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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

Prior to the start of radiotherapy, Wong underwent a planning CT scan while wearing a mask that helps to keep his head and neck still during treatment.

His radiotherapy started a few days later, once his plan was ready and approved by his oncologist.

Although Wong was worried about his radiotherapy (as his friends had said that he would feel "heaty"), he was surprised that the treatment session itself was very similar to having a CT scan.

He lay on the treatment table and wore his mask for about 10 minutes while the radiotherapy machine moved around him. Once his session finished, the radiographers came in to remove his mask and he was able to drive himself home.

For the first three weeks of treatment, Wong felt his usual self. He had some mild nausea for a couple of days after his weekly sessions of chemotherapy.

Towards the end of the third week, he began to develop a sore throat. His oncologist prescribed some medication to help with the sore throat but the soreness continued to worsen as Wong's treatment progressed. He could only manage soft foods. He also noticed some dry peeling of the skin on his neck.

His oncologist prescribed stronger medication to control the throat discomfort so that Wong could continue to eat.

Radiotherapy to the nasopharynx and lymph nodes in the neck commonly causes an inflammation of the lining of the throat. This inflammation usually appears after two weeks of treatment and develops slowly over the subsequent weeks.

It is this throat inflammation that causes the soreness and discomfort.

Careful attention needs to be given to prevent infection during this time as it can worsen the patient's symptoms. This can be done by regular mouthwashes and early treatment with antifungals or antibiotics.

The patient needs to avoid spicy food, alcohol and chillies as these can aggravate his symptoms.

He is strongly advised to avoid smoking cigarettes during radiotherapy for head and neck cancer as it worsens the throat inflammation and reduces the chance of cure.

Wong finally completed his seven weeks of chemoradiotherapy a few days ago. He lost about 5kg and still eats soft foods at the moment, but his oncologist assures him that this will improve and he can go on a normal diet again in a few weeks.

Although he currently has a dry mouth, this too will improve over the next few months as his oncologist treats him with intensity-modulated radiotherapy (IMRT) using the Hi-ART TomoTherapy system. This is an advanced radiotherapy technique that concentrates the dose to the cancer and limits doses to nearby normal tissues such as the salivary glands. This lower dose allows the salivary glands to recover faster and Wong's dry mouth will be much better in a few months.

With older 3D radiotherapy techniques, the salivary glands are permanently damaged. In addition to the patient suffering from a permanent dry mouth, dental and gum problems can also occur.

Wong is also reassured that compared to 3D radiotherapy, the chance of the cancer relapsing in the nasopharynx and neck is minimal with IMRT.

Cancer treatments are always evolving. Technological improvements in radiotherapy, new chemotherapy drugs, breakthroughs in understanding how cancers grow and develop as well as how our bodies fight cancers allow doctors to improve the chance of cure and minimise the side-effects of treatment so that patients can lead long and happy lives.

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