Patient Journeys

Neck and Tongue Cancer Patient Journey - Mr GL

Mr GL is a 68 year old builder. He lives with his wife in Kent and has three grown-up children. Two months ago he noticed a lump in his neck on the right side. He was initially treated with anti-biotics, but when the problem did not resolve he was referred to his local hospital to the team which specialises in suspected cancers of the neck. He was seen by an ear, nose and throat (ENT) surgeon specialising in cancer who arranged for a needle sample of the lymph node swelling. Following this, he was admitted to the hospital for an examination of the throat to see if the site of origin of the tumour could be determined.

After these tests, the surgeon told him and his family the results. He had a cancer of the back of the tongue, which had spread to the neck. He needed treatment in the form of chemotherapy and radiation. He was referred to Prof Nutting at the Royal Marsden Hospital for this specialist treatment with the aim of tumour cure.

Prof Nutting explained the treatment schedule in detail over the course of two appointments. Additional tests had to be carried out to assess his fitness for the chemotherapy part of the treatment.

He was admitted to the hospital for 5 days of chemotherapy. During that time he was connected to a drip 24 hours per day receiving chemotherapy drugs. The doctors and nurses on the ward looked after him. He lost his appetite during this period, but strong anti-sickness medicines mostly kept nausea at bay.

21 days later, the second cycle of chemotherapy was administered. A time line of the treatment schedule is given below.

After 2 cycles of chemotherapy, radiation therapy started. This was administered each week day (Monday to Friday, 5 treatments per week). The radiation therapy lasted a full six weeks. During that time he received two overnight admissions for further chemotherapy, each lasting about 18 hours. Prof Nutting recommended intensity modulated radiotherapy, not available in his local cancer centre to reduce the complications of treatment.

Prof Nutting saw Mr GL regularly during treatment. Assessments of the response of the tumour were made during consultations and also with scans during these weeks of treatment. The radiotherapy caused severe sore throat which made swallowing difficult. He lost his taste, developed copious sticky saliva and lost a lot of weight. Prof Nutting reviewed him every week during this period and with careful pain management and the help of the other members of the team, Mr GL completed treatment successfully.

During the last fortnight of treatment the assistance of the dietician, swallowing therapist, and clinical nurse specialists were invaluable. He came close to hospital admission for managing these side effects, but in the end this was not necessary.

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