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Radiation Fibrosis Syndrome: What It Is and How to Treat It

See more Expert Speaks
CANCERFORWARD | BY MICHAEL D. STUBBLEFIELD, MD

Radiation therapy, like surgery and chemotherapy, is a mainstay of cancer treatment. The reason radiation is used to treat cancer is that it is usually toxic to the fast growing cancer cells while supposedly having little adverse effects on the slow growing and relatively radiation resistant normal body cells. Unfortunately, normal cells are often affected by radiation in a variety of ways, especially over time. One of these changes is the abnormal production of the protein, fibrin, which accumulates in and damages the radiated tissue. This process is known as radiation fibrosis (RF).

Any tissue within the radiation field can be affected including nerves, muscles, blood vessels, bones, tendons, ligaments, heart or lungs. The clinical manifestations (i.e., signs and symptoms) that result from RF are called radiation fibrosis syndrome (RFS). RF can occur a few weeks or months after radiation treatment and continues for the duration of a cancer survivor’s life. The patient and their doctor may not notice RFS until years after treatment. Unfortunately, there is no way to stop the progressive RF that results from radiation treatment. There are, however, ways to treat the signs and symptoms of RFS and improve the quality of life of most patients afflicted by this disorder.

Not all patients treated with radiation develop clinically significant RFS. Standard therapy for common disorders such as prostate and breast cancers use limited radiation fields (the part of a person’s body treated with radiation) in doses that are generally well tolerated. Only patients who are very sensitive to the effects of radiation will experience complications. Radiation treatment for other types of cancer, however, may produce a much higher risk of developing RFS. Patients treated with mantle field, periaortic, inverted-Y, or total nodal radiation therapies for Hodgkin lymphoma (HL), especially if given before the 1990’s, are at particular risk of developing RFS since much higher doses of radiation were generally used. Similarly, patients with head and neck cancer (HNC) may also have a higher risk for developing RFS due to the high doses of radiation they receive and the critical structures that are often included in the radiation treatment field.

The clinical complications of RFS vary greatly from patient to patient and depend upon a number of factors. These factors include the type and dose of radiation given, how the radiation was delivered (i.e., how many treatment sessions), and perhaps most importantly, the radiation field. Other critically important determinates of how the radiation is tolerated include the age of the patient, their overall health, and any medical co-morbidities such as diabetes, heart disease, and arthritis. Radiation issues tend to worsen over time; the more time that has elapsed since treatment, the more likely a patient is to develop RFS. This tends to cause much confusion for both patients and their physicians who often have difficulty believing that a new symptom they develop could be due to in whole or in part to radiation they received years or even decades ago.

It is impossible to cover all the potential complications resulting from radiation in a short article since literally every organ system in the body can be affected. If a large area of the body is affected, as in the case of HL survivors, then very significant side effects can result. The two most ominous late-term effects faced by many HL survivors treated with mantle and other types of radiation are a greatly elevated risk of secondary cancers and cardiac disease. Multiple cancers are seen including thyroid, breast and lung cancers as well as sarcomas. Cardiac disease not only includes accelerated atherosclerosis, but valvular heart disease, pericardial disease, cardiomyopathy, and arrhythmias. Close monitoring is recommended to help identify and manage problems early.

Neuromuscular and functional problems are also very common in HL survivors. The spinal cord, nerve roots, plexus, peripheral nerves, and muscles within the radiation field can be affected. Common manifestations of radiation treatment in HL survivors include neck extensor weakness (a.k.a., dropped head sydrome), neck and shoulder pain, weakness, fatigue, gait and dexterity problems, numbness, tingling, and difficulty performing activities of daily living. All too often these problems are misdiagnosed by physicians unfamiliar with the long-term sequelae of radiation as being due to fibromyalgia, chronic fatigue syndrome, neuropathy of various types, spinal stenosis, or disk herniations. In many instances the physician just tells the patient there is nothing wrong with them. For many patients this leads to years of suffering, isolation, inappropriate treatment such as unneeded surgeries, and lost quality of life.

HNC patients are another group who often develop complications of radiation therapy. As with the HL survivors and other patients with RFS, the issues seen depend on the radiation field treated, the dose given, and factors unique to the patient such as age and medical co-morbidities including cervical arthritis and carotid atherosclerosis. Surgery is often used to resect HNC tumors and may contribute significantly to disabilities in this population. Even so, radiation is often the major source of long-term issues in this group. Common radiation-induced complications include trismus (decreased mouth opening), cervical dystonia (neck spasms, pain, and tightness), facial lymphedema (swelling), as well as difficulties with speech and swallowing.

