New to the club here..Larynx Cancer.

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. 

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

.

Learn this site doesn't have enough bandwidth.

My apologies.

I would delete these if I could.

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.

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.

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.

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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.

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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.