My dear aunt now has a Tracheostomy due to a tumpr in the Pharynx. Cannot eat or swallow. CT shows spread to bones of neck only. She had maximum dose of radiation and two Chemo treatments. Can tumor be shrunk further to with more chemo to allow her to eat? She is very thin otherwise in good health. Is this some chemo which could do this gently? Thank you if you can offer any advice.
Reply: ---------------------
Your description of your aunt's problem suggests that she has an advanced pharyngeal carcinoma. If it has indeed spread to involve the cervical vertebrae ("bones of the neck") then the chances of cure are slim and therefore palliative therapy primarily directed towards comfort measures are the most appropriate intervention.
Whether or not radiation or chemotherapy is recommended is dependent on a number of factors including the general health status of the patient. These measures are meant to shrink tumors and improve function while possibly prolonging life in situations where the effect of the tumor is worse than the potential side effects of the treatments. They would not realistically be intended to cure if spread to bones has occurred however. Unfortunately, in the case of cancers that involve the mouth or throat, radiation treatment or chemotherapy can result in a diffuse painful inflammation of the lining known as mucositis. Thus even though the tumor may be temporarily shrunken, the mucositis that frequently occurs will still prevent normal swallowing in many patients for a certain period of time. This often times necessitates alternative feeding methods at least on a temporary basis.
Usually when pharyngeal cancers become advanced to the point that tracheostomy is necessary and when prospects for cure are slim, and therefore prognosis poor, alternative feeding methods are usually recommended to maintain nutrition. Most of the time this ultimately means the placement of a tube in the stomach known as a gastrostomy tube through which liquid nourishment can be delivered directly into the stomach so as to avoid starvation. A more temporary method is the placement of a small tube through the nostril into the stomach known as a nasogastric tube.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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