Treatment of the complications of RFS depends entirely on the issue faced by the patient. The patient’s primary oncologists can usually direct the care of cancer-related medical issues that develop for at least the first few years after treatment. This group includes most HNC patients, breast and prostate cancer patients and others. Survivorship clinics have been established at many major cancer centers to provide guidance on medical matters such as how best to screen for cardiac disease and secondary malignancies in high-risk HL survivors. These clinics are intended for patients who no longer need the care of their primary oncologist but have cancer treatment-related medical issues.

Unfortunately, even at the top cancer centers, there are not enough resources available to evaluate and treat the rehabilitation issues faced by patients with RFS. For instance, HL survivors often have neuromuscular and musculoskeletal pain, as well as problems with function. These can be highly complex with multiple interrelated diagnoses and require a comprehensive and highly specialized multidisciplinary approach so that they can be accurately evaluated and comprehensively and effectively treated. Prescribing a treatment plan that maximizes the function and quality of life of certain patient populations, such as HL survivors, can be extremely challenging. Physical, occupational, and lymphedema therapy are often major components of their rehabilitation program and requires specialized skill sets from highly trained therapists with extensive experience. At Memorial Sloan-Kettering Cancer Center, a patient is often co-treated by several therapists during the course of their treatment to take advantage of advanced myofascial, neuromuscular reeducation, and manual lymphatic drainage techniques.

Physical therapy is highly individualized to the patient and involves normalizing body balance by stretching tight structures, strengthening weakened muscles, and retraining the body’s sensory organs to re-establish coordination. For instance, in the case of HL patients with dropped head syndrome and severe neck pain, functional deficits are not just a simple matter of the patient not having enough strength and endurance to lift their head. Invariably their chest wall and pectoral girdle are tight and bound down with their shoulders forward which puts their neck in a flexed position. All of this must be released which is where advanced myofascial techniques come into play. Their core muscles must also be strengthened and conditioned as they are almost always very weak. The fibrosis restricts the flow of lymph fluid throughout their chest and thorax creating a barrier that must be mobilized if the proprioceptors (sensory organs that provide position sensation) are to function effectively. Without properly functioning proprioceptors, the patient cannot even tell that their head is upright without their eyes open making them more prone to fatigue. Only after these tasks and many more are accomplished can we finally have hope of returning the head to its “upright and locked position” and keeping it there with much less effort and pain. In many cases we use orthotic collars such as the Headmaster™ cervical collar. When necessary, nerve stabilizing and pain relieving medications such as pregabalin (Gabapentin®) are often needed to reduce neuropathic pain and muscle spasms associated with RFS.

In HNC patients, the principles of treatment are similar but the disorders they face are very different. For instance, dropped head syndrome is less common but severe neck spasms (termed “radiation-induced cervical dystonia”) are often seen. This can be treated effectively with specialized physical therapy, nerve stabilizing agents, and in selected cases, botulinum toxin injections. Caution is advised for patients seeking botulinum toxin injections for this disorder as very few clinicians have the clinical skills and experience necessary to perform this procedure safely and effectively in this high-risk population. Another common problem in HNC patients is trismus. Physical therapy is the initial treatment modality in mild cases but a jaw stretching device is necessary for most patients. At MSKCC we use a device called the Therabite which is inexpensive and easy to obtain for patients who develop trismus immediately after treatment (i.e., in the first 6 months). For patients with more chronic trismus, however, we switch to a device called the Dynasplint as it is customizable and uses a better mechanism of jaw opening that is much safer and more effective. Botulinum toxin injections can help relieve the muscle spasms associated with trismus but jaw stretching is still the mainstay treatment.

RFS is a common complication of radiation for certain types of cancer. While there is no cure, there are treatments that can improve the function and quality of life for most patients. Programs specializing in the treatment of the medical complications of cancer survivors are currently being established across the country. More work has yet to be done to develop programs specializing in the physical rehabilitation of cancer survivors. For now, patients who do not have access to specialized cancer rehabilitation programs should take advantage of the general rehabilitation programs in their community and continue to advocate for the creation of more specialized rehabilitation programs.


The information found here is not intended to provide nor should it be interpreted to provide professional medical, legal or financial advice. You should consult a trained professional for more information.

