Can NPC cancer spread to feeding tube site?

Purplemountain

Hi everyone.

Just a curious question.  Can the cancer at the H & N metastasis to the PEG site?  Anyone has experienced or know of such?

What are the sign and symptom for the spread?

Thanks.

PM

phrannie51

I haven't heard of it on here

...or in any of the other groups, either.  Not saying it's never happened ever....but would be very very rare.  I had NPC, and not a single soul in the medical field ever said anything.

p

donfoo

in the other thread

There is mention of the cancer spreading via the blood to both the port and PEG areas. check here

PJ47

That would be unusual from what I have read

It (cancer cells) most likely would have to have been carried there in some way (i.e. by PEG procedure).  The most recent study of these cases is from Endoscopy 2013:45

Ellrichmann et al Malignant Cell Seeding after Peg.  The study was retrospective and concluded the patient's cancer stage and age contributed to this risk.  

PJ

donfoo

PJ47 said:

That would be unusual from what I have read

It (cancer cells) most likely would have to have been carried there in some way (i.e. by PEG procedure).  The most recent study of these cases is from Endoscopy 2013:45

Ellrichmann et al Malignant Cell Seeding after Peg.  The study was retrospective and concluded the patient's cancer stage and age contributed to this risk.  

PJ

That report is actually quite

That report is actually quite frightening. Quote

This study proved a high rate (22.5%) of direct malignant seeding in patients with esophageal and ENT cancers immediately after pull-through PEG tube placement and 9.4% of malignant cell seeding at follow-up. All of these were in patients with SCC. This risk is particularly high in older patients and those with higher tumor stages. Therefore, direct placement of PEG tubes or prior radio-/chemotherapy should be favored in this group of patients despite the markedly higher complication rate. Larger studies are necessary to confirm these data.

PJ47

donfoo said:

That report is actually quite

That report is actually quite frightening. Quote

This study proved a high rate (22.5%) of direct malignant seeding in patients with esophageal and ENT cancers immediately after pull-through PEG tube placement and 9.4% of malignant cell seeding at follow-up. All of these were in patients with SCC. This risk is particularly high in older patients and those with higher tumor stages. Therefore, direct placement of PEG tubes or prior radio-/chemotherapy should be favored in this group of patients despite the markedly higher complication rate. Larger studies are necessary to confirm these data.

Although I had my tongue base tumor removed surgically

and with clear wide margins, I thought it prudent to go with the laproscopic method of tube placement so as to not disturb the throat area where the primary site had been. Probably overkill and then the lap surgery did not take and I had the interventional radiology procedure which went directly into the stomach and that has been very painfull.  

One would think that the MD's are aware of this but all of the ones I discussed this with  seemed to dismiss the posibility as "rare".  Anyway, feeding tubes themselves have a high mortality and complication rate as well, which is also downplayed.

I believe that the seeding if it is going to occur depends a lot on when the PEG is placed and where the primary tumor is located.  The nasal area is probably not going to be disturbed during placement unless they feed a tube through the nose and directly into the stomach.  

If reseeding is going to happen in the stomach, it is usually not long after the radiation is completed (2-6 mos).  After that time, it is probaly nothing to worry about.  

PJ

 

donfoo

PJ47 said:

Although I had my tongue base tumor removed surgically

and with clear wide margins, I thought it prudent to go with the laproscopic method of tube placement so as to not disturb the throat area where the primary site had been. Probably overkill and then the lap surgery did not take and I had the interventional radiology procedure which went directly into the stomach and that has been very painfull.  

One would think that the MD's are aware of this but all of the ones I discussed this with  seemed to dismiss the posibility as "rare".  Anyway, feeding tubes themselves have a high mortality and complication rate as well, which is also downplayed.

I believe that the seeding if it is going to occur depends a lot on when the PEG is placed and where the primary tumor is located.  The nasal area is probably not going to be disturbed during placement unless they feed a tube through the nose and directly into the stomach.  

If reseeding is going to happen in the stomach, it is usually not long after the radiation is completed (2-6 mos).  After that time, it is probaly nothing to worry about.  

PJ

 

not so suure

Even though there is a peer reviewed report about such high incidence of cancer spread via PEG placement, it either does not seem to result in actual cancer recurrence. So many here have had PEG placements and in the past year I have been here, I can not recollect a single report. That is not to say it never happens but at least from experiences here, it does seem a rare incident.

Cancer is a complicated disease and obviously quite elusive to even the best scientific minds as evicenced by the lack of actual curative therapies. Maybe it does spread but there are other conditions at the site that trigger a cancer to grow and spread. Just dropping some cancer cells into some random place may not have the right set of conditions for it to take off. Let's hope and pray it remains a rare instance where it actually does cause recurrence.

Don

Skiffin16

donfoo said:

not so suure

Even though there is a peer reviewed report about such high incidence of cancer spread via PEG placement, it either does not seem to result in actual cancer recurrence. So many here have had PEG placements and in the past year I have been here, I can not recollect a single report. That is not to say it never happens but at least from experiences here, it does seem a rare incident.

Cancer is a complicated disease and obviously quite elusive to even the best scientific minds as evicenced by the lack of actual curative therapies. Maybe it does spread but there are other conditions at the site that trigger a cancer to grow and spread. Just dropping some cancer cells into some random place may not have the right set of conditions for it to take off. Let's hope and pray it remains a rare instance where it actually does cause recurrence.

Don

Agree...

Though I've never been a big fan of some MD's or  thinking that a PEG should be inserted just incase a patient may need it down the road..., that's another entirely different issue.

But of the almost five years that I have been kicking around here, these few posts concerning seeding and PEG sites having any chance of becoming a source of cancer occurence are new to me.

I have never even heard mention of this before actually....

Definitely something to discuss with your MD's if a PEG is mentioned.

I know in some cases that a PEG is considered a life saver, and not taking anything away from those that have needed them. But this is some scary stuff if it has any validity to it...

John

 

phrannie51

I'm sure glad I

didn't hear about this when I was first diagnosed.....at that time one of my biggest fears was fighting the disease and then starving to death instead.  For me, it's worse to plant seeds in my head, than to plant them in my belly....Instead of my regular scan time symptoms of ear aches, sore throats, plug ears......I'd be feeling possibilities in my tummy.....  

 

Hondo

Worry

Anything is possible in this life; a meteor can fall out of the sky and hit us while we are sleeping.  But right now you need to keep focus on getting through your treatment and nothing else. I know you are worried about all kind of things, but all they will do is to just make you sicker. You need to find something to keep you focus on getting over your NPC. If you believe in God put Him in your life and focus on His grace to help you. Sometimes we can worry so much that all it does is to make us sicker, think positive. If you are worried about pain in the PEG tube and not satisfied with what your doctor is saying or doing go and get another opinion. I have pain with my PEG tube and in the stomach from the day they put the PEG tube in but it is not C.  So please try not to worry, keep positive and keep focus on getting better. I been to hell and back fighting this NPC 3 times and I am still here by the grace of God. You will be too.

 

God Bless

Hondo