Nasopharyngeal Cancer: Key Tests and Treatment Questions

Nasal cavity and nasopharyngeal cancer examination items and issues?

Hello Dr.
Chen, my husband recently discovered a lump on the left side of his neck.
After going to the hospital for examination, the biopsy report on April 15 confirmed nasopharyngeal carcinoma.
He was referred to a larger hospital for further treatment.
He stayed at the larger hospital for five days and underwent the following tests: blood draw, electrocardiogram, X-ray, MRI of the head and neck, bone scan, abdominal ultrasound, and dental examination.
The results indicated that he has stage III nasopharyngeal carcinoma, with cancer cells present not only in the nasal cavity but also in both sides of the neck.
Starting from May 7, he will undergo 33 sessions of radiation therapy, and he will begin taking oral chemotherapy on April 22, with plans to start chemotherapy injections in conjunction with radiation therapy from May 7.
I would like to ask Dr.
Chen the following questions:
1.
Can these tests comprehensively identify where cancer cells are located throughout the body? Are there any other more precise tests that may be necessary?
2.
During radiation therapy, there was mention of using a helical knife.
Does this method reduce subsequent side effects? Will it improve the effectiveness of treating nasopharyngeal carcinoma? Since the out-of-pocket costs are significant, I would like to understand the differences in effectiveness.
3.
Although he has not yet started radiation therapy, I have seen many accounts suggesting that radiation therapy often leads to oral ulcers that make eating difficult.
If the helical knife method is used, will the severity of the ulcers be reduced? Does using L-glutamine really help alleviate oral discomfort? There are many L-glutamine products available, with varying purity; how should one choose?
4.
During the radiation and chemotherapy period, are there any foods that should be avoided? I have heard that most foods are acceptable, but it is advised to limit salt, sugar, and oil, avoid spicy foods, raw foods, and beverages like coffee and tea.
Are there any other foods to avoid? For example, is it okay to eat more beef? Can commercial chicken essence or ginseng chicken essence be consumed? Is yogurt containing live cultures permissible?
Thank you for your time in answering these questions.
Thank you!!

Xiao Qian, 30~39 year old female. Ask Date: 2013/04/26

Dr. Chen Sirong reply Oncology

1.
Can these tests comprehensively identify where cancer cells are located in the body? Are there any other more precise tests available? Is it necessary to undergo them? A: Generally, these tests are sufficient and comprehensive.
There is no need for additional tests.
Of course, a whole-body PET scan is more detailed, but doing more tests would only delay treatment.
A PET scan would just confirm the findings again.
2.
In radiation therapy, it has been mentioned that a helical knife can be used.
Does this method reduce subsequent side effects? Will it improve the effectiveness of treatment for nasopharyngeal cancer? Since the out-of-pocket costs are not low, I would like to understand the differences in effectiveness.
A: It will reduce side effects; however, it will not enhance the effectiveness, but it will lower the side effects.
3.
I have not yet started radiation therapy, but I have seen many accounts suggesting that radiation therapy will inevitably lead to oral ulcers and difficulties in eating.
If the helical knife method is used, will the severity of the ulcers be reduced? Does L-glutamine really help alleviate oral discomfort? There are many L-glutamine products available, with varying purity; how should I choose? A: The helical knife method should reduce the severity of ulcers.
As for L-glutamine, I still recommend that you choose one for yourself.
4.
During radiation and chemotherapy, are there any foods that should be avoided? I have heard that everything is permissible, but one should pay attention to low salt, low sugar, low oil, avoid spicy foods, raw foods, and limit coffee and tea...
Are there any other foods to avoid? For example, is it okay to eat more beef? Can I consume commercially available chicken essence or ginseng chicken essence? Is yogurt containing live cultures acceptable? A: Western medicine typically does not specify what cannot be eaten.
For now, focus on gaining weight; you will naturally lose some during treatment.
Thank you.

Reply Date: 2013/04/26

More Info

Dear Patient,
Thank you for reaching out with your questions regarding your husband's diagnosis and treatment plan for nasopharyngeal cancer (NPC). It’s understandable to have many concerns at this stage, especially with the complexity of cancer treatment. Let’s address your questions one by one.

1. Comprehensive Testing for Cancer Spread: The tests your husband has undergone, including blood tests, electrocardiogram (ECG), X-rays, MRI of the head and neck, bone scans, abdominal ultrasound, and dental evaluations, are quite thorough. These tests are designed to assess the extent of the cancer and check for metastasis. However, while these tests provide a good overview, there are additional imaging techniques, such as PET scans, that can sometimes offer more detailed information about cancer spread. If there is a concern about metastasis that these tests did not clarify, discussing the possibility of a PET scan with his oncologist may be beneficial.

2. Use of Helical Knife in Radiation Therapy: The helical knife, or intensity-modulated radiation therapy (IMRT), is a more advanced form of radiation therapy that allows for more precise targeting of the tumor while sparing surrounding healthy tissue. This precision can potentially reduce side effects, including those affecting the mouth and throat, which are common with traditional radiation therapy. While the upfront costs may be higher, the long-term benefits in terms of reduced side effects and improved quality of life can be significant. It’s essential to discuss with your treatment team whether this option is suitable for your husband’s specific case.

3. Managing Oral Side Effects: Oral mucositis is indeed a common side effect of radiation therapy for head and neck cancers. While using advanced techniques like the helical knife may help reduce the severity of mucositis, it is not a guarantee. L-glutamine, an amino acid supplement, has been studied for its potential to help reduce the severity of mucositis, but the evidence is mixed. If you decide to use L-glutamine, look for high-purity products and consult with a nutritionist or your oncologist for recommendations on dosage and brand.
4. Dietary Considerations During Treatment: Nutrition plays a crucial role in supporting your husband’s health during treatment. While it is generally advised to avoid spicy, acidic, or hard foods that can irritate the mouth, a balanced diet rich in proteins, vitamins, and minerals is essential. Lean meats, such as chicken and beef, can be beneficial, but they should be prepared in a way that is easy to consume. Commercial chicken essence and ginseng chicken essence can be consumed, but moderation is key. Probiotic-rich yogurt can also be beneficial for gut health, especially during chemotherapy. However, it’s best to avoid raw foods, as they can pose a risk of infection, and limit caffeine and alcohol, as they can exacerbate dehydration and irritation.

In summary, your husband’s treatment plan is comprehensive, and it’s essential to maintain open communication with his healthcare team regarding any concerns or side effects he experiences. They can provide tailored advice and adjustments to his treatment as necessary.
Wishing you both strength and support during this challenging time. Please feel free to reach out with any further questions.

Best regards,
Doctor Q&A Teams

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