– See more at: http://www.cancerforward.org/survivor-resources/experts-speak/Michael-D-Stubblefield-MD/radiation-fibrosis-syndrome-what-it-is-and-how-to-treat-it#sthash.M5gNgI4L.5h44wEMC.dpuf

Radiation Fibrosis Syndrome: What It Is and How to Treat It

See more Expert Speaks
CANCERFORWARD | BY MICHAEL D. STUBBLEFIELD, MD

Radiation therapy, like surgery and chemotherapy, is a mainstay of cancer treatment. The reason radiation is used to treat cancer is that it is usually toxic to the fast growing cancer cells while supposedly having little adverse effects on the slow growing and relatively radiation resistant normal body cells. Unfortunately, normal cells are often affected by radiation in a variety of ways, especially over time. One of these changes is the abnormal production of the protein, fibrin, which accumulates in and damages the radiated tissue. This process is known as radiation fibrosis (RF).

Any tissue within the radiation field can be affected including nerves, muscles, blood vessels, bones, tendons, ligaments, heart or lungs. The clinical manifestations (i.e., signs and symptoms) that result from RF are called radiation fibrosis syndrome (RFS). RF can occur a few weeks or months after radiation treatment and continues for the duration of a cancer survivor’s life. The patient and their doctor may not notice RFS until years after treatment. Unfortunately, there is no way to stop the progressive RF that results from radiation treatment. There are, however, ways to treat the signs and symptoms of RFS and improve the quality of life of most patients afflicted by this disorder.

Not all patients treated with radiation develop clinically significant RFS. Standard therapy for common disorders such as prostate and breast cancers use limited radiation fields (the part of a person’s body treated with radiation) in doses that are generally well tolerated. Only patients who are very sensitive to the effects of radiation will experience complications. Radiation treatment for other types of cancer, however, may produce a much higher risk of developing RFS. Patients treated with mantle field, periaortic, inverted-Y, or total nodal radiation therapies for Hodgkin lymphoma (HL), especially if given before the 1990’s, are at particular risk of developing RFS since much higher doses of radiation were generally used. Similarly, patients with head and neck cancer (HNC) may also have a higher risk for developing RFS due to the high doses of radiation they receive and the critical structures that are often included in the radiation treatment field.

The clinical complications of RFS vary greatly from patient to patient and depend upon a number of factors. These factors include the type and dose of radiation given, how the radiation was delivered (i.e., how many treatment sessions), and perhaps most importantly, the radiation field. Other critically important determinates of how the radiation is tolerated include the age of the patient, their overall health, and any medical co-morbidities such as diabetes, heart disease, and arthritis. Radiation issues tend to worsen over time; the more time that has elapsed since treatment, the more likely a patient is to develop RFS. This tends to cause much confusion for both patients and their physicians who often have difficulty believing that a new symptom they develop could be due to in whole or in part to radiation they received years or even decades ago.

It is impossible to cover all the potential complications resulting from radiation in a short article since literally every organ system in the body can be affected. If a large area of the body is affected, as in the case of HL survivors, then very significant side effects can result. The two most ominous late-term effects faced by many HL survivors treated with mantle and other types of radiation are a greatly elevated risk of secondary cancers and cardiac disease. Multiple cancers are seen including thyroid, breast and lung cancers as well as sarcomas. Cardiac disease not only includes accelerated atherosclerosis, but valvular heart disease, pericardial disease, cardiomyopathy, and arrhythmias. Close monitoring is recommended to help identify and manage problems early.

Neuromuscular and functional problems are also very common in HL survivors. The spinal cord, nerve roots, plexus, peripheral nerves, and muscles within the radiation field can be affected. Common manifestations of radiation treatment in HL survivors include neck extensor weakness (a.k.a., dropped head sydrome), neck and shoulder pain, weakness, fatigue, gait and dexterity problems, numbness, tingling, and difficulty performing activities of daily living. All too often these problems are misdiagnosed by physicians unfamiliar with the long-term sequelae of radiation as being due to fibromyalgia, chronic fatigue syndrome, neuropathy of various types, spinal stenosis, or disk herniations. In many instances the physician just tells the patient there is nothing wrong with them. For many patients this leads to years of suffering, isolation, inappropriate treatment such as unneeded surgeries, and lost quality of life.

HNC patients are another group who often develop complications of radiation therapy. As with the HL survivors and other patients with RFS, the issues seen depend on the radiation field treated, the dose given, and factors unique to the patient such as age and medical co-morbidities including cervical arthritis and carotid atherosclerosis. Surgery is often used to resect HNC tumors and may contribute significantly to disabilities in this population. Even so, radiation is often the major source of long-term issues in this group. Common radiation-induced complications include trismus (decreased mouth opening), cervical dystonia (neck spasms, pain, and tightness), facial lymphedema (swelling), as well as difficulties with speech and swallowing.

Treatment of the complications of RFS depends entirely on the issue faced by the patient. The patient’s primary oncologists can usually direct the care of cancer-related medical issues that develop for at least the first few years after treatment. This group includes most HNC patients, breast and prostate cancer patients and others. Survivorship clinics have been established at many major cancer centers to provide guidance on medical matters such as how best to screen for cardiac disease and secondary malignancies in high-risk HL survivors. These clinics are intended for patients who no longer need the care of their primary oncologist but have cancer treatment-related medical issues.

Unfortunately, even at the top cancer centers, there are not enough resources available to evaluate and treat the rehabilitation issues faced by patients with RFS. For instance, HL survivors often have neuromuscular and musculoskeletal pain, as well as problems with function. These can be highly complex with multiple interrelated diagnoses and require a comprehensive and highly specialized multidisciplinary approach so that they can be accurately evaluated and comprehensively and effectively treated. Prescribing a treatment plan that maximizes the function and quality of life of certain patient populations, such as HL survivors, can be extremely challenging. Physical, occupational, and lymphedema therapy are often major components of their rehabilitation program and requires specialized skill sets from highly trained therapists with extensive experience. At Memorial Sloan-Kettering Cancer Center, a patient is often co-treated by several therapists during the course of their treatment to take advantage of advanced myofascial, neuromuscular reeducation, and manual lymphatic drainage techniques.

Physical therapy is highly individualized to the patient and involves normalizing body balance by stretching tight structures, strengthening weakened muscles, and retraining the body’s sensory organs to re-establish coordination. For instance, in the case of HL patients with dropped head syndrome and severe neck pain, functional deficits are not just a simple matter of the patient not having enough strength and endurance to lift their head. Invariably their chest wall and pectoral girdle are tight and bound down with their shoulders forward which puts their neck in a flexed position. All of this must be released which is where advanced myofascial techniques come into play. Their core muscles must also be strengthened and conditioned as they are almost always very weak. The fibrosis restricts the flow of lymph fluid throughout their chest and thorax creating a barrier that must be mobilized if the proprioceptors (sensory organs that provide position sensation) are to function effectively. Without properly functioning proprioceptors, the patient cannot even tell that their head is upright without their eyes open making them more prone to fatigue. Only after these tasks and many more are accomplished can we finally have hope of returning the head to its “upright and locked position” and keeping it there with much less effort and pain. In many cases we use orthotic collars such as the Headmaster™ cervical collar. When necessary, nerve stabilizing and pain relieving medications such as pregabalin (Gabapentin®) are often needed to reduce neuropathic pain and muscle spasms associated with RFS.

In HNC patients, the principles of treatment are similar but the disorders they face are very different. For instance, dropped head syndrome is less common but severe neck spasms (termed “radiation-induced cervical dystonia”) are often seen. This can be treated effectively with specialized physical therapy, nerve stabilizing agents, and in selected cases, botulinum toxin injections. Caution is advised for patients seeking botulinum toxin injections for this disorder as very few clinicians have the clinical skills and experience necessary to perform this procedure safely and effectively in this high-risk population. Another common problem in HNC patients is trismus. Physical therapy is the initial treatment modality in mild cases but a jaw stretching device is necessary for most patients. At MSKCC we use a device called the Therabite which is inexpensive and easy to obtain for patients who develop trismus immediately after treatment (i.e., in the first 6 months). For patients with more chronic trismus, however, we switch to a device called the Dynasplint as it is customizable and uses a better mechanism of jaw opening that is much safer and more effective. Botulinum toxin injections can help relieve the muscle spasms associated with trismus but jaw stretching is still the mainstay treatment.

RFS is a common complication of radiation for certain types of cancer. While there is no cure, there are treatments that can improve the function and quality of life for most patients. Programs specializing in the treatment of the medical complications of cancer survivors are currently being established across the country. More work has yet to be done to develop programs specializing in the physical rehabilitation of cancer survivors. For now, patients who do not have access to specialized cancer rehabilitation programs should take advantage of the general rehabilitation programs in their community and continue to advocate for the creation of more specialized rehabilitation programs.


The information found here is not intended to provide nor should it be interpreted to provide professional medical, legal or financial advice. You should consult a trained professional for more information.

