But the NPC that Xiaoke is going to talk about today.
Not in the game
It is short for cancer.
Nasopharyngeal carcinoma (NPC)
It is a kind of malignant tumor that occurs in nasopharyngeal mucosa epithelium, mostly in the top wall and lateral wall of nasopharynx, especially in pharyngeal recess, and it is one of the common malignant tumors in China. In China, the incidence rate is the highest in South China and less in North China, which is mainly related to infection, heredity and environment.
I remember six years ago.
A relative of Xiaoke was diagnosed with nasopharyngeal carcinoma.
Although I don't know what kind of factors caused it.
But thanks to timely treatment, he has recovered now.
However, I also suffered a lot during radiotherapy.
Then why choose radiotherapy instead of surgery for nasopharyngeal carcinoma?
Brief remarks on the director of radiotherapy department of Suzhou Science and Technology Town Hospital
It is helpful to improve the therapeutic effect and quality of life of nasopharyngeal carcinoma patients by adopting multidisciplinary comprehensive treatment model and making individualized comprehensive treatment plan in a planned and reasonable way. Radiotherapy is the only radical treatment for nasopharyngeal carcinoma. Chemotherapy and targeted therapy can further improve the therapeutic effect of nasopharyngeal carcinoma.
Nasopharyngeal carcinoma is very sensitive to radiotherapy.
Radiotherapy is the first choice for radical treatment.
Early nasopharyngeal carcinoma can be cured by radiotherapy alone.
But advanced nasopharyngeal carcinoma usually needs to be selected.
Radiotherapy combined with chemotherapy, targeting and even immunization.
Comprehensive treatment mode can achieve better curative effect.
The radiotherapy department of the hospital has a radiotherapy hall of nearly 3000 square meters.
At present, it is equipped with American 1 Varian medical linear accelerator.
Can do four-dimensional therapy, traction therapy, stereotactic radiotherapy and so on.
2 sets of Eclipse treatment planning system and 1 Pinnacle planning system.
Philips large aperture CT and other international advanced radiotherapy equipment.
At the same time, the radiotherapy team of Professor Zhang zhen from Fudan University Cancer Hospital was introduced.
Especially head and neck tumors.
Have strong practical ability, set up MDT team as support.
Provide high-quality medical resources for patients
A comprehensive treatment model combining radiotherapy and chemotherapy with targeted and immunotherapy.
Case 1
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Mr. Zhang, 52 years old, is an undifferentiated stage T3N3M0Ⅳ a of advanced non-keratinizing squamous cell carcinoma of nasopharyngeal carcinoma. While receiving treatment, Professor Lu, an expert from the Cancer Hospital affiliated to Fudan University, was invited to guide the treatment plan and carry out induction chemotherapy, concurrent radiotherapy and chemotherapy plus targeted therapy. Under the standardized treatment and nursing of medical staff, she was discharged from the hospital after achieving the clinical cure effect, and was regularly reviewed in the outpatient department until her condition was stable after two years.
Case 2
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Ms. Wei, 40 years old, was diagnosed with advanced non-keratinized undifferentiated CT3N3M0Ⅳ A stage of nasopharyngeal carcinoma in other hospitals, with lymph node metastasis in clavicle region. Radical radiotherapy and chemotherapy were performed in the middle and high risk lymph node drainage area in our hospital. The process was smooth and the patient's condition was relieved well.
Radiotherapy for nasopharyngeal carcinoma usually takes 6-7 weeks.
For patients receiving treatment, this process is long.
Because the anatomical position of nasopharynx is close to the radiation-sensitive organs
Such as parotid gland, optic nerve, chiasma, cochlea, brain stem and frontal lobe.
It is bound to produce adverse reactions.
Including acute adverse reactions and late adverse reactions.
Acute adverse reaction
Include dermatitis, mucositis, dry mouth, taste change, gastrointestinal reaction, etc. The acute adverse reaction improved obviously after several weeks, but the radiation injury of grade 3-4 lasted for a long time, and the dry mouth continued after radiotherapy.
Late adverse reactions
Late adverse reactions include skin reaction, muscle and soft tissue fibrosis, dry mouth, dental caries, sinusitis, hearing loss, difficulty in opening mouth, radiation osteonecrosis, brain injury, brain spinal cord injury, pituitary dysfunction, second primary tumor, etc.
Ms. Xu, in her early 60s this year, has undifferentiated CT3N1M0Ⅲ of non-keratinized nasopharyngeal carcinoma. After receiving concurrent radiotherapy and chemotherapy in our hospital, she was treated for oral pain. Ms. Xu is older, has poor compliance, oral leukoplakia, oral ulcer, nausea and vomiting, and has psychological resistance to hospitalization. After careful and patient education and urging the patient's doctor's advice, four mouthwashes (fluconazole tablets, Kangfuxin, lidocaine and gentamicin) suitable for Ms. Xu's current situation were prepared according to the patient's specific situation to guide, urge and encourage her to persist in treatment. We emphasize mental and physical treatment, and medical staff help patients get rid of bad emotions. * * * Together, Ms. Xu was discharged from the hospital after the oral mucositis improved, and the follow-up after discharge showed that she recovered well.
