New to the club here..Larynx Cancer.
Comments
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I realize this is too soon to
I realize this is too soon to ask, as I don't even have my PET done yet. But, if they only recommend radiation. To be on the safe side, should I request a bit a chemo (is that what everyone sort of means when they imply the "kill/ cure" and get it the first time? I don't want this half a**ed... You know, I am not asking for medical advice here. I'm just curious. Just say it's still T2N0M0 when the PET comes back (It better not look like a Christmas tree) then would people here trust only radiation to kill it when it's been hanging out on my left vocal cord? I can't have rads there again if it came back... I'd probably have to get my voicebox taken out. Or find someone that would do laser (if possible) and then chemo.
You've had a tough time of it, and you and your boyfriend are both warriors.
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Cancer Center
Well, if you are at a Comprehensive Cancer Center and have a top notch head & Neck team, you will be relying 100% on their prescribed treatment plan.
I've had Laser surgery to the mass at my Right vocal cord, and it came back, actually larger than before.
I have 2 Head & Neck surgeons, one is for everything above the vocal cords ( and he is an internationally known surgeon) and my other one is Director of Voice & Swallowing disorder s program . Each specialize in different areas.
Anyway, if you have a great team, they will meet together, discuss your case and put forth the prescribed treatments best for you.
I have to get o bed. My Bronchoscopy in the hospital is Wednesday and I've lots to do tomorrow
Night, Crystal
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Steph
First, you can make it thru the Rads and Chemo, if that's their plan. I, and most everybody else, did. And I went thru concurrent solo with a Port and FT (except for the 3 weeks I needed a coworker to drive me to and from Rads).
The larynx thing reminds me of another coworker. Heavy smoker, and still does. I was a couple years out to the good. Everybody noticed his voice, and he waited almost 6 months to have an ENT visit. Because of my experience, we talked. Let him know I was shocked his Dr. did not have him go thru a PET/CT. All they did was zap him with Rads in 3 places around his voice box, and I want to think that was back in 2011-12. I retired in late 2015. Met him in a Wally's in late-2019. Said he had been to the U of Iowa twice, with the last very recent, to have growths removed- the last time they took a little bit of his tongue.
Everybody is different, Steph, but you only want to go thru this once. The Rad sessions do not involve pain, and the mask just takes some getting used-to.
I've said this before because I think it is the correct perspective: you go thru what you have to because the C has only one thing in mind- killing you. Seems that some lose sight of that fact and gripe about the side-effects we all experience to different degrees. I was unknown Primary NPC, so the Local Loco Rad Dr. blasted me in 20 places/session and some 9 years out I became FT-dependent for the rest of my life due to the Rad damage to my collateral-damaged esophagus, and in week #6 got so sick I had to be hospitalized for anitbiotic drips for 4 nights- so try to imagine how pleasant tx was for me. Whatever the scans show and your C team's plan is- just do it.
If their plan is radical, however, a 2nd opinion at a major C Center is advised.
Best of luck, Steph. I'm less than a month away from being 13 years out to the good. ?
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Steph Once They
Get finished evaluating your scans they usually get together as a cancer board and work out a treatment plan.
I think some places invite the patient or you can ask to be there when they do your case.
I don't think you told us where you are getting treatment.
But at some point, they should lay out your treatment plan to you and you can ask questions then such as about the chemo
or anything else about it you want to discuss.
I agree and I think we all feel that way that you want whatever dose of treatment needed to make this a one-shot deal.
In fact, that is what my radiation doctor said to me "This is a One-Shot Deal" and I am sure your team is of the same mindset.
Logan is correct that if the treatment plan they give you is really making you feel uncomfortable or unsure ask plenty of
questions and be comfortable with it but if not a second opinion is an option.What I can tell you is standard treatment it seems for H&N cancer is 35 radiation treatments and chemo beginning, middle, and at the end.
