中藥治療第三期口腔癌淋巴轉移腫塊病例報告

Case Report: Traditional Chinese Medicine Treatment in Advanced Oral Cancer

"本案例為一40歲男性患者，罹患口腔癌（squamous cell carcinoma, iT2N1M0），2019年5月病灶出現在舌頭的右側底部，腫痛不癒，不願就診，至2020年2月健檢時發現白色斑塊，口腔念珠球菌感染，舌出血潰瘍，延伸至右下頷腫痛，經切片診斷為口腔癌。病人拒絕手術，2020年3月經同步化學放射治療（concurrent chemoradi otherapy, CCRT）執行化療cisplatin 3次、電療35次，效果不佳。初診7月17日見右側臉頰及下頷頸部腫脹硬塊已直徑5 cm，觸之熱燙，患者感覺頭、耳內至頸部脹痛甚。耳鼻喉科診斷為第三期口腔癌，轉診血液腫瘤科，需2小時服用嗎啡一次止痛，腫塊亦影響吞嚥和語言，體重由未發病時（2019年5月）92公斤，至初診日（2020年7月）下降為54.4公斤，全身倦怠無力，面色萎黃，納差，二便少，脈弦細滑，舌紅苔薄。中醫病機為長時間服食熱毒之物（抽菸、飲酒、檳榔），熱盛毒聚，積蘊於舌，損傷肌肉，經絡阻滯，形成腫塊。影響吞嚥，病久身形消瘦，氣陰兩虛。證型氣陰兩虛夾熱毒氣鬱。治則：清熱解毒，除痰散結，通絡怯瘀，兼補氣陰。經中藥處方25次，腫塊潰膿消失成1cm以內，脹痛減（嗎啡使用由2小時一次，減為4小時以上一次），較可吞嚥。"

A 40-year-old male presented with tongue ulcer, dysphagia, and hemoptysis for one year. He had a history of >20-year chewing betel quid, tobacco, and alcohol use. Advanced Oropharyngeal cancer (squamous cell carcinoma, C02.1 malignant neoplasm of border of tongue, iT2N1M0) was found, with metastatic lymphadenopathies. The tumor was treated by concurrent chemoradiation therapy (cisplatin*3). However, he has suffered from neck mass(a cluster of metastatic lymphadenopathies with central necrosis, in right upper neck and invades into the right parotid gland, 5cm), sore throat, dysphagia, otalgia, headache, odynophagia, change in voice, loss of appetite, weight loss(92Kg to 54.4Kg), sallow complexion, and fatigue after refusing the surgical excision since one month ago. The pulse diagnosis was string-like, fine, and slippery. Also, the tongue diagnosis was red tongue with thin fur. According to such many signs, a diagnostic conclusion according to Traditional Chinese Medicine Theory, pattern, suggested retained dampness heat toxin in tongue with dual deficiency of qi and yin constitutions. Therefore, we used the therapeutic principle--clearing heat, detoxify, dispelling phlegm, dispersing nodules, tonifying qi and enriching yin. After the Chinese Medicine based on the principle was given to the patient, he reduced the dose of morphine (one time 2 hours to 4 hours). Additionally, right lymph node mass shrank from 5cm to 1cm, and otalgia, headache, odynophagia all were relieved.