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Lymph node spread

Posted by Ozark @ozark, Apr 19, 2018

My husband has a laryngectomy last August and two PET scans have just shown cancer in lymph nodes in his neck and thoracic area. Can anyone offer any insight about treatment? The one doctor said further tests would be need to see if thoracic nodes are even operable. Radiation is out and chemo sounds pretty iffy. My husband is inclined, in any case, to skip further treatment. One doctor we spoke to gave pretty sketchy information and I hope to contact his surgeon in the next day or so. (He was busy.) Can anyone tell me where we might expect next spread of the cancer —is the lung the likely place? And ANY information on prognosis (doctor said 6-12 mos.) such as what kind of care he will need and how quickly. I’ve been scanning the internet but can’t seem to find what I’m looking for. Any help would be appreciated.

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carol cowan harris | @carolcowan | Apr 19, 2018

Ozark,
I'm Carol, a moderator here. Exactly what kind of cancer does your husband have? If it's laryngeal cancer, the lymph node metastasis means he's stage 4. That's where it most often metastasizes to. Less frequently the lungs, bone, or liver are the sites it spreads to. His prognosis depends on what treatment he gets and other variables like what other health problems he may have, His attitude can impact that, too. Can he speak? It's not uncommon for stage 4 patients with compromised quality of life to decide to stop treatment. In many cancers there are ways the patient could die that are more common or predictable, laryngeal cancer isn't one of them.
Carol

REPLY
Ozark | @ozark | Apr 20, 2018

Hi Carol, thanks so much for responding. My husband had cancer of his larynx which was removed in August at Roswell. He had a PET scan in February or March of his neck area and had several lymph nodes that were suspicious. One they biopsied that day which later was revealed to be cancer. He had a PET scan Wednesday of his chest area and several additional suspicious nodes in his chest cavity were discovered. Ultimately, we were told all the nodes were cancerous. One of the written reports considered them “active metastasis” from the larynx cancer. My husband told the doctor he really didn’t want further treatment, he’s been sick a very long time and was tired. The doctors wanted and expected him to see a thoracic surgeon today but I canceled the appointment because my husband said he didn’t want to go. When we were at Roswell on Wednesday the first doctor was a little unsure about how to answer some of our questions and suggested we talk to Dr. Arshad. We waited a little but he was busy and my husband had had no nutrition or pain medicine all day. So we left. I’ve tried to call Dr. Arshad but haven’t heard back — I know he’s very busy and was in surgery today. I guess my main question is, is declining treatment at this time reasonable? The doctor we spoke to said that, as a surgeon, she, of course, would would to operate if that was determined to even be possible. She mentioned chemo. My husband will never do radiation again. We talked about the return of the cancer even if he did consent to some kind of treatment. I guess, what I’m looking for, is some reassurance that lack of treatment in these circumstances seems like a logical path to take. I’d hate to think some “simple” surgery would have been possible and he decided against it. Secondly, I’m trying to determine where the cancer would likely spread from here. I’m assuming the cancer in the nodes would lead to some other place in the body and the doctor had indicated the lung is the usual place. Beyond that, of course, what will the next 6-12 months entail. If it does go to the lung would he be susceptible to infection or pneumonia? He has other medical issues — he’s had open-heart surgery, rheumatoid arthritis, and diabetes. He lost about 90 pounds and did gain about 20 back. He is still in a peg tube and doesn’t take too much by mouth. I know that’s a lot to ask, I’m just hoping someone has gone through this and could offer some perspective. And, of course, any expert opinion on the plan my husband is considering. I know this is a lot but I’m hoping you or someone can help us!

REPLY
2 replies
StarWolf | @esther2k5 | Apr 20, 2018
In reply to @ozark "Hi Carol, thanks so much for responding. My husband had cancer of his larynx which was..." + (show)
@ozark