Mr. Fu, aged 28, is a nasopharyngeal malignant tumor (ct4n 1m 0ⅳA, non-keratinized undifferentiated cancer). In the early stage of radiotherapy, there were serious side effects, such as dry mouth, oral ulcer, decreased taste, nausea and vomiting, and secondary inhibition of bone marrow. According to the rich clinical experience of medical staff, he actively cooperated with us and paid attention to oral care and functional exercise in the early stage, but the side effects in the middle and late stage of radiotherapy were more serious than before.
Early nasopharyngeal carcinoma patients should be treated with radiotherapy if they are found in time.
Most tumors can completely regress.
However, there are still about 15% patients who unfortunately relapse.
Recurrent advanced nasopharyngeal carcinoma received radiotherapy again.
The 5-year survival rate is only about 30.3%~55.5%.
Moreover, the adverse reaction of radiotherapy is serious, which leads to poor quality of life of patients.
Huan Jian said that after radiotherapy for nasopharyngeal carcinoma,
There will be some uncomfortable symptoms.
1, systemic reactions: including fatigue, dizziness, anorexia, nausea, vomiting, taste change, insomnia, etc.
2. Mucosal reaction: After 40Gy irradiation, mucous membrane of oropharynx, nasopharynx, nasal cavity and paranasal sinuses may appear mucosal edema or congestion, and sore throat, eating difficulty and nasal congestion often occur during irradiation.
3, salivary gland radiation reaction: saliva secretion is significantly reduced, the patient is dry mouth, it is difficult to eat dry food.
4. Radiation reaction of skin and subcutaneous tissue: erythema, pigmentation, hair shedding and dry peeling generally appear on the skin in the irradiated area. If the radiation dose is large, the skin will continue to be irradiated when edema occurs, which can form blisters and merge into large pieces of wet peeling, becoming moist dermatitis with exudation and erosion.
5. Late radiation reaction of radiotherapy: skin and subcutaneous tissue atrophy, skin thinning, telangiectasia, hypopigmentation, etc.
6. Difficulty in opening mouth: Exposure of masticatory muscles and temporomandibular joint can cause different degrees of difficulty in opening mouth.
7. Radiation dental caries and radiation mandibular necrosis.
8, radioactive skin and subcutaneous tissue erysipelas.
9, radiation otitis media.
10, radiation-induced brain and spinal cord injury.
Therefore, nursing after radiotherapy is extremely important.
Correct nursing can alleviate the pain of patients.
Improve the quality of life of patients.
So what exactly should we do?
1. Nursing care of dry mouth
Principle: gargle, drink warm water and juice.
Methods: carry warm water with you; Oral vitamin c or candy promotes secretion; Use drugs that stimulate secretion.
Late reaction: If the parotid gland is completely destroyed, there is no good prescription.
2. Nursing care of acute parotitis and oral mucositis
Diet: The principle is to abstain from irritating food, liquid and digestible food.
Local: oral hygiene, mouthwash or special analgesic mouthwash.
Severe: gastric tube
3. Nursing care of periodontal tissue lesions and tooth necrosis
Principle: Pay attention to oral hygiene.
Methods: Brush your teeth and rinse your mouth with a soft toothbrush after meals.
Prevention: Before radiotherapy, the dentist will check and pull out the affected teeth.
4. Nursing care of mouth opening difficulties
Principle: open mouth training.
Methods: Progressive tongue depressor method.
5. Nursing care of taste changes
Principle: Eat soft food with high protein, high calorie and high vitamin, and avoid stimulating or overheated or supercooled food.
Methods: Add lemon juice, mint and spices. When he is tired of protein, he will eat protein diet, eat more meals and soft foods (steamed fish, eggs, porridge, noodles, soft fruits, etc.). When he has a bad appetite.
6. Hair loss care
Principle: Cover with a headscarf or wear a wig.
7. Nursing care of gastrointestinal reaction
Principle: Pay attention to diet, eat more soft food with less residue, easy digestion, high protein, high calorie, nutrition and no stimulation, and eat more fresh fruits and vegetables.
Method: When you feel uncomfortable, eat some soft foods with high protein, such as eggs, milk, noodles, porridge, bananas and juice. Do not eat fried, greasy, chocolate, coffee, etc. After diarrhea, wash the anus with warm water or neutral soapy water and take a warm bath; In severe cases, antiemetic drugs and antidiarrheal drugs.
8. Nursing care of myelosuppression
Principle: Check blood routine every week.
Methods: When leukopenia occurs, wear a mask, rest or isolate nursing, and the doctor decides whether to stop radiotherapy.
Guan Jian
Director, chief physician, associate professor, master tutor, doctor of medicine.
Medical expertise: radiotherapy for chest and abdomen solid tumors, focusing on the precise definition of the gross volume of head and neck tumors, focusing on the rational use of stereotactic radiotherapy in the body.
Academic part-time: member of Radiation Oncology Branch of Jiangsu Medical Association, member of Radiotherapy Professional Committee of Suzhou Medical Association, standing member of Radioimmunity Working Committee of China Tumor Radiotherapy Cooperative Group, member of Radiotherapy Professional Committee of Jiangsu Cancer Prevention Alliance, and member of Precision Radiotherapy Group of Clinical Precision Medicine Professional Committee of Jiangsu Medical Association.
Shen
Chief physician, medical doctor
Academic part-time: Lecturer of Nanjing Medical University.