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Could that lump in your neck mean cancer?

Thursday, Aug 23, 2012
The Star/Asia News Network
By Dr Muhammad Azrif

Intensity-modulated radiotherapy (IMRT) is an advanced radiotherapy technique that concentrates the radiation dose to the cancer and limits exposure to nearby normal tissues such as the salivary glands.

A person with nasopharyngeal cancer often presents with a lump in the neck, but this can be preceded by nasal symptoms a few months prior to the emergence of the neck lump.

WONG had not been feeling well. He had been troubled by a blocked nose and reduced hearing for a couple of months. He became more worried after he noticed a lump in his neck one morning while shaving.

He went to see his panel doctor, who then referred him to an ear, nose and throat (ENT) surgeon at his local hospital.

After listening to Wong describe his symptoms, the doctor inserted a thin scope into Wong's nostril. He found a large mass lying on the left wall of the nasopharynx, which is an area right behind the nose. A small part of the mass was biopsied and sent to the laboratory.

This confirmed nasopharyngeal cancer.

Nasopharyngeal cancer is the fourth commonest cancer in Malaysia. Nearly three Malaysians a day are diagnosed with this disease. It mainly affects Chinese men and more than two-thirds are diagnosed with stage 3 or 4 cancer.

Patients commonly present to hospital with a lump in the neck, but this is often preceded by nasal symptoms a few months prior to the emergence of the neck lump. The nasopharynx has many lymphatic vessels and therefore cancer cells spread easily to the lymph nodes in the neck, hence the lump that prompted Wong to go and see a doctor.

Wong was referred to an oncologist for further treatment. The oncologist arranged a magnetic resonance (MR) scan of the head and neck, a CT scan of the chest and abdomen, and a bone scan.

These showed that the cancer had spread to a few lymph nodes on both sides of the neck. Fortunately, it had not spread elsewhere in the body. The oncologist explained that Wong had stage 3 cancer of the nasopharynx and advised seven weeks of radiotherapy combined with chemotherapy.

He was also advised to stop his 10 cigarettes a day smoking habit and to see his dentist for a dental assessment prior to the start of treatment.

Once a cancer has been diagnosed, staging of the cancer is important to help guide treatment. Ideally, an MR scan is done to properly visualise the tumour in the nasopharynx, and its encroachment to surrounding tissues.

Cancers in stage 1-3 are curable and the treatment recommended is intended to eradicate the cancer completely. Certain stage 4 cancers may be curable, provided the cancer has not spread elsewhere. Although the public often associates stage 4 cancers as incurable, the staging of cancers very often differ in its details. For example, cancer of the nasopharynx that invades up towards the brain is classified as stage 4, but it is still curable with chemotherapy and radiotherapy.

As Wong has stage 3 nasopharyngeal cancer, the standard treatment in this situation would be concurrent chemoradiotherapy, which consists of 35 sessions of radiotherapy combined with weekly low-dose chemotherapy over seven weeks.

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