Aug 31, 2008 - 10:41 am
I notice that some people posted fairly recently who have had - or have - cancer of the nasopharynx, and thought I would share my experience so far.
My wife was diagnosed with Stage IVb Nasopharyngeal carcinoma (NPC) around a month ago, and is being treated in Taiwan, where the disease is much more common than in Western countries. It would appear that Chinese people are predisposed to the undifferentiated form of the cancer. She is 32 years old. She did an MRI scan, bone scan, chest xray and pet scan and was staged with T4N3aM0 undifferentiated NPC. The size of her larger neck node was measured at 8cm diameter. She had no other presenting symptoms other than the neck lump, which suddenly flared up in June. Undifferentiate NPC is the most aggressive form of the cancer, but conversely the most responsive to radiotherapy.
In Taiwan, they start straight away on concurrent chemoradiation. She is being given 7 weekly doses of 30mg/m2 cisplatin with 35 sessions of radiotherapy (IMRT) lasting for 15 minutes each, 5 days per week - so the treatment is due to last 7 weeks. She's done nearly 3 weeks so far.
She takes glutamine supplements to try to help with mucositis (throat sore), and they give her several anti-nausea drugs to help overcome the side-effects of cisplatin. The main drug they give against cisplatin (they give quite a few different medicines) is a 5-F3 inhibitor, which in her case is Tropisetron. They also give another drug called Emend (aprepitant) if the nausea gets really bad, which she hasn't needed yet. She still feels the nausea on days 2 and 3 after chemotherapy though, although she hasn't vomited at all during treatment so far.
Some of the hair on the back of her head has fallen out and the side of her neck is darkened due to the radiotherapy, but she hasn't really got a sore throat yet. She complains that her taste is really odd though, that things taste of "lead". She brushes her teeth with dry mouth toothpaste and has a special mouthwash to use.
Her lump has gone down a lot on her neck - so much that it is barely visible any more - and she had another CT scan at the end of last week to re-work her mask and to make sure the radiotherapy was still aiming at the right places! All that seems to be left on her neck is a tiny lump, which isn't visible to the naked eye, and that is shrinking back too. This has obviously given me a great deal of hope, as apparently this speed of response doesn't always occur. The correct doctor wasn't present at the CT scan last week, but we'll ask her about the state of the primary tumour when we see her next.
The main problem we have at the moment is that her blood count last week showed falling white blood cell count, and she might have to miss some chemotherapy if it falls much further.
They aren't using 5FU during the treatment (the toxicity is too great), and they say she doesn't require a PEG tube for her stomach. We'll just have to wait and see if that's a good idea...