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CASE REPORT
Year : 2017  |  Volume : 44  |  Issue : 1  |  Page : 40-42

Improved level of function in an individual with Carcinoma of the pyriform sinus undergoing radiotherapy: A case report study


Department of Oncology Physiotherapy, KLEU Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Web Publication20-Mar-2017

Correspondence Address:
A K Akhil
Department of Oncology Physiotherapy, KLEU Institute of Physiotherapy, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-5009.202549

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  Abstract 


A 72-year-old female with a history of cough and difficulty in swallowing was admitted in KLE Cancer Hospital and was diagnosed with carcinoma of the pyriform sinus, where she was undergoing radiotherapy and was referred for physiotherapy. On examination, she had chest secretion, cough, breathlessness, and generalized body weakness that led to functional limitations. Pre- and postfunctional assessment was done with the help of Functional independence measure (FIMS) scale. A 10-day physiotherapy intervention was given and post intervention evaluation showed an increased functional level.

Keywords: Active resisted exercise, chest physiotherapy, cough


How to cite this article:
Akhil A K, Naik V. Improved level of function in an individual with Carcinoma of the pyriform sinus undergoing radiotherapy: A case report study. J Sci Soc 2017;44:40-2

How to cite this URL:
Akhil A K, Naik V. Improved level of function in an individual with Carcinoma of the pyriform sinus undergoing radiotherapy: A case report study. J Sci Soc [serial online] 2017 [cited 2017 Jul 27];44:40-2. Available from: http://www.jscisociety.com/text.asp?2017/44/1/40/202549




  Introduction Top


Squamous cell carcinoma of the pyriform sinus is a highly malignant disease with a generally poor prognosis, accounting for almost 70% of all hypopharyngeal cancers.[1] It arises from the mucosa of the anatomic subsite of the hypopharynx represented as analogous to an inverted pyramid situated lateral to the larynx, with the base located superiorly and the anterior, lateral, and medial walls narrowing inferiorly to form the apex with its tip extending slightly below the cricoid cartilage. The pyriform sinus, lying outside the glottis, is a silent area allowing tumors to grow for a substantial period of time before symptoms occur.[2],[3] Early stage pyriform sinus cancers can produce a mild, nonspecific sore throat, or vague discomfort on swallowing.

High doses of radiation are used to destroy cancer cells. Side effects occur because radiation can additionally damage healthy cells and tissues near the treatment area. Radiation therapy is a local treatment. Therefore, it only affects the area of the body where the tumor is located: The head and the neck. If radiation therapy is aimed at a person's head and/or neck, they may experience the following side effects: Dry mouth, mouth, and gum sores, difficulty in swallowing, stiffness in the jaw, nausea, chest. Radiation therapy aimed at the chest may cause the following side effects: Difficulty swallowing, shortness of breath, shoulder stiffness, cough, fever, and fullness of the chest called radiation pneumonitis that happens between 2 weeks and 6 months after radiation therapy.[4],[5]


  Case Report Top


A 72-year-old female with the history of cough and difficulty in swallowing was admitted in KLES cancer hospital and necessary investigation was done and it was diagnosed as carcinoma of the pyriform sinus. The patient was undergoing radiotherapy and chemotherapy. The patient was then referred for physiotherapy.

On observation

  • The patient was in a supine position.
  • Pigmentation present over the neck region.
  • Edema present over the bilateral foot.
  • Tracheostomy tube present.


On auscultation

  • Crepitus present on bilateral upper lobes and lower lobes and right middle lobes.
  • Tachypnea present.
  • Air entry reduced in all the lobes.


Muscle power

(Conventional grading)

Upper limb: 3/5

Lower limbs: 3/5

Treatment given

  • Nebulization followed by chest percussion, vibration, shaking, and suctioning.
  • Deep breathing exercise, segmental breathing exercise, thoracic expansion exercise.
  • Active resisted exercise for upper limb and lower limb was given with weight cuffs of 500 g for 10 repetition two times a day for 10 days. Exercise given was for bilateral shoulder flexors, extensors, abductors, and adductors and elbow flexors and extensors. Similarly, for lower limb for hip flexors, extensors, abductors and adductors, and knee flexors, extensors.
  • The patient was made to walk 5 m with rest of 1 min on the first day and then the walking distance was gradually increased to 20 m on the tenth day.
  • The treatment was given two times a day for 10 days.


Posttreatment evaluation

The functional level was increased, cough and breathlessness was reduced [Table 1].
Table 1: Functional evaluation

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  Discussion Top


In this present study, physiotherapy intervention was given to improve functional level for a individual with carcinoma of the pyriform sinus. A study where chest physiotherapy in lung cancer patients were given where it was found that chest physiotherapy programs were beneficial to lung cancer patients by reducing respiratory symptoms, pain, and improving health-related quality of life and exercise capacity. The results of this study suggest that chest physiotherapy programs that are prepared by taking the individual requirements of lung cancer patients, should be placed in the treatment of the lung cancer.[3] There are studies that have shown that physiotherapy can reverse the adverse effect of radiotherapy. Hence, physiotherapy in cancer patients can help in improving the quality of life.


  Conclusion Top


Physiotherapy will improve level of function and quality of life in patients undergoing radiotherapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Prades JM, Schmitt TM, Timoshenko AP, Simon PG, de Cornulier J, Durand M, et al. Concomitant chemoradiotherapy in pyriform sinus carcinoma. Arch Otolaryngol Head Neck Surg 2002;128:384-8.  Back to cited text no. 1
    
2.
Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T. Larynx preservation in pyriform sinus cancer: Preliminary results of a European Organization for Research and Treatment of Cancer phase III Trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst 1996;88:890-9.  Back to cited text no. 2
    
3.
Ozalevli S, Ilgin D, Kul Karaali H, Bulac S, Akkoclu A. The effect of in-patient chest physiotherapy in lung cancer patients. Support Care Cancer 2010;18:351-8.  Back to cited text no. 3
    
4.
Ntoumenopoulos G, Presneill JJ, McElholum M, Cade JF. Chest physiotherapy for the prevention of ventilator-associated pneumonia. 2002;28:850-6.  Back to cited text no. 4
    
5.
Rose-Ped AM, Bellm LA, Epstein JB, Trotti A, Gwede C, Fuchs HJ. Complications of radiation therapy for head and neck cancers. The patient's perspective. Cancer Nurs 2002;25:461-7; quiz 468-9.  Back to cited text no. 5
    
6.
Kidd D, Stewart G, Baldry J, Johnson J, Rossiter D, Petruckevitch A, et al. The Functional Independence Measure: A comparative validity and reliability study. Disabil Rehabil 1995;17:10-4.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1]



 

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Case Report
Discussion
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