Question regarding Nasopharyngeal cancer

Bay Area Guy

Hi. I’m from the kidney cancer board, class of 2016 (for removal of one cubic inch of my right kidney). I’m here today about my wife’s brother. He was diagnosed in September, 2009 with nasopharyngeal cancer, Stage 4A. He underwent radiation, M-F for three months along with a monthly dose of chemo (I forget the drug used) for four months. All was well until August when a scope uncovered a hyper vascular lesion in his left nasal cavity. A follow up scope this week showed a slight, but measurable, increase in the size. He’s been referred for an MRI tomorrow (Christmas Eve of all days).

A couple of questions that I hesitate asking of Dr Google as the results of the searches all have to be hyper analyzed as to when they were posted and who posted them.

1. Is a recurrence of nasopharyngeal cancer common?
2. Does the treatment differ based on recurrence versus the original diagnosis?
3. Have there been changes (improvements) in treatments? What’s the “gold standard” for treating a recurrence? In my case, while there were alternative, less invasive treatments, the gold standard was surgery.

I appreciate any information folks can share. In 2009/10, I spent over three months with this man, going to every radiation session and every chemo session with him and I’ll be right there for him again if this turns out to be a recurrence, but I desperately need information.

wbcgaruss

Well, hello Bay Guy and let me say your brother-in-law is Blessed to have someone like you stick close through thick and thin.

As far as nasopharyngeal cancer I can't say I am familiar with it I had different cancer. But it is still an H&N cancer.

First off we have a saying on here and probably other cancer boards do too that it's not cancer till they say it's cancer. Which involves what he is going through. I don't know what a hypervascular lesion is but checked on the net and the best I can figure is it is an abnormality or growth that can be either benign or malignant. Anyway, they are taking him on the right path, they see something that doesn't look as it should so they are sending him for a scan. Depending on what they see on the scan they may want to verify if it is cancerous or not so next they would order a biopsy to determine if it is cancer and if so what kind. The type of cancer if so determines how they would treat it as per the type of chemo etc. Hopefully, it is not cancer but they may want to operate and remove it or just observe and wait. But again it's not cancer till they say it's cancer which is scoping, visual, then, MRI or CT Scan, then a biopsy.

Is recurrence common? I would not think it is a common thing and happens a lot considering effective treatments today and even when he had them done. I have not heard of recurrences being more for one cancer or another and I think a lot of that just depends on your genes other than shoddy treatment where they miss cancer cells and if that would be the case he would have had an issue sooner than 11 years out. I think in his case if there is cancer it may just be new cancer not necessarily a recurrence but could be either.

I don't know if treatment would vary except there are probably some new machines and techniques available that were not some 11 years ago when he had cancer. I think they would approach it with all options open but certainly, his previous treatment would be a factor. Such as radiation in the same area twice I don't think they like to do it and the reason is it just increases fibrosis and makes everything stiffer and less flexible. I had radiation twice but not exactly in the same area but both times in the H&N area.

I would say since his last time treated there are big improvements in drugs and surgery and radiation such as Proton which is much more accurate and focused, damaging much less surrounding tissue. I don't think there is what you call a gold standard for treating recurrence although I could be wrong but I think it would be approached on a case-by-case basis taking into account any previous treatments and what they were such as the amount and strength of chemo and or rads.

Here again, what I am giving you is a lot of ideas and opinions based on my experience and reading this forum, and going to our local campus support group meetings. So this is just my take on it.

So in closing, I say again "It's not cancer till they say it is"

If unfortunately it is see what the treatment plan is and if not completely satisfied many on here recommend getting second opinions and going to major cancer centers to get the best possible treatment.

So hopefully we get a result of-hey no big deal, just an oddity and we will monitor it.

Here I go being a windbag again but in all my bluster I hope there are a couple of things in there that help.

Wishing You and your buddy Best-Take Care-God Bless-Russ

Logan51

Sorry to hear about the growth. I'm 13 years out to the good for stage-3 NPC, so I am also a 2009er. Typical for a reoccurrence is in the lungs w/NPC. I cut all ties with my Chemo and Rad Drs. after 4 years, have a fairly constant nasal drip thing, so maybe I should get scoped there by my ENT- who I did not cut ties with.

To answer your questions: everything is dependent on the growth and what the Drs. think is the best way to attack it so he has another long stretch of NED. They say you can only get so much in terms of Rads a 2nd time, due to the damage with the 1st, but quite a while has passed. Proton Rads are the best- zero in on the target with minimal collateral damage, FYI. Rads damage tissue and creates scar tissue, is the simplest way of putting it, and I have heard of people getting lesser Rads with a 2nd bout.

Bay Area Guy

https://csn.cancer.org/discussion/comment/1691610#Comment_1691610

Thank you for a very detailed response. Yeah, we say much the same thing over at the kidney board regarding it not being cancer until they say it is. I forgot that in my search for information.

LitlCJdoll

Hello Bay Area Guy,

I myself am honored to hear from someone so concerned fro, and seeking answers for,CA family member. Wishing we could all be so lucky as to have someone like You, on our side!!

I hope they accurately assess it soon, but yes, hyper vascular lesions can go either way, benign or malignant. I have 2 hyper vascular lesions on my Spleen. They are Not small either. Its been a couple Years since imaging scans have visualized that area, though, because they are instead hyper focused always on my head, neck and chest. Out of sight out of mind, i guess.

I think it was forgotten about, when a mass by my right vocal cord was found ( its Severe Dysplasia, pre malignant) and then all attention to trying to get rid of it with laser surgery ( didn't work).

I am 3 years out from radiation treatments.... 9 months after treatments, I had a New Primary, different site ( but still h/ n), really fast growing and invasive . It was not a hyper vascular lesion... It was straight up one of my classic fast growing SCC Tumors.

I guess my point is, we can display many different kinds of " growths" and abnormalities. One of my 3+ hour surgeries was for a large benign cyst, which formed after a Chyle Leak during a major surgery. Inpatient, lost a lot of blood and on oxygen, due to a very large benign growth in neck. Doesn't have to be cancer , to cause big time problems!

And I'm exhausted talking about it!! LOL

Please keep us informed about your brother in law, and Thank You for being that strong support and caring, in his life.

LitlCJdoll