Occasionally you will see someone who got 30 rads instead.Here is a page with a basic explanation of how chemo and rads work https://www.webmd.com/cancer/cancer-chemotherapy-radiation-differences#undefined-3
In the treatment called chemo-radiation, you will get both chemotherapy and radiation at the same time. Chemotherapy weakens the cancer cells which helps radiation to work better. Your treatment team consists of your medical oncologist and your radiation oncologist.Take Care-God Bless-Russ0 -
Today's Adventure
I realize they state not to give a lot of personal information considering this is a public forum, but whatever...
I am live in Wilmington, NC. So, currently the care team is here. They have a cancer center here called the Zimmer Center (that's chemo) then the radiation happens at the rad Oncologists office.
I will also be getting a 2nd opinion at Chapel Hill on the 7th of November (the day before my radiation therapy starts) I plan to drive up the night before, spend the night, and be there in the AM. I want them to check me out. I'll be taking the PET scan CD with me.
MY PCP is aware all of this is going on. (I have a couple reasons for this which I will explain later on)
I'll check in later today and let everyone know how the days activities went.
Onward!
-S
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You have inspired two new videos!
I won't say much here since you have been reading and following along with many of the locals. But I have been thining of adding 2 new videos and since you are where you are in your treatment plan, I wil use you as my muse! One will be What Friends and Family Can Give You and the other will be about the radiation process itself from the patient's POV.
Thank you for participating here and we all look forward to when you are providing assistance to others!
If you have not yet, please consider reviewing my vidoes on YouTube... this is not solicitation since these are NOT revenue-generators but designed to help folks just like you. If you subscribe you will get notifications when I add the new ones.
I, too, went through much of my junk during the holidays last year...surgery was two days before Thanksgiving and chemo/rads started first week of January. So I missed them all ... from Thanksgiving past Valentine's Day.
We all look forward to helping you through this.
Don--Beagledad
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No worries, Don. (I have
No worries, Don. (I have watched your videos, by the way!)
It was an extremely easy radiation simulation for me. I had absolutley no problems with it.
I arrive, wait my turn, and when called - I strip from the waist up and put a partial gown on. They call me back into the room where the radiation machine is located and have me take my mask off so they can take a photo of me.
They then brought out the mask, and told me what they planned to do and it would be very warm, and it was. After they placed it on me, they just kept pushing on it everywhere to mold it to me until it cooled. I just layed there with my eyes closed. They finish up and leave, and turn the zapper machine on. I just lay there still, I was actually pretty relaxed. It didn't bother me a bit. I didn't even find the mask uncomfortable at all.
I will not get a full schedule of times until I arrive next week (unless something else happens in Chapel Hill) However, the nurse told me they were so booked it would take time to fit my daily tx's in. This particular Rad Oncologist has 3 machines there, and they are that booked.
Makes me very sad there are that many people that need radiation.
I have a funny story from the dentist, though. I shall create a new thread regarding that on a lighter note. But today was REALLY nothing to be afraid of. I was never scared of today. I have never been scared of the mask. That has never been the fear.
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Steph,
I actually have mild claustrophobia, like I can't wear a necktie for long (not that I want to) - and I buy a motorcycle helmet with a quick flip-up front, that I feel more comfortable with.
It's great that it doesn't bother you. I think that "constrained" feeling gets to a lot of people.
I recall that the radiation was spooky the first couple times, but after that, it got to be very easy!
They should be offering up lots of advice on skin care, and my treatment center gave me all the lotion I wanted. It certainly pays to keep your skin moisturized!
My Oncologist told me it was like a sunburn, but since it's not UV damage - it seems to heal up much faster, when you're done.
I hope you're able to get scheduled as soon as possible!
MG
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Update - Had the PET This morning and below are the results:
IMPRESSION:
HYPERMETABOLIC MASS AT THE LEFT VOCAL CORD CONSISTENT WITH
NEOPLASM WITHOUT EVIDENCE OF METASTATIC DISEASE.
