Post-Treatment Concerns for Nasopharyngeal Cancer Survivors

Post-treatment issues of nasopharyngeal carcinoma?

I would like to ask the doctor...
My mother was diagnosed with stage II nasopharyngeal carcinoma in 2001.
After treatment, she has been returning for follow-up appointments every six months.
However, it has been 3.4 years since her last detailed imaging examination (such as cancer cell testing).
Although she has had blood tests during this time, I am still concerned that these checks may not be thorough enough.
After all, the greatest fear with cancer is recurrence and metastasis.
Therefore, I would like to ask: 1.
What changes or discomforts in the body should we pay special attention to? 2.
How often should she undergo a more detailed imaging examination? 3.
What is the name of this type of examination? 4.
Can we request the doctor to arrange for such examinations ourselves?

Xiao Ming, 20~29 year old female. Ask Date: 2007/09/10

Dr. Chen Sirong reply Oncology

1.
A.
The onset of tinnitus when there was none before B.
Nosebleeds C.
Bone pain D.
Poor appetite and continuous weight loss E.
Persistent cough with blood-streaked sputum F.
Visiting an ENT specialist every time I catch a cold, and also seeing the doctor who treated my mother for nasopharyngeal cancer, although it's not necessary.

2.
Once a year is sufficient.

3.
Chest X-ray, bone scan, abdominal ultrasound, nasopharyngeal CT scan or MRI.

4.
Yes, but the doctor may not agree because the recurrence rate of nasopharyngeal cancer after treatment is less than 3% within three years.
Since your mother has been treated for six years, the recurrence rate is even lower.
Therefore, it may not be necessary to undergo these tests.
I recommend an annual self-paid comprehensive health check-up, as early detection of other cancers could be more beneficial, such as A.
PET scan (Shin Kong, Chang Gung) B.
Whole-body MRI (Taipei Veterans General Hospital, Chung Shan Medical University Hospital) C.
General comprehensive health check-up (various major hospitals).
I suggest you undergo different types of examinations each year.
Thank you for your letter.

Sincerely,
Chen Si-Rong

Reply Date: 2007/09/10

More Info

Post-treatment concerns for nasopharyngeal cancer survivors are crucial for ensuring long-term health and monitoring for potential recurrence or metastasis. Given your mother's history of stage II nasopharyngeal cancer diagnosed in 1990 and her ongoing follow-ups, it's understandable to have concerns about her health status and the adequacy of her monitoring regimen. Here are some insights based on your questions:
1. Physical Changes and Symptoms to Monitor: Survivors of nasopharyngeal cancer should be vigilant for several signs and symptoms that may indicate recurrence or complications from treatment. These can include:
- Persistent or worsening sore throat: This could indicate local recurrence.

- Difficulty swallowing or changes in voice: These symptoms may suggest structural changes or recurrence in the nasopharyngeal area.

- Unexplained weight loss: Significant weight loss can be a red flag for various health issues, including cancer recurrence.

- Swollen lymph nodes: Particularly in the neck area, swollen lymph nodes can indicate metastasis.

- New headaches or neurological symptoms: These could suggest metastasis to the brain or other complications.

- Hearing loss or tinnitus: Changes in hearing can occur due to treatment effects or recurrence.

2. Frequency of Detailed Imaging Studies: The frequency of detailed imaging studies, such as MRI or PET scans, can vary based on individual risk factors, treatment history, and physician recommendations. Generally, for high-risk patients, imaging may be recommended every 6 to 12 months for the first few years after treatment, then less frequently if no issues are detected. Given that your mother has not had a detailed imaging study in over three years, it may be prudent to discuss the possibility of scheduling one soon, especially if she exhibits any concerning symptoms.

3. Types of Imaging Studies: The most common imaging studies used to monitor for recurrence in nasopharyngeal cancer include:
- MRI (Magnetic Resonance Imaging): This is particularly useful for assessing soft tissue and detecting local recurrence.

- PET (Positron Emission Tomography) Scan: This can help identify metabolically active cancer cells and is often used in conjunction with CT scans.

- CT (Computed Tomography) Scan: This can provide detailed images of the head and neck region.

4. Requesting Imaging Studies: Yes, patients can and should feel empowered to discuss their concerns with their healthcare providers. If you believe that more detailed imaging is warranted due to the time elapsed since the last comprehensive check or due to any new symptoms, you can certainly request that your mother's physician schedule these tests. Open communication with her healthcare team is essential, and they should be receptive to your concerns and willing to provide the necessary evaluations.

In conclusion, ongoing vigilance is vital for nasopharyngeal cancer survivors. Regular follow-ups and appropriate imaging studies are essential components of post-treatment care. Encourage your mother to maintain her follow-up appointments and to communicate any new or concerning symptoms to her healthcare provider promptly. It’s always better to err on the side of caution when it comes to cancer surveillance.

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