I. On admission.
After physical examination by the physician, nasopharyngeal fiberoptic and pathological confirmation, the patient was admitted to the hospital. Further routine examinations were completed, blood was drawn for blood count, biochemical indexes, blood EB-VCA-IgA, EB-EA-IgA, T-cell subsets, hormone level tests (TSH, growth hormone, sex hormone, etc.), X-ray, abdominal ultrasound (super body examination), ECG, nasopharyngeal and neck MRI plain + enhancement, whole body DWI, bone scan, chest CT if necessary and whole body PET/CT.
All tests will be completed in about 3-7 days, and pathology will be confirmed and submitted to the department for discussion, staging and treatment plan. The attending physician will discuss the patient’s condition with the patient and family, formulate a specific treatment plan, cost and advise on the preparation for radiotherapy. The treatment course is approximately 2-4 months.
Patient psychological guidance: understand the condition and cooperate with treatment.
Light, high-quality protein diet during radiotherapy; wear cotton or silk clothes, keep face and neck dry, avoid friction and irritating skin care products or alcohol, tincture of iodine and other medications, drink more water. Women cut short hair flush with ears.
Second, in treatment
Possible adverse reactions and complications during radiotherapy and precautions.
Swelling of bilateral parotid area and dry mouth in 1-3 days after the beginning of radiotherapy: due to the decrease of plasma secretion in oral saliva and obstruction of parotid ducts. Generally, no treatment is needed, but those with obvious symptoms are given anti-inflammatory pain and dexamethasone tablets to relieve pain and reduce swelling.
Radiation stomatitis: It occurs about 2 weeks after radiotherapy. Insist on rinsing the mouth, brushing teeth with a softer toothbrush or cotton swab, suggesting eating soft food, avoiding hot, fried and rough food rubbing the oral mucosa to prevent the mouth from breaking down. Drink more water, pay attention to vitamins, fruit juice, vegetable juice, high-quality protein, and maintain nutritional balance. Adjust your mood, ensure rest and good sleep.
Radiation dermatitis: keep the neck dry, avoid friction and irritating skin care products or alcohol, tincture of iodine and other medications; wear cotton or silk collars, stay in air-conditioned rooms as much as possible, and avoid scratching the skin of the neck. You can protect your skin with skin protectant, baby powder or tea oil, aloe vera.
Nasal and nasopharyngeal bleeding: avoid blowing nose hard, use ephedrine to shrink nasal turbinates, cod liver oil to moisten nasal cavity, and nasopharyngeal stuffing to stop bleeding in serious cases.
Adhere to nasopharyngeal rinsing, regular physical examination, and review nasopharyngeal fiberscopy.
Chemotherapy reactions and precautions.
Nausea, vomiting, loss of appetite. Light diet, high quality protein, high vitamin, high fiber diet, less frequent meals, less greasy, fried food.
Hair loss: New hair will grow 2-3 months after the end of chemotherapy.
Fatigue: easy to catch cold, pay attention to keep warm, avoid getting cold, ensure sleep time.
Palpitations and chest tightness: Oxygen intake if necessary.
Stomatitis: strengthen mouthwash and maintain oral hygiene. Cooperate with mouthwash and eating cold things. In severe cases, cooperate with anti-inflammatory rehydration, anti-infection and nutritional support treatment.
Granulocyte deficiency and thrombocytopenia: increase nutrition, prevent colds, and inject blood-raising injections.
Impaired liver and kidney function: monitor liver and kidney function regularly. Timely symptomatic liver preservation treatment.
Peripheral peripheral neuritis: avoid cold water, vitamin supplementation.
Near the end of treatment, physical examination, blood sampling, fiberoptic nasopharyngoscopy and MRI examination are required to evaluate the efficacy and discharge from the hospital.
III. Follow-up after radiotherapy.
Refer to NCCN 2009 guidelines for regular review.
Year 1-2: review every 1-3 months;
Year 3: review every 4-6 months;
Year 4-5: Every 6 months;
After the fifth year: review every year.
Review content and items.
Pay attention to pronunciation, hearing, teeth, vision, swallowing function, repair function, mental status.
Physical examination, nasopharyngeal fiberscopy;
Checking blood picture, liver and kidney function, EBV-DNA, every 6-12 months.
Imaging.
X-rays, abdominal ultrasound, nasopharyngeal MRI, PET/CT if necessary;
Oral examination, no smoking and alcohol.
IV. Functional exercise after discharge.
No irritating medication and skin care products for one month for the face and neck. Stomatitis and neck can return to normal within one month after radiotherapy.
Insist on nasopharyngeal rinsing.
After discharge from hospital, turn the neck more than 100 times in the morning and evening, and open the mouth 200 times.
Insist on mouth rinsing, dry mouth can chew gum, appropriate with oral health care products for post-radiation therapy.
In principle, no tooth extraction within 2 years, you can fill the teeth, when you need to extract teeth, you should consult the stomatologist and give anti-inflammatory treatment first.
Pay attention to strengthening nutrition, supplementing vitamin C, B, E, and preventing colds.
V. After-effects of radiotherapy.
Dry mouth, hearing loss, nasal dryness, nasopharyngeal bleeding, dental caries, neck fibrosis, memory loss, gum atrophy, restricted mouth opening, difficulty in opening mouth in severe cases, radiation encephalopathy, temporal lobe injury, cranial nerve injury, nasopharyngeal ulcer, bone marrow suppression, radiation osteonecrosis, low immunity, poor body condition, easy to catch cold.