A 4.1 CM MASS IN THE RIGHT LIVER IS WITHOUT ACTIVITY. THIS MAY BE
A BENIGN LIVER MASS SUCH AS HEMANGIOMA OR FNH ALTHOUGH
INCOMPLETELY CHARACTERIZED ON THIS EXAM.
Electronically Signed By: -----------------------
Narrative
PET/CT SCAN, SKULL BASE TO MID THIGHS:
COMPARISON: CT neck 11/16/2021
RADIOPHARMACEUTICAL: 12.33 mCi fludeoxyglucose F-18 (FDG)
injection administered intravenously. Images were obtained from
the skull base to mid thighs using attenuation correction. In
addition, axial non-contrasted CT images were obtained and
correlated with the PET exam. Separate PET/CT images of the neck
performed.
BGL: 80
FINDINGS:
Hypermetabolic activity in the left vocal cord with SUV 10.4. The
activity does appear to contact the anterior midline area. No
hypermetabolic axilla, neck, mediastinal or hilar lymph node.
General mediastinal activity SUV 2.8. General hepatic activity
SUV 3.4. No focal hepatic or splenic activity. Adrenal activity
within normal limits. There does appear to be a low-density
masslike area in the right liver measuring 4.1 cm x 3.5 cm
however there is not any significant activity. No hypermetabolic
pulmonary nodule. A 5.6 mm groundglass opacity right upper lobe
without activity. No hypermetabolic bone activity.
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The masslike area in my liver in quite a common thing and many people are born with them. It is likely 99% HEMANGIOMA which is common and no issue. I could have been born with it. My PCP scheduled a MRI w/ and w/out contrast to rule out that 1% and I am having that done Monday. Then driving to Chapel Hill. Tuesday AM is my appt. there, and I'll find out if surgery is possible in any way, if not - then radiation moves forward Wednesday.
Onward!
Steph
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Chapel Hill update:
Samip Natverlal Patel, MD at 12/07/21 0830
Otolaryngology-Head and Neck Surgery Consult Note
Date of Service: December 7, 2021
Requesting Attending Physician: Warhaftig, Jeffrey L, MD
Reason for Consult: SCC of the left vocal cord
Assessment:
1.
Laryngeal cancer (CMS-HCC)
2.
Dysphonia
46 y.o. female presenting with a T2N0 SCC of the left supraglottis.
I personally reviewed the patient's CT neck dated 11/16/21 which shows a soft tissue lesion on the left true vocal fold extending into the ventricle, false fold and subglottis. Agree with radiology read.
Plan:
- Discussed nature of diagnosis, prognosis, etiology, natural history, and management of the patient's left laryngeal ca. This is a T2 transglottic tumor. We discussed that she is not a good surgical candidate due to the functional deficits she would have to her voice and swallow post-operatively. She would need elective neck dissection as well and is at risk for needing adjuvant radiation as well. The patient is already planned for radiation with Dr. McGuire; I have strongly recommended she pursue this. We discussed that radiation has a very good chance for cure (70-80%). The patient is in agreement.
- See Dr. McGuire for primary radiation therapy.
- Follow up with me PRN.
Chief Complaint
Patient presents with
•
New Patient
History of Present Illness:
Stephanie Sands is a 46 y.o. Caucasian pleasant female being seen in consultation at the request of Dr. Warhaftig for evaluation and opinion of a T2N0 SCC of the left vocal cord.
The patient presents today for further evaluation and discussion of treatment options. She has been scheduled for primary radiation therapy with Dr. McGuire, but is interested in any surgical options if possible. Briefly, the patient has an 8-month history of worsening hoarseness, globus sensation, and throat pain. She began to develop left ear fullness and pain, and was subsequently evaluated by an ENT where the lesion on her vocal cord was noted. This was biopsied on 11/3/21 via direct laryngoscopy in the OR. The patient has been set up with a dentist.
The patient is a former smoker, and quit in 2011 or so.
Modifying factors: None
Other associated symptoms: Hoarseness
Severity is rated as moderate/severe.
