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Diagnosed With Throat Cancer. Unable To Move Head And Limbs. Chances Of Recovery?

Posted on Thu, 2 May 2013

Question: Hi, the patient, 76 years old has been diagnosed by PET with stage IV b throat cancer. The base of the tongue and the lymph nodes appear to have been affected too. The patient stopped swallowing any food about 7 days ago and his mobility has deteriorated fast and now is very feeble and under liquid feed only. He is unable to move his head and limbs. He is recognizing people slowly and talks very little with a slur. The doctors want to avoid a biopsy as they fear bleeding and a UT has been referred today.What are the possible steps of cures and the chances of recovery?

Answered by Dr. Indranil Ghosh (1 hour later)

Hi
Thanks for your query.

It appears that the patient is in poor general health at this point. Given his condition, multiple coexisting illnesses and advanced disease, I don't think any curative option is available.

Probably the best way to relive him of some of his symptoms is to insert a feeding tube (so that nutrition can be maintanied), do a biopsy (can be done in OT so that bleeding can be taken care) and give low dose radiation to improve pain and swallowing. Unfortunately life expectancy is poor (4-8 months).

If he is unable to move limbs and has slur in speech, spread to the brain should be ruled out by an MRI.

Hope I have answered your query. I will be available to answer follow up queries, if any.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (23 hours later)

Hi,
Pt currently not maintaining much consciousness & remains very drowsy. This condition initiated since the 28th March prior to which he was quite mobile on his own support. Why is this happening and how he can gain consciousness? Kindly advise. The main reports are as follows-

# Pt had a MRI Brain (Plain) on 01/10/2012 - T1,T2 and FLAIR images - impression: multiple small areas of ischemia in periventricular white matter of bilateral fronto parietal regions.

# US of Abdomen & Pelvis on 04/10/2012 impression:Gr-IV prostatomegaly with thickened urinary bladderwall & residual urine vol - 223 ml ; medical renal disease.

# 18F FDG PET/CT WB on 03/04/2013: report - study reveals soft tissue density mass with increased FDG uptake measuring 5.6 x 5.3 cm in base of tongue (Rt side), Rt side floor of mouth, bulging into orophanyx causing obliteration of rt vallecula. also noted enlarged BL cervical (level II) lymph nodes (Rt > Lt). also noted mildly reduced FDG uptake in Rt horal genglion - likely vascular etiology.

Answered by Dr. Indranil Ghosh (11 hours later)

The various causes of unconsciousness in him may be spread of cancer to brain (not picked by PET hence a fresh MRI may help, the MRI you posted was 6 mo back), new stroke (he has evidence of small strokes in the MRI), electrolyte imbalance like low sodium or some undiagnosed infection in the body.
Of these infection and electrolyte imbalance are potentially treatable and should be excluded.

Overall I want to reiterate that the outlook appears quite grim.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (2 days later)

Hi, the doctors are saying that after PET, MRI of brain is not necessary and it appears clean. The pt is being treated for hyponetramia and being given antibiotic injections with the aim to stabilize and improve his general condition. Since his condition was considered unfit for a biopsy, some doctors have advised for a FNAC of lymph node to determine malignancy and stage of Cancer. However, the doctor of the ward where he has been admitted, is apprehensive that FNAC could cause bleeding and aspiration. He is of the opinion that in this condition also the pt cannot be given palliative radiotherapy. What is your opinion, Sir?

Answered by Dr. Indranil Ghosh (5 hours later)

Final decision obviously lies with the treating physician.

Hyponatremia (low sodium) may explain some of his drowsiness. PET is not good for brain imaging but I agree that even if MRI shows something it may not be treatable at this stage.
If there is a gland in the neck, the FNAC can be done without much risk but if they are planning FNAC from base of tongue it may not be feasible. It is unlikely to show anything.

If patient continues to be unconscious then palliative RT will not be useful.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (4 hours later)

Sir, the patient is not ambulatory - can just move slightly his hands and remains awake for a few hours daily and talks with a slurred speech. Though he recognizes most visitors. He appears to be in deep sleep with mouth open for most time and drifts between heavy drowsiness to light drowsiness when awake. In this condition, would he be suitable for FNAC and more so for palliative RT? This debate continues and in the meantime the patient is only being attended for hyponatremia, glucose instability, insulin shots etc. Kindly give us some definitive advice what we must insist with the doctors or look for alternate hospitals? Thank you.

Answered by Dr. Indranil Ghosh (10 hours later)

If the patient is not considered fit for RT then no point in going for FNAC.
From your description I don't think he will benefit from pall RT and it will be difficult to administer.
I think his doctor is doing the reasonable thing.

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar