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Nasopharyngeal cancer, three masses are active, cant get to third. Why surgery?

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Posted on Tue, 22 May 2012
Question: My letter is to Dr Prasaid.

Dr Prasaid I received an answer to my question from Dr Ani Thakwani. It was quite satisfactory but I wanted to ask one last question.
I wanted to know since he felt my brother in law might be in the last stages of nasopharyngeal cancer because they are trying to get to two of three masses that became active in his throat, why would they even attempt the surgery. If they thought these were malignant. I hope you have the former letter and info I gave you last week. Just to freshen up....my brother in law has had this cancer for 10 years and has survived three recurrences. But after the last recurrence three years ago, he was taking scans every three months.....April scan showed activity. One of the masses that seems active is in the original site of the cancer thatbwas diagnosed 10 years ago. So again my question. Why would they do the surgery, which is the second try since last week they could not Intubate him because of the damage to his throat. This time (on Wed) they will attempt through the nose. The Doctors him they will send the specimens to be analyzed. Taking into account his history, why would they even try to take two of the massesvwhen they can't get to the third, which to me is the most XXXXXXX I am getting mixed signals because they are doing the surgery. This is the first time in 10 years they ever tried surgery. But I don't want to get my hopes up. If theyvarecsending these TUMORS out to be analyzed then do they think they could be benign....even with his history of recurrences.
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Follow up: Dr. Anil Thakwani (6 minutes later)


Sorry for the typos...

Again, my basic question is.....why would they be doing surgery on the throat( this time going through the nose) if like you told me this cancer may be in it's late stage. I am really confused. You would think after three recurrences which they managed to control with chemotherapy and zeloda that they would give him just chemotherapy again. Please Dr, do not sugar coat anything. Just tell me what to probably expect
doctor
Answered by Dr. Anil Thakwani (10 hours later)
Hi XXXXXXX

As told in my earlier replies the treatment of choice is Radiation therapy for NPC (Nasopharyngeal Cancer).

It is recurrence as it is appearing from PET scan report as an uptake. It means it is an active lesion so no doubt it is stage 4. Second it is recurrence so prognosis is not that good as I mentioned in my earlier reply. Reirradiation can be the option during recurrences. Chemotherapy can be tried depending on general condition of the patient. This is the general impression without seeing him.

Now why is the surgery done? This is not completely understandable. Any cancer therapy is going to be tailor made as per the person's requirements.

According to the literature the surgery is attempted after radiation therapy if:
1) Recurrence of NPC with no scope of radiation anymore and the General condition is not permitting a chemotherapy.
2) A salvage surgery to open the closing airway, a palliative measure to preserve life further. Did they say that they are going to do a Tracheostomy also (making a hole in the throat to create an airway)
3) Nasal approach being taken to resect what ever the mass that can be.
4) If they can pick the mass they are going to send for pathological analysis as per protocol.

Regards,
Dr. Thakwani.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Anil Thakwani

Oncologist

Practicing since :2004

Answered : 11 Questions

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Nasopharyngeal cancer, three masses are active, cant get to third. Why surgery?



Sorry for the typos...

Again, my basic question is.....why would they be doing surgery on the throat( this time going through the nose) if like you told me this cancer may be in it's late stage. I am really confused. You would think after three recurrences which they managed to control with chemotherapy and zeloda that they would give him just chemotherapy again. Please Dr, do not sugar coat anything. Just tell me what to probably expect