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Forum Name: Cancer of Unknown Primary

Question: New CUP Diagnosis


 jteasley - Tue Aug 17, 2004 3:32 pm

I have been diagnosed with a CUP. I have had surgery and the reccommended course of treatment is radiation therapy. However, when pressed my radiation doctor hedges on radiation being absolutely required. Here is some of his comments to me.

Thanks for you questions and I do appreciate how overwhelming this must
be. I did speak to the pathologist. Apparently the pathology was not
labeled properly and so nodal counts which are usually done on neck
dissections were not done. One node was involved with cancer and there
was no extracapsular spread. The size was 3.5 x 5.0 cm on the CT scan
which means it is a stage N2a. Your base of tongue biopsy also shows
dysplasia which is suggestive of an underlying malignancy in the base
of tongue.

Most people in the country would recommend treatment unless the node was
under 3 cm. It is difficult to find information to tell us what the rate
of developing a cancer in the throat is but one paper said that it was
44% in patients who only had neck dissection compared with 8% for those
who had radiation.
We will be presenting your films, slides, and history tomorrow at our
tumor board. I will certainly call you after that to let you know what
was said.

There is no way to tell whether radiation improves survival because as I
said many patients have other medical problems. My feeling is that you
are young, healthy and generally in better health than many patients
with this diagnosis. You apparently have only one node involved. The
survival rate that is often quoted is for patients who present with all
forms of neck disease.


My question is due to the side effects of radiation, some not so pleasant, what is the down side to doing nothing but having frequent checkups over the next two years or so.
 Dr. Jeffrey Gordon - Sun Mar 06, 2005 8:14 pm

My apologies for the delay in your getting a response to your question. There has been a backlog of questions here at The lounge. We are endeavoring to respond to all questions, including old ones. As more of us are responding to questions, we hope to be able to respond to new questions in a timely manner. I hope that you will visit The Lounge again and that you next experience here will be better than your last.

Your situation is not straight foward and there is not particular right or wrong answers to it.

The upside of treatment is that it could well be of benefit in treating the cancer, especially if there is not much cancer present. The downside of therapy is that you could have various side effects without much benefit. The upside of monitoring the situation closely is that treatment could be offered at a time that it is more strongly indicated (and thus the risks of treatment are outweighed by the benefits). The downside of monitoring the situation is that an opportunity to treat the cancer may be missed or that doing treatment later may be less effective than doing treatment up front because there has been more time for cancer to grow and to spread.

Could you let us know what has developed?

Jeffrey A. Gordon, M.D.
 Pdogs08 - Tue Aug 16, 2005 6:08 pm

I need your help : fast - please, i'M 16 YEARS OLD, MALE, NO HISTORY OF CANCER IN ME..........
Lately (the past few months) I've been getting an increasing amount of diarehha. It starts off with stomach pains, then the diarehha comes, then its usually okay. This happens, it seems, when I eat certain foods. The diarehha on a scale from 1 to 10, (10 being the worst) is commonly between a 4 and 7. I hope this is just irretable bowel syndrome, but if it is, its minor.

Also, lately, I've been getting a few off and on spells where I feel slighltly weak, and very slightly dizzy. It also seems like i get rather shaky and sweaty with these. These are only off and on about, oh, 1-3 times per week. Maybe this is just in my head, maybe not.

I've mentioned this to my mom, and she dowplayed it, saying its just what im eating if anything, and shes not reallu up to much at all for taking me to the doctors.

What do you think I have, and what do I think I should do. Thanks for the nice replies.

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