[quote=Anne-Marie]After reading all of the above, and because tongue cancers tend to be aggressive, I would lean towards surgery and then IMRT radiation. I have no medical background but here are some questions I would be asking the doctors:
Re Opinion #1:
Since this is not a CCC I would have more confidence in the opinion of an ENT from a CCC.

The questions I would have the following questions to ask of the #2 and #3 doctors:

1. Is a tongue dissection another word for a type of Biopsy where only a portion of the lump is removed for analysis?

(see OCF link to detailed info on Biopsy types here:
http://www.oralcancerfoundation.org/discovery-diagnosis/detailed-biopsy.php

2. First opinion was Stage 1 which seems to indicate very early stage.
How does the staging as well as the depth of 0.7mm figure into to the type of treatment recommended?

3. Is it recommended that surgery be to remove existing or remaining tissue from the tongue, the lymph nodes or both? Why?

Re the 2nd opinion Dr. Jacobs (Northwestern Univ) recommends radiation therapy alone (IMRT).

4. Why only radiation? Does he think the earlier neck dissection being Stage 1 removed all visible cancer cells?

Re the 3rd opinion Dr. Spector (Univ of Ann Arbor) who recommends
tongue surgery with neck dissection, reconstruction of tongue and radiation.

5. Is the re-incision/surgery to remove any possible remaining cancer cells?
6. Is the neck dissection to remove lymph nodes?
7. Why is rebuilding the tongue necessary? Is the staging still Stage 1?
8. When Dr. Spector said �radiation is not really as effective � did he mean Radiation alone? My understanding is that Surgery takes care of everything they see during surgery and radiation following surgery takes care of whatever not seen during surgery.

Maybe you and your brother could make a list of all the questions you both have, type them up with copies for when you next see the doctor. Or you could fax them to the doctors to be able to prepare their answers for you. That's what I have done and have had good results from the doctors I have dealt with. Making a list can lessen any feelings of confusion and helps to "release them from your brain".


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Hi Anne-Marie:
I am going to answer all of these questions as best as I can. (we will be meeting with the Karmanos doctor tomorrow morning along with his tumor board).

1. The tongue dissection they are referring to is doing another surgery of removing the tongue.
2. The depth changed things a bit because even though he is a stage 1 all doctors agreed that the depth worried them and thats why they all recommended more treatment.
3. The tissue on the tongue is clear but the third doctor recommended removing more clean tissue because the margins were close. Also, he recommended the neck dissection to remove lymph nodes. the reason why he wanted to remove lymph nodes is because he wants to properly stage him.
4. He recommended only radiation because he thinks that only 1 out of 5 chances would a lymph node be involved. My brother has not done a neck dissection yet.
5. Yes.
6. Yes.
7. He wants to remove a lot so he thinks rebuilding will be necessary. I will ask the 2nd part of the question to the doctor.
8. Yes, thats what he meant and thats why im confused because one doctor told me that radiation will kill remaining cells but Dr. Spektor says it will not be as affective.

I love all of your questions and tomorrow morning I am going to use them all! thank you.