The patient denies fevers, weight loss, SOB, dysphagia, hemoptysis, or neck masses/growths.
Past Medical History
Past Medical History:
Diagnosis
Date
•
Cancer (CMS-HCC)
No current facility-administered medications for this visit.
Allergies
Sulfa (sulfonamide antibiotics)
Social History:
Tobacco use: reports that she has quit smoking. Her smoking use included cigarettes. She quit after 15.00 years of use. She has never used smokeless tobacco.
Alcohol use: has no history on file for alcohol use.
Drug use: has no history on file for drug use.
Family History
The patient's family history is not on file.
Review of Systems
A 10 system review of systems was negative except as noted in HPI and intake encounter form, which was reviewed and scanned into the media section of the medical record
Objective
Vital Signs
BP 111/83 | Pulse 91 | Temp 36.3 °C (97.4 °F) | Resp 18 | SpO2 100%
Physical Exam
Vitals signs reviewed in the nursing chart
General: WD, WN, well groomed, pleasant female, sitting up in NAD, normal appearance and voice, communicates appropriately, no stridor.
Psychiatric/Neuro: A&Ox3, Normal mood and affect, Following commands, MAE. Cranial nerves 2-12 intact, No focal deficits.
Head and Face: AT, NC, no asymmetry, Skin with no masses or lesions, sinuses nontender to palpation. Parotid and submandibular glands normal bilaterally. Facial strength normal bilaterally.
Eyes: EOM Intact, sclera anicteric, no conjunctival injection, PERRL.
Nose: Normal external nasal pyramid, anterior rhinoscopy shows normal mucosa, septum, and turbinates.
Ears: Normal auricles, EAC's, and TM's to otoscopy. TM's intact and mobile, Middle ears aerated bilaterally.
Hearing: Normal hearing to whispered voice.
Oral Cavity: Normal lips, gingiva, tongue, hard palate, and dentition; pink, moist mucosa, no lesions, tongue is mobile. Floor of mouth is soft.
Oropharynx: No masses or lesions. BOT soft, normal tonsils, soft palate and posterior pharynx, symmetric pink, moist mucosa
Neck: No masses, no thyroid nodules, no thyromegaly, trachea midline. Normal laryngeal crepitus.
Lymphatics: No cervical lymphadenopathy.
Respiratory: Normal respiratory effort, symmetric chest rise, no accessory muscle usage.
Cardiovascular: No clubbing, cyanosis, swelling, edema or varicosities in extremities, Regular Rate.
Laryngoscopy
Procedure Note
Pre-operative Diagnosis: SCC of the left TVC
Post-operative Diagnosis: same
Anesthesia: None
Surgeon: Samip N. Patel
Endoscopy Type: Flexible Fiberoptic Laryngoscopy
Laryngoscope B (serial number 2938213) was used during this visit on December 7, 2021.
Indications: To better evaluate the patient’s tumor site
Procedure Details:
The patient was placed in the sitting position. After topical anesthesia and decongestion, the 4 mm laryngoscope was passed. The nasal cavities, nasopharynx, oropharynx, hypopharynx, and larynx were all examined. Vocal cords were examined during respiration and phonation. The following findings were noted:
Findings:
Nasal cavities: Normal mucosa, patent, no masses, lesions, normal turbinates and septum, mucosa pink and moist.
Nasopharynx: Normal pink moist mucosa, normal eustachian tubes, no masses.
Oropharynx: Normal palate, tonsils, pharyngeal wall, and base of tongue, no masses, mucosa pink and moist
Hypopharynx: Normal pharyngeal walls and pyriform sinuses, no pooling of secretions
Larynx: Supraglottis, false and true vocal cord are normal.
Vocal cord mobility is normal. Tumor occupying the bulk of her left true vocal cord with extension towards the anterior commissure, into the ventricle and false folds
Subglottis is patent.
Condition:
Stable. Patient tolerated procedure well.
Complications:
None
Test Results
I have personally reviewed all pertinent test results.