– See more at: http://www.cancerforward.org/survivor-resources/experts-speak/Michael-D-Stubblefield-MD/radiation-fibrosis-syndrome-what-it-is-and-how-to-treat-it#sthash.M5gNgI4L.5h44wEMC.dpuf

Radiation Fibrosis Syndrome: What It Is and How to Treat It – See more at: http://www.cancerforward.org/survivor-resources/experts-speak/Michael-D-Stubblefield-MD/radiation-fibrosis-syndrome-what-it-is-and-how-to-treat-it#sthash.M5gNgI4L.5h44wEMC.dpuf

Radiation Fibrosis Syndrome: What It Is and How to Treat It

MICHAEL D. STUBBLEFIELD, MD

     Radiation therapy, like surgery and chemotherapy, is a mainstay of cancer treatment. The reason radiation is used to treat cancer is that it is usually toxic to the fast growing cancer cells while supposedly having little adverse effects on the slow growing and relatively radiation resistant normal body cells. Unfortunately, normal cells are often affected by radiation in a variety of ways, especially over time. One of these changes is the abnormal production of the protein, fibrin, which accumulates in and damages the radiated tissue. This process is known as radiation fibrosis (RF).

     Any tissue within the radiation field can be affected including nerves, muscles, blood vessels, bones, tendons, ligaments, heart or lungs. The clinical manifestations (i.e., signs and symptoms) that result from RF are called radiation fibrosis syndrome (RFS). RF can occur a few weeks or months after radiation treatment and continues for the duration of a cancer survivor’s life. The patient and their doctor may not notice RFS until years after treatment. Unfortunately, there is no way to stop the progressive RF that results from radiation treatment. There are, however, ways to treat the signs and symptoms of RFS and improve the quality of life of most patients afflicted by this disorder.

     Not all patients treated with radiation develop clinically significant RFS. Standard therapy for common disorders such as prostate and breast cancers use limited radiation fields (the part of a person’s body treated with radiation) in doses that are generally well tolerated. Only patients who are very sensitive to the effects of radiation will experience complications. Radiation treatment for other types of cancer, however, may produce a much higher risk of developing RFS. Patients treated with mantle field, periaortic, inverted-Y, or total nodal radiation therapies for Hodgkin lymphoma (HL), especially if given before the 1990’s, are at particular risk of developing RFS since much higher doses of radiation were generally used. Similarly, patients with head and neck cancer (HNC) may also have a higher risk for developing RFS due to the high doses of radiation they receive and the critical structures that are often included in the radiation treatment field.

     The clinical complications of RFS vary greatly from patient to patient and depend upon a number of factors. These factors include the type and dose of radiation given, how the radiation was delivered (i.e., how many treatment sessions), and perhaps most importantly, the radiation field. Other critically important determinates of how the radiation is tolerated include the age of the patient, their overall health, and any medical co-morbidities such as diabetes, heart disease, and arthritis. Radiation issues tend to worsen over time; the more time that has elapsed since treatment, the more likely a patient is to develop RFS. This tends to cause much confusion for both patients and their physicians who often have difficulty believing that a new symptom they develop could be due to in whole or in part to radiation they received years or even decades ago.

     It is impossible to cover all the potential complications resulting from radiation in a short article since literally every organ system in the body can be affected. If a large area of the body is affected, as in the case of HL survivors, then very significant side effects can result. The two most ominous late-term effects faced by many HL survivors treated with mantle and other types of radiation are a greatly elevated risk of secondary cancers and cardiac disease. Multiple cancers are seen including thyroid, breast and lung cancers as well as sarcomas. Cardiac disease not only includes accelerated atherosclerosis, but valvular heart disease, pericardial disease, cardiomyopathy, and arrhythmias. Close monitoring is recommended to help identify and manage problems early.

     Neuromuscular and functional problems are also very common in HL survivors. The spinal cord, nerve roots, plexus, peripheral nerves, and muscles within the radiation field can be affected. Common manifestations of radiation treatment in HL survivors include neck extensor weakness (a.k.a., dropped head sydrome), neck and shoulder pain, weakness, fatigue, gait and dexterity problems, numbness, tingling, and difficulty performing activities of daily living. All too often these problems are misdiagnosed by physicians unfamiliar with the long-term sequelae of radiation as being due to fibromyalgia, chronic fatigue syndrome, neuropathy of various types, spinal stenosis, or disk herniations. In many instances the physician just tells the patient there is nothing wrong with them. For many patients this leads to years of suffering, isolation, inappropriate treatment such as unneeded surgeries, and lost quality of life.

