Pam,

This is a VERY SERIOUS disease. Don't take it lightly. Many people die.

First things first. H&N cancer is a different animal. Its substantially less common than breast cancer or prostate cancer, to name just two, and it occurs in a part of the body that is very difficult to treat. Its crucial that you have a medical team (led by an MO you trust) that is highly experienced in treating H&N cancer. I'll say again, your most important decision is which medical team you choose for treatment. In my opinion, the 4 best places in the USA for treating H&N cancer are: John's Hopkins University (Baltimore), M.D. Anderson (Houston, not Orlando), Massachusetts General Hospital (Boston), and Dana Farber Cancer Institute (Boston). They are the best because of the experienced medical teams they have, not because they have fancy equipment or nice corridors or low prices or whatever. If you want to live, talk with staff at these places and find a way to get treated at one of them; these centers have specialized staff who will help you find low-cost accommodation for yourself (and a willing friend) while you are being treated.

Next: Treatment Plan. My expectation is that any of the four places mentioned above will recommend a plan that starts with Induction Chemo (IC) and then moves on to concurrent chemoradiation treatment (CRT). Since I live near Boston, I visited both MGH and DFCI... they both recommended the same treatment plan. Having now had time to research this, I would INSIST on having IC and I strongly recommend that you do the same... if your doctors refuse to offer IC (or if they demur, saying they don't see the benefit), hold their feet to the fire and ask them to show you the studies that say there are better outcomes without IC (they won't be able to do this because they don't exist).

After this, its all details. Which chemical cocktails they'll use and which radiation treatment they'll use. [They use IMRT at both MGH and DFCI. I actually liked the fancy/newer Tomotherapy technology better but, after lots of research, I concluded that a radiation planning team using Tomotherapy needs to have MORE experience than one uses IMRT in order to get as good of an outcome. Further, I scoured the USA and could not find an experienced team using Tomotherapy to treat H&N cancer. JHU uses Tomotherapy only for prostate cancer and their doctors (who are proponents of the Tomotherapy technology) told me I'd be better off with IMRT because I'd have a better medical team for my cancer. The H&N doctors at JHU and MDA (Houston) don't use Tomotherapy; some H&N doctors at MDA (Orlando) do use Tomotherapy but they're not as experienced as my H&N doctors at MGH. So I ended up getting all my treatment at MGH.]

Beyond treatment details, there are many details about how they'll keep the treatment itself from killing you and how they'll keep you reasonably comfortable throughout the process. No matter what they do to make you comfortable, it will be miserable. Focus on getting through all the misery knowing that it does come to an end; you will eventually feel better and enjoy life again... and if you've made the right decisions on the big items (above), you'll probably live a long time. Don't let the small detailed decisions sway you on the big decisions.

Best, Rob