Imaging
11/16/21 CT neck:
IMPRESSION:
Soft tissue lesion of the left true vocal fold extending inferiorly, suspicious for glottic malignancy with subglottic extension and likely anterior commissure involvement.
No lymphadenopathy in the neck.
5 mm ground glass nodule in the right apex, nonspecific. Prior imaging, if available, would be useful for comparison. Alternatively, continued attention on follow up studies recommended.
I have personally reviewed all pertinent imaging results.
Scribe's Attestation: Samip N. Patel, MD obtained and performed the history, physical exam and medical decision making elements that were entered into the chart. Signed by Shreyas Pyati, Scribe, on December 7, 2021 at 8:59 AM.
----------------------------------------------------------------------------------------------------------------------
December 7, 2021 9:11 AM. Documentation assistance provided by the Scribe. I was present during the time the encounter was recorded. The information recorded by the Scribe was done at my direction and has been reviewed and validated by me.
----------------------------------------------------------------------------------------------------------------------
Patient Instructions
Tabitha L Thomas, CMA at 12/07/21 0830
Para Espanol: 984-974-1293
For nursing questions please call Tabitha Thomas, CMA at 984-974-0000 or send a secure message through
Your UNC MyChart for a faster response.
FAX: 984-215-3945... Attention Tabitha
For oncology related questions, call the Nurse Navigator Hazel Hampton, at 984-974-0000
For surgery scheduling please call Patricia Longest at 919-966-7491
For scheduling clinic appointments please call 984-974-6484
For appointments or questions about radiology appointments please call 984-974-1884
If you are concerned, do not hesitate to seek medical help at your local emergency department.
After hours, please call 984-974-1000 and ask for the ENT physician on call.
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Tomorrow will be my 3rd radiation treatment and then I have the weekend off! So far I am tolerating it well.
If only it could stay this way, it would be a breeze. They've been GREAT scheduling me during rush hour traffic, though. It hasn't been too bad. I am determined to drive to every one of my appointments.
If someone is in my area or near vicinity and needs transport, please reach out. I am in Wilmington, NC.
-Steph
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I think it is due to the fact he was an Indian. I lost a close colleague of mine to cancer quite a few years back. He was from India. I also had a pediatrition that was Indian. I guess I've accepted my diagnoses? I am not that way towards my Oncologists, I just nod and agree. They both wear these stupid masks that are a play on Schitts Creek, which I have never watched. The First Oncologist literally was a jerk. God complex type. He would be my chemo doc if I need it.
I swear, I would leave to run to Dr. Patel and stay in Chapel Hill with him and what he refers before having to see that man again.
Logan, you are awesome! Hang in there ALWAYS! Believe me, I plan to leave this planet like I came in. Kicking, screaming, and crying :) But it's looking okay so far.
Onward!
Steph
P.S.
Patrick D Maguire, MD at 12/08/21 0900
RADIATION ONCOLOGY ON TREATMENT VISIT MD NOTE
Diagnosis:
ICD-9-CM
ICD-10-CM
1.
Squamous cell carcinoma of left vocal cord (HCC)
161.0
C32.0
Cancer Staging: Cancer Staging
Squamous cell carcinoma of left vocal cord (HCC)
Staging form: Larynx - Glottis, AJCC 8th Edition
- Clinical: Stage II (cT2, cN0, cM0) - Signed by Kenneth W Kotz, MD on 11/19/2021
Medical Oncologist: No care team member to display
Surgical Oncologist: No care team member to display
Primary Care Physician: Jeffrey L. Warhaftig, MD
Site(s) under treatment: Larynx and nodes
Cumulative dose/ # fractions 200 cGy/1fx
Planned dose/ # fractions 7000cGy/35fx
Concurrent systemic therapy: None
S: No treatment issues. Endorses dental evaluation by Dr. Overton, no oral work needed, just cleaning. Seen by Dr. S Patel, UNC Rad ONC yesterday.
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