     HNC patients are another group who often develop complications of radiation therapy. As with the HL survivors and other patients with RFS, the issues seen depend on the radiation field treated, the dose given, and factors unique to the patient such as age and medical co-morbidities including cervical arthritis and carotid atherosclerosis. Surgery is often used to resect HNC tumors and may contribute significantly to disabilities in this population. Even so, radiation is often the major source of long-term issues in this group. Common radiation-induced complications include trismus (decreased mouth opening), cervical dystonia (neck spasms, pain, and tightness), facial lymphedema (swelling), as well as difficulties with speech and swallowing.

     Treatment of the complications of RFS depends entirely on the issue faced by the patient. The patient’s primary oncologists can usually direct the care of cancer-related medical issues that develop for at least the first few years after treatment. This group includes most HNC patients, breast and prostate cancer patients and others. Survivorship clinics have been established at many major cancer centers to provide guidance on medical matters such as how best to screen for cardiac disease and secondary malignancies in high-risk HL survivors. These clinics are intended for patients who no longer need the care of their primary oncologist but have cancer treatment-related medical issues.

     Unfortunately, even at the top cancer centers, there are not enough resources available to evaluate and treat the rehabilitation issues faced by patients with RFS. For instance, HL survivors often have neuromuscular and musculoskeletal pain, as well as problems with function. These can be highly complex with multiple interrelated diagnoses and require a comprehensive and highly specialized multidisciplinary approach so that they can be accurately evaluated and comprehensively and effectively treated. Prescribing a treatment plan that maximizes the function and quality of life of certain patient populations, such as HL survivors, can be extremely challenging. Physical, occupational, and lymphedema therapy are often major components of their rehabilitation program and requires specialized skill sets from highly trained therapists with extensive experience. At Memorial Sloan-Kettering Cancer Center, a patient is often co-treated by several therapists during the course of their treatment to take advantage of advanced myofascial, neuromuscular reeducation, and manual lymphatic drainage techniques.

     Physical therapy is highly individualized to the patient and involves normalizing body balance by stretching tight structures, strengthening weakened muscles, and retraining the body’s sensory organs to re-establish coordination. For instance, in the case of HL patients with dropped head syndrome and severe neck pain, functional deficits are not just a simple matter of the patient not having enough strength and endurance to lift their head. Invariably their chest wall and pectoral girdle are tight and bound down with their shoulders forward which puts their neck in a flexed position. All of this must be released which is where advanced myofascial techniques come into play. Their core muscles must also be strengthened and conditioned as they are almost always very weak. The fibrosis restricts the flow of lymph fluid throughout their chest and thorax creating a barrier that must be mobilized if the proprioceptors (sensory organs that provide position sensation) are to function effectively. Without properly functioning proprioceptors, the patient cannot even tell that their head is upright without their eyes open making them more prone to fatigue. Only after these tasks and many more are accomplished can we finally have hope of returning the head to its “upright and locked position” and keeping it there with much less effort and pain. In many cases we use orthotic collars such as the Headmaster™ cervical collar. When necessary, nerve stabilizing and pain relieving medications such as pregabalin (Gabapentin®) are often needed to reduce neuropathic pain and muscle spasms associated with RFS.

     In HNC patients, the principles of treatment are similar but the disorders they face are very different. For instance, dropped head syndrome is less common but severe neck spasms (termed “radiation-induced cervical dystonia”) are often seen. This can be treated effectively with specialized physical therapy, nerve stabilizing agents, and in selected cases, botulinum toxin injections. Caution is advised for patients seeking botulinum toxin injections for this disorder as very few clinicians have the clinical skills and experience necessary to perform this procedure safely and effectively in this high-risk population. Another common problem in HNC patients is trismus. Physical therapy is the initial treatment modality in mild cases but a jaw stretching device is necessary for most patients. At MSKCC we use a device called the Therabite which is inexpensive and easy to obtain for patients who develop trismus immediately after treatment (i.e., in the first 6 months). For patients with more chronic trismus, however, we switch to a device called the Dynasplint as it is customizable and uses a better mechanism of jaw opening that is much safer and more effective. Botulinum toxin injections can help relieve the muscle spasms associated with trismus but jaw stretching is still the mainstay treatment.

     RFS is a common complication of radiation for certain types of cancer. While there is no cure, there are treatments that can improve the function and quality of life for most patients. Programs specializing in the treatment of the medical complications of cancer survivors are currently being established across the country. More work has yet to be done to develop programs specializing in the physical rehabilitation of cancer survivors. For now, patients who do not have access to specialized cancer rehabilitation programs should take advantage of the general rehabilitation programs in their community and continue to advocate for the creation of more specialized rehabilitation programs.


The information found here is not intended to provide nor should it be interpreted to provide professional medical, legal or financial advice. You should consult a trained professional for more information.


