need surgery, what about the lymph nodes? What do they do to check those and will they remove them? Thanks a million and good health to everyone!

Hello Maur
I was told I might have to have new mask about week 4. This was not becuse of the tumour shrinking as they did not know where it was. But I imagine if it was a big shrinking tumour they would need to remeasure as everything is calculated to work to within a fine margin of about 5 millimeteres. Half a centimetre is really quite small when you think about it if his lump was large.

They did threaten to remake my mask if the fit got any worse - this was because I lost so much weight during radiotherapy that the mask began to rise above my chest where I had lost so much weight off a rather full bust.

Perhaps it is coupled with weight loss too. The close fit of the mask is vital for successful targeted treatment and they may be intending to give directed electron boosts.

Hi Maureen

The important thing is that the tumour and lymph nodes appear to have responded to the chemo-radiotherapy (sometimes known as Radsplat, a name derived from radiation and cisplatin)- that's good news.

Studies are showing encouraging results with this type of intensive targetted concomitant chemo-radiation, despite its toxicity, in head and neck cancer patients with stage 4 inoperable disease.

In a recent study involving 79 patients in Holland reported by Dr I Bing Tan at Maastricht, complete tumour response was achieved in 72 patients (91%) and a partial response in 3 patients. The complete response rate of neck node metastases was 90%. The one and two year local/regional control rates were 82% and 69% respectively. The median overall survival time was 2.2 years with a three-year survival probability of 43%.

Despite your friend's functionally inoperable cancer, I hope that you will find some comfort from this. Let us hope that the tumor will be completely erradicated in Rod's case.

Best wishes
Vinod :coffee:

Dr. Vinod,

Thank you for your response and I did find comfort in the studies you posted. Thank you! Rod seems to be hanging in there but is very depressed. He hardly ever gets sick and this is a hard one for him. Cancer was always his biggest fear since so many people in his family had it. He isn't coping well at all but i am not sure I would under the circumstances. One thing I didn't understand was the overall survival time being 2.2 years. Does this mean people with stage 4 only live that long? I am sorry but I am new at this and there is so much I don't understand. Anyway, Rod is at his 6th week of radiation and will see about his next and last chemo session. He is no longer eating with his mouth just using the tube. I know this is silly but he has not lost his hair from chemo(he is very happy about that) but is that possible or will he eventually? Thanks so much Dr for your time. Will keep you posted this week.God bless!Maureen

No one wants to touch this one??? I can handle it, I really can, does anyone know?

Hi Maur

I haven't been avoiding answering. Just been busy with work - and also been away in London twice this week attending committee meetings. The real reason was that I was thinking of how to reply!

The median survival is the time at which the percentage surviving is 50%. So the study showed that 50% of treated patients survived for 2.2 years and only 43% survived for 3 years. Don't let it all depress you. There is always someone who wins the lottery. (Our national lottery slogan is """It Could Be You"""). For a greater understanding of this please read Steve Dunn's excellent article on Survival Curves: The Basics.

Regarding Rod's hair, there have been no studies on hair fall-out yet , so can't say but let's keep our fingers crossed!

Have a nice weekend. If it is sunny tomorrow, I will be mowing the lawn

Best wishes
Vinod :coffee:

Dr Vinod, Thank you for your reply and the additional info, but all this is so hard for me to understand. :banghead: I read it but I don't quite get it. But thanks anyway. I think at this point all we can do is wait until he is finished with treatment and go from there. He has 2 more weeks of radiation and 1 more round of chemo. He will be in the hospital for the chemo, the doctrs want to watch him because of his weight. I am very concerned about him and a little down today. I am shocked at how many people you talk to and you tell them about yourself or in my case my friend's cancer and they proceed to tell you about people they know who died. I just don't understand people. Oh well thanks anyway and I just needed to vent.God bless