Appointment sheet
Hypopharyngeal cancer
Prepared with OnCo (onco.cc/prep/hypopharyngeal-cancer/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
23 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Stage, cartilage invasion and oesophageal extension on CT or MRI, Vocal cord fixation, Second primary in the oesophagus or lung at panendoscopy, Nutritional status, PD-L1 combined positive score), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Diagnosis and staging
- 5.For my situation (diagnosis and staging), which of the standard options do you recommend and why?
Early disease (T1 to T2, node-negative)
- 6.For my situation (early disease (t1 to t2, node-negative)), which of the standard options do you recommend and why?
Locally advanced, larynx preservable
- 7.For my situation (locally advanced, larynx preservable), which of the standard options do you recommend and why?
- 8.Am I a candidate for Cisplatin, Fluorouracil (5-FU), Docetaxel, and what side effects should I expect?
- 9.How do the results of RTOG 91-11 apply to someone like me?
Cannot have cisplatin
- 10.For my situation (cannot have cisplatin), which of the standard options do you recommend and why?
- 11.Am I a candidate for Cetuximab, Carboplatin, and what side effects should I expect?
- 12.How do the results of Bonner trial (cetuximab plus radiotherapy) apply to someone like me?
Extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapy
- 13.For my situation (extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapy), which of the standard options do you recommend and why?
- 14.Am I a candidate for Cisplatin, and what side effects should I expect?
Recurrent or metastatic
- 15.For my situation (recurrent or metastatic), which of the standard options do you recommend and why?
- 16.Am I a candidate for Pembrolizumab, and what side effects should I expect?
- 17.How do the results of KEYNOTE-048 apply to someone like me?
Prevention
- 18.For my situation (prevention), which of the standard options do you recommend and why?
Any stage
- 19.Are there clinical trials I could join, for example of NIVOPOSTOP (GORTEC 2018-01), KEYNOTE-689, Adaptive radiotherapy (online replanning), Pembrolizumab?
- 20.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 21.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 22.I read that “Survival has barely improved in thirty years”. How does that affect my plan?
- 23.I read that “Choosing between preservation and laryngopharyngectomy in the most extensive tumours”. How does that affect my plan?
The words I may hear
- Chemoradiation (chemoradiotherapy, CRT): Radiotherapy given at the same time as chemotherapy, which sensitises the cancer to radiation.
Tests and results to bring
Diagnosis and staging: Panendoscopy with biopsy, CT of the neck and chest, PET-CT for stage III to IV, and assessment of swallowing and nutrition before treatment.
Biomarker results to ask for: Stage, cartilage invasion and oesophageal extension on CT or MRI, Vocal cord fixation, Second primary in the oesophagus or lung at panendoscopy, Nutritional status, PD-L1 combined positive score (recurrent disease).
Scans and tests linked to this cancer: PET/CT.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Prevention: Smoking cessation and alcohol reduction; no screening programme exists. (Smoking cessation in cancer patients, Alcohol reduction, pricing and cancer warning labels)
- Early disease (T1 to T2, node-negative): Radiotherapy alone, or transoral or open partial pharyngectomy in selected small tumours, with treatment of both sides of the neck. (IMRT / IGRT (modern external beam), Transoral robotic surgery (TORS))
- Locally advanced, larynx preservable: Concurrent cisplatin chemoradiation to 70 Gy; induction cisplatin-fluorouracil (EORTC 24891) or docetaxel-cisplatin-fluorouracil followed by radiotherapy in some centres. (Cisplatin, Fluorouracil (5-FU), Docetaxel, Chemoradiation (chemoradiotherapy, CRT), IMRT / IGRT (modern external beam), RTOG 91-11)
- Cannot have cisplatin: Cetuximab with radiotherapy (Bonner), or carboplatin-based chemoradiation. (Cetuximab, Bonner trial (cetuximab plus radiotherapy), Carboplatin)
- Extensive disease (cartilage destruction, oesophageal extension) or recurrence after radiotherapy: Total laryngopharyngectomy with neck dissection and free-flap or gastric pull-up reconstruction, then postoperative radiotherapy or cisplatin chemoradiation by pathology. (IMRT / IGRT (modern external beam), Cisplatin, Chemoradiation (chemoradiotherapy, CRT))
- Recurrent or metastatic: Pembrolizumab alone or with platinum-fluorouracil (KEYNOTE-048). (Pembrolizumab, KEYNOTE-048, Recurrent or metastatic head and neck squamous cell carcinoma)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call