Oral Cancer Metastasis: Treatment Options and Costs

Oral cancer metastasis

Hello Doctor: My father is 60 years old and was diagnosed with stage IV gingival cancer that had invaded the mandible in June of last year.
He underwent surgery to remove the mandible and had lymphadenectomy, and the postoperative report showed no cancer cells in the lymph nodes.
He subsequently received radiation therapy combined with chemotherapy and has been attending regular follow-ups.
A CT scan in early November showed normal results.
However, in February of this year, he experienced pain and discomfort in his right shoulder and chest.
A CT scan revealed a tumor near the right lung, adjacent to the right ribs, and below the sternum.
The doctor indicated that it was a metastasis and did not perform a biopsy, stating that the location was not suitable for surgery and recommended chemotherapy (once a week, two weeks on, one week off).
After two months, a follow-up examination is scheduled to assess the treatment's effectiveness.
He has completed 10 sessions of radiation therapy, and due to financial constraints, he is currently receiving chemotherapy covered by health insurance (cisplatin + gemcitabine), having completed the fourth cycle.
My father's physical condition is deteriorating.
I would like to ask what other treatment options are available if the upcoming examination shows poor treatment results, what medications could be considered, and what the approximate costs of these treatments might be.
Thank you, Doctor, for your response!

Zhuang Xiaojie, 20~29 year old female. Ask Date: 2016/04/01

Dr. Lai Yicheng reply Oncology

Dear Miss Chuang,
Thank you for your letter.
Here is my response:
1.
Your father is currently receiving the standard treatment regimen of "cisplatin + gemcitabine" for head and neck cancer.
If this treatment fails, there are many other chemotherapy agents available, so there is no need to worry.
Regarding the treatment costs, it is difficult for me to provide an exact figure, as the expenses vary depending on the choice of medications.
2.
Based on your description, your father has metastatic tumors in the right lung, right rib cage, and below the sternum.
I am unsure if your attending physician has informed you whether these are bone metastases, mediastinal lymph node metastases, or right internal mammary lymph node metastases.
Without seeing the CT scans, I cannot ascertain the exact situation.
If it is bone metastasis, I recommend conducting a whole-body bone scan to confirm whether there are any other bones with metastatic lesions.
Thank you for your inquiry.
Changhua Hospital cares about you.
Sincerely,
Dr.
Lai Yi-Cheng
Department of Radiation Oncology

Reply Date: 2016/04/01

More Info

I'm sorry to hear about your father's situation. It sounds like he has been through a lot with his oral cancer diagnosis and subsequent treatments. Understanding the complexities of cancer treatment, especially when it involves metastasis, is crucial for making informed decisions moving forward.

Oral cancer, particularly when diagnosed at an advanced stage like IV, can be aggressive and may lead to metastasis, as you've experienced with the recent findings in your father's lungs and ribs. The treatment options for metastatic cancer depend on various factors, including the location of the metastasis, the patient's overall health, and previous treatments.

Currently, your father is receiving chemotherapy with cisplatin and 5-fluorouracil (5-FU), which are standard treatments for head and neck cancers. If the response to this regimen is inadequate, there are several other chemotherapy options available. These may include:
1. Taxanes (e.g., Docetaxel or Paclitaxel): These drugs are often used in combination with other agents and can be effective against various types of cancer.

2. Cetuximab: This is a targeted therapy that can be used in combination with chemotherapy for head and neck cancers. It works by targeting the epidermal growth factor receptor (EGFR), which is often overexpressed in these cancers.

3. Nivolumab or Pembrolizumab: These are immune checkpoint inhibitors that have shown promise in treating recurrent or metastatic head and neck cancers. They work by enhancing the body’s immune response against cancer cells.

4. Clinical Trials: Depending on your father's specific situation, he may be eligible for clinical trials that explore new treatment options. These trials can provide access to cutting-edge therapies that are not yet widely available.

Regarding the costs of these treatments, it can vary significantly based on the specific drugs used, the treatment facility, and whether the treatments are covered by insurance. Chemotherapy can range from a few thousand to tens of thousands of dollars per cycle, especially for newer targeted therapies or immunotherapies. It's essential to discuss with your healthcare provider about the potential costs and what might be covered under your father's health insurance plan.

In addition to chemotherapy, supportive care is crucial, especially as your father's strength declines. This can include pain management, nutritional support, and possibly palliative care services to improve his quality of life.

It's also important to maintain open communication with your father's healthcare team. They can provide the most accurate information regarding his prognosis, the effectiveness of current treatments, and the best next steps based on his response to therapy.

In summary, while the situation is challenging, there are multiple avenues to explore if the current treatment is not effective. Discussing these options with his oncologist will help you make informed decisions about his care moving forward. Remember to also consider supportive care to help manage symptoms and maintain quality of life during this difficult time.

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