Treatment Options for Advanced Throat Cancer

Cancer treatment

Hello Dr.
Lai, my husband discovered a hard lump on the right side of his jaw near the neck in January, which has been growing larger.
He visited the ENT department at the hospital, where the doctor used an endoscope and noted an ulcer in the deep throat.
Due to the swelling in the right neck, there was a suspicion of cancer cell metastasis, so he was referred to a larger hospital.
On February 20, the doctor immediately diagnosed it as a malignant tumor, stating it was already in stage III or IV, and arranged for hospitalization to perform a biopsy.
After the biopsy, a CT scan of the neck was conducted.
The biopsy report has not yet been released, but the doctor indicated it is a malignant tumor in the epiglottic region (cT3N2bM0) and scheduled a bone scan and gastroscopy.
We are to return on March 1 to discuss the biopsy and other reports, as well as the treatment plan.
However, the doctor has already explained that surgery is not an option, and only radiation therapy combined with chemotherapy can be performed.
I would like to ask if this process is correct.
What type of tumor is a malignant tumor in the epiglottic region? We are feeling lost and unsure whether to start treatment immediately or seek opinions from other hospitals.
I would like to know Dr.
Lai's opinion.
Thank you!

Jia Jia, 30~39 year old female. Ask Date: 2016/02/27

Dr. Lai Yicheng reply Oncology

Dear Ms.
Chia,
I received your letter regarding your husband's condition, and I would like to respond as follows:
1.
The epiglottic vallecula is located anterior to the epiglottic cartilage and is associated with malignant tumors of the oropharynx.
2.
The original treating physician diagnosed him with cT3N2bM0, which is classified as stage IVa (locally advanced malignancy).
I personally believe that considering a combination of radiation therapy and targeted drug treatment could be beneficial.
The criteria for insurance coverage include: (1) age over 70 years, (2) creatinine clearance (CCr) less than 50 ml/min, (3) hearing impairment, and (4) inability to tolerate standard chemotherapy.
You may discuss with the treating physician whether to opt for a combination of radiation and targeted therapy, as I have had good experiences with treatment responses.
3.
If he does not meet the insurance coverage criteria, the combination of radiation and chemotherapy, according to literature and our experience, has shown tumor control rates of up to 90%.
Wishing your husband a speedy recovery.
Sincerely,
Dr.
Lai Yi-Cheng
Changhua Hospital

Reply Date: 2016/02/27

More Info

Understanding treatment options for advanced throat cancer, particularly in the context of a diagnosis involving a malignant tumor in the hypopharynx (the area of the throat just above the esophagus), is crucial for making informed decisions about care. Your husband's situation, as described, indicates a diagnosis of cT3N2bM0, which suggests a locally advanced cancer that has spread to nearby lymph nodes but not to distant sites. This staging is significant as it informs the treatment approach.

In cases of advanced throat cancer, especially when surgical options are limited due to the extent of the disease, the standard treatment typically involves a combination of chemotherapy and radiation therapy. This approach is often referred to as chemoradiation. The rationale behind this combined modality is to maximize the chances of tumor control while minimizing the risk of recurrence. Chemotherapy can enhance the effectiveness of radiation therapy, making cancer cells more susceptible to the effects of radiation.

The treatment plan your husband’s medical team has proposed—chemotherapy combined with radiation therapy—is consistent with current guidelines for managing advanced head and neck cancers. The specific chemotherapy agents used can vary, but common regimens may include cisplatin or carboplatin combined with 5-fluorouracil (5-FU) or taxanes. The choice of regimen often depends on the patient's overall health, the specific characteristics of the tumor, and the potential side effects.

Regarding your concerns about the treatment process and whether to seek a second opinion, it is entirely reasonable to want to ensure that you are making the best possible decisions for your husband’s care. Seeking a second opinion can provide additional insights and may help you feel more confident in the treatment plan. It is essential to consult with specialists who have experience in treating head and neck cancers, as they can offer tailored advice based on the latest research and treatment protocols.

In terms of the timeline for starting treatment, it is generally advisable to begin as soon as possible, especially in cases of advanced cancer. Delays can sometimes allow the cancer to progress, potentially making treatment more challenging. However, it is also important that the treatment plan is well-coordinated and that all necessary evaluations (such as imaging studies and biopsies) are completed to ensure that the most effective and appropriate treatment is administered.

As for the specific type of tumor, hypopharyngeal cancers are classified as head and neck cancers and can be associated with risk factors such as tobacco use, alcohol consumption, and HPV infection. The prognosis for advanced hypopharyngeal cancer can vary based on several factors, including the tumor's response to treatment, the patient's overall health, and the presence of any comorbid conditions.

In summary, the treatment approach of combining chemotherapy and radiation therapy for your husband's advanced throat cancer is appropriate and aligns with standard practices. Seeking a second opinion can provide additional reassurance and options. It is crucial to act promptly while ensuring that the treatment plan is comprehensive and tailored to your husband's specific needs. Open communication with the healthcare team is vital, and do not hesitate to ask questions or express concerns about the treatment process.

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