Chairmans note: We do know that the bombardment of radiation can make the underside of the jaw feel almost concrete like, which of course completely inhibits speech via any form of electro-larynx. Time is the great healer and it has been known to take up to 2 years for the tissue to become pliable enough to utilise such speech methods.

*****

Michael Douglas

Film Star and fellow throat cancer sufferer Michael Douglas has now stated that his particular form of throat cancer (a walnut sized lump at the very back of his tongue was the indication) was caused through oral sex; ie the Human Papilloma Virus

Read the full report here:

 

 

http://www.dailymail.co.uk/news/article-2334749/Michael-Douglas-Oral-sex-caused-cancer.html

 

*****

Here is an information site  that is a must read for any lary/prospective lary

 

http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Larynx/Livingwithlaryngealcancer/Livingwithalaryngectomy.aspx

 

*****

Thanks to Louise Goodwin (ENT nurse at Leicester Royal Infirmary) for this excellent find:

Videostroboscopy is one of the most practical methods for viewing and recording the motion of the vocal cords during speaking or singing. A digital computer and strobe light are used to make the images of the vocal cord vibrations appear in slow motion, so that any abnormal patterns of vibration may be detected.
What are the advantages of videostroboscopy?

The vibrations of the vocal cords are much too rapid to be observed by the unaided eye under a regular light source. Stroboscopy provides illumination of the larynx with quick pulses of light, which allows for accurate, detailed assessment of vocal cord movement.
By viewing these images of the larynx and vocal cords, the speech pathologist, physician and patient can obtain a better understanding of the way the vocal folds are functioning, and develop a specific treatment plan. This helps to determine what changes need to be made in order to treat the problem. Other structural or tissue abnormalities may be detected as well.
If a repeat videostroboscopy is needed at a later date, the results can be compared to the previous exam. This allows the voice care team to evaluate the patient’s progress.
Formal reports, still photos and portions of the video exam can be provided to the other members of the patient’s healthcare team.
Who performs this procedure at the Center for Voice?

The examination is performed by a licensed speech pathologist, with special training in voice disorders. Results are then communicated to the referring physician, who will make the medical diagnosis.
What should I expect during the procedure?

First, you will be asked to give a brief medical history and a description of your voice or throat problem.
The procedure itself lasts for just 10-15 minutes. A rigid telescope is placed into the mouth OR a small flexible telescope is placed into the nose. The scope will be in the mouth or nose for just a brief time (no longer than 1 minute at a time, usually), and you will always be able to breathe during the test. You will be asked to say various sounds, and a video of the vocal cords will be displayed on a television monitor. (The recording will be replayed for you later, and the anatomy will be explained to you in detail.)
Will I be sedated?

A light spray of topical anesthetic may be used if needed, but there is no sedation necessary. The anesthetic is sweet-tasting, and usually wears off in about 15-20 minutes. There is no need to arrange for someone to drive you to and from the appointment.
Do I need to do any preparation before the procedure?

No special preparation is required. You do not need to refrain from eating prior to your visit.
How long does it take?

The videostroboscopy takes just 10 to 15 minutes, but there will be discussion with the speech pathologist before and interpretation after the procedure. Plan on approximately one hour for the entire evaluation to be completed.

See video here

*****

 

 

 

 

 

 

 

 

 

LOS ANGELES —

A woman who smoked a cigarette through a hole in her throat to illustrate her struggle with nicotine addiction in a California public service advertisement has died of cancer, health officials and her family said Wednesday.

Woman who smoked through hole in throat dies photo

Debi Austin

Debi Austin died Feb. 22, 2013, at Valley Presbyterian Hospital in Van Nuys, according to family friend and spokesman Jim Walker. She was 62.

Austin first appeared on television in 1996, telling viewers she began smoking at age 13 and could never quit. In a quiet, halting rasp, Austin told the camera, “They say nicotine isn’t addictive,” before inhaling from a lit cigarette held to a hole in her throat.

“How can they say that?” Austin asked viewers, as cigarette smoke wafted from the hole.

Called a stoma, the hole in her throat allowed her to breathe after her larynx was removed at age 42.

The TV spot was “the most-recognized and talked about California tobacco control ad,” according to the state health department.

“Debi was a pioneer in the fight against tobacco and showed tremendous courage by sharing her story to educate Californians on the dangers of smoking,” said Dr. Ron Chapman, who heads the health department. “She was an inspiration for Californians to quit smoking and also influenced countless others not to start.”