Hi Carol, thanks so much for responding. My husband had cancer of his larynx which was removed in August at Roswell. He had a PET scan in February or March of his neck area and had several lymph nodes that were suspicious. One they biopsied that day which later was revealed to be cancer. He had a PET scan Wednesday of his chest area and several additional suspicious nodes in his chest cavity were discovered. Ultimately, we were told all the nodes were cancerous. One of the written reports considered them “active metastasis” from the larynx cancer. My husband told the doctor he really didn’t want further treatment, he’s been sick a very long time and was tired. The doctors wanted and expected him to see a thoracic surgeon today but I canceled the appointment because my husband said he didn’t want to go. When we were at Roswell on Wednesday the first doctor was a little unsure about how to answer some of our questions and suggested we talk to Dr. Arshad. We waited a little but he was busy and my husband had had no nutrition or pain medicine all day. So we left. I’ve tried to call Dr. Arshad but haven’t heard back — I know he’s very busy and was in surgery today. I guess my main question is, is declining treatment at this time reasonable? The doctor we spoke to said that, as a surgeon, she, of course, would would to operate if that was determined to even be possible. She mentioned chemo. My husband will never do radiation again. We talked about the return of the cancer even if he did consent to some kind of treatment. I guess, what I’m looking for, is some reassurance that lack of treatment in these circumstances seems like a logical path to take. I’d hate to think some “simple” surgery would have been possible and he decided against it. Secondly, I’m trying to determine where the cancer would likely spread from here. I’m assuming the cancer in the nodes would lead to some other place in the body and the doctor had indicated the lung is the usual place. Beyond that, of course, what will the next 6-12 months entail. If it does go to the lung would he be susceptible to infection or pneumonia? He has other medical issues — he’s had open-heart surgery, rheumatoid arthritis, and diabetes. He lost about 90 pounds and did gain about 20 back. He is still in a peg tube and doesn’t take too much by mouth. I know that’s a lot to ask, I’m just hoping someone has gone through this and could offer some perspective. And, of course, any expert opinion on the plan my husband is considering. I know this is a lot but I’m hoping you or someone can help us!

Jump to this post

I'm so sorry for what you and your husband are going through. I believe in miracles so don't let him give up hope. I still am convinced that medical cannabis can help him immensely if it's available in your state.
I am considering getting a permit for it, myself, to help with my own post surgery depression. Glad your husband has you advocating for him.

REPLY
Ozark | @ozark | Apr 20, 2018
In reply to @ozark "Hi Carol, thanks so much for responding. My husband had cancer of his larynx which was..." + (show)
@ozark

Hi Carol, thanks so much for responding. My husband had cancer of his larynx which was removed in August at Roswell. He had a PET scan in February or March of his neck area and had several lymph nodes that were suspicious. One they biopsied that day which later was revealed to be cancer. He had a PET scan Wednesday of his chest area and several additional suspicious nodes in his chest cavity were discovered. Ultimately, we were told all the nodes were cancerous. One of the written reports considered them “active metastasis” from the larynx cancer. My husband told the doctor he really didn’t want further treatment, he’s been sick a very long time and was tired. The doctors wanted and expected him to see a thoracic surgeon today but I canceled the appointment because my husband said he didn’t want to go. When we were at Roswell on Wednesday the first doctor was a little unsure about how to answer some of our questions and suggested we talk to Dr. Arshad. We waited a little but he was busy and my husband had had no nutrition or pain medicine all day. So we left. I’ve tried to call Dr. Arshad but haven’t heard back — I know he’s very busy and was in surgery today. I guess my main question is, is declining treatment at this time reasonable? The doctor we spoke to said that, as a surgeon, she, of course, would would to operate if that was determined to even be possible. She mentioned chemo. My husband will never do radiation again. We talked about the return of the cancer even if he did consent to some kind of treatment. I guess, what I’m looking for, is some reassurance that lack of treatment in these circumstances seems like a logical path to take. I’d hate to think some “simple” surgery would have been possible and he decided against it. Secondly, I’m trying to determine where the cancer would likely spread from here. I’m assuming the cancer in the nodes would lead to some other place in the body and the doctor had indicated the lung is the usual place. Beyond that, of course, what will the next 6-12 months entail. If it does go to the lung would he be susceptible to infection or pneumonia? He has other medical issues — he’s had open-heart surgery, rheumatoid arthritis, and diabetes. He lost about 90 pounds and did gain about 20 back. He is still in a peg tube and doesn’t take too much by mouth. I know that’s a lot to ask, I’m just hoping someone has gone through this and could offer some perspective. And, of course, any expert opinion on the plan my husband is considering. I know this is a lot but I’m hoping you or someone can help us!

Jump to this post

I just talked to Dr. and got many of my questions answered. Apparently my husband decision isn’t unreasonable. The doctor suggested talking to palliative care to prepare for the future. I will, of course, but would love to hear from anyone who could provide some insight into what the next few months will entail. I really like that doctor.

REPLY
carol cowan harris | @carolcowan | Apr 21, 2018

Ozark,
No, your husband is not being unreasonable at all. The people you're looking for who can give you EXACTLY the answers you're looking for are palliative care! You can be followed by them and the doctor you like who suggested them. I like him for suggesting them! They'll see your husband's records and can advise you better than I can. They will be who guides you through this and help you and your husband make informed decisions. You'll get the emotional support you need.
Here's a link from Dana Farber, one of the best places for cancer care in the country that talks about the benefits of palliative care.
http://blog.dana-farber.org/insight/2017/12/10-things-know-palliative-care/
Carol

REPLY
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