Four months after the ad, Austin quit smoking — halting a two- to three-pack-a-day habit. She fought various forms of cancer for the rest of her life. She starred in other ads and spent the rest of her life advocating against the use of tobacco.

“True to Debi’s spirit, she was a fighter to the end and leaves a big hole in our hearts and lives. Debi will be remembered fondly by those who love her to be caring, courageous, very funny and always there to offer advice or lend a hand,” the family’s statement said.

*****

This you need to read folks:

http://oralcancernews.org/wp/throat-cancer-and-hpv-the-researcher/

 

Assoc Prof Karen Canfell is a researcher with the Lowy Cancer Research Centre at the University of NSW. HPV is her area of expertise. What does she want us to know about HPV and the vaccination program?

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Experts warn of epidemic of head andneck tumors caused by sexually transmitted hpv infections and obesity

Source: www.dailymail.co.uk
Author: staff

While cancer rates continue to drop, two new increasingly common causes of cancer could lead to an epidemic of head and neck cancer, experts warn.

Obesity and the human papillomavirus, or HPV, are the next wave of cancer threats, according to a report released Monday with data from the American Cancer Society, the Centers for Disease Control and Prevention,

 

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Most cases of cancer of the larynx occur in people aged over 60. The common early symptom is a persistent hoarse voice. Many cases are diagnosed at an early stage when there is a good chance of a cure. In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative.

What is the larynx?

The larynx is the top part of the trachea (windpipe). It is about 5 cm long and is sometimes called the ‘voice-box’. You can see and feel the front part of the larynx as the ‘Adam’s apple’ on the front of the neck, just below the chin.

The larynx contains the vocal cords. These are ‘V’ shaped ridges of muscle tissue on the inside lining of the larynx. They vibrate when air passes between them to produce speech.

When you breathe in, air passes into the larynx and down the trachea towards the lungs. When you swallow, the larynx moves upwards slightly and a flap of cartilage tissue at the back of the tongue called the epiglottis closes over the entrance to the larynx. This ensures that food or drink go down the oesophagus (gullet) and not down the trachea.

What is cancer of the larynx?

Cancer of the larynx is sometimes called laryngeal cancer. Some people also call it ‘throat cancer’. However, the throat includes the larynx and other nearby structures. Cancer of the larynx is just one type of cancer that can occur in the throat. Cancer of the larynx is uncommon in the UK with around 2000 cases developing each year. It is four times more common in men than women. It is rare in people under 40 years and is most common in people over 60 years.

There are different types of cancer of the larynx:

  • Squamous cell carcinoma of the larynx occurs in more than 9 in 10 cases. This type arises from cells which are on the inside lining of the larynx.
  • Other types. There are some rare types of cancer which arise from other types of cells within the larynx. For example, adenocarcinoma of the larynx arises from cells in the tiny glands in the wall of the larynx that make mucus. There are some other very rare types.

The rest of this leaflet is about squamous cell carcinoma of the larynx.

What causes cancer of the larynx?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply ‘out of control’. (See separate leaflet called ‘Cancer – What Causes Cancer‘ for more details.)

Some people develop cancer of the larynx for no apparent reason. However, certain ‘risk factors’ increase the chance that cancer of the larynx may develop. These include:

  • Ageing. It is more common in older people. Most cases are in people over 60.
  • Smoking. The damaging smoke passes through the larynx to get to the lungs.
  • Drinking a lot of alcohol, especially spirits.
  • A poor diet may be a risk factor, especially a diet lacking certain vitamins and minerals.
  • Long-term exposure to certain chemicals, fumes or pollutants may ‘irritate’ the larynx if you breathe them in and may increase the risk.
  • Human papilloma virus (HPV) has been shown in some studies to be associated with cancer of the larynx.

What are the symptoms of cancer of the larynx?

  • A hoarse voice is often the first symptom because most cancers of the larynx first start on, or close by, a vocal cord. The problem is, a hoarse voice is a common symptom of laryngitis (a viral infection of the larynx). Most people with hoarseness do not have cancer. However, laryngitis usually clears within a week or so. Therefore, see a doctor if you develop a hoarse voice which does not go within 2-4 weeks.
  • Other symptoms that may occur as the tumour grows in the larynx include: a lump in the throat, pain in the throat when swallowing, difficulty with breathing. These symptoms may occur before a hoarse voice develops if the tumour does not start next to the vocal cords.
  • If the cancer spreads to local lymph nodes (lymph glands) then the nearby glands in the neck will swell.
  • If the cancer spreads to other parts of the body, various symptoms can develop.

All the symptoms can be due to other conditions, so tests are needed to confirm the diagnosis.


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