Stage 4A has a bit of a different meaning if it's HPV related. There are a lot of stage 4 HPV cancer survivors here on this forum because it responds so well to rads and chemo. Hopefully, the outcome will be the same for your nephew. A stage 4 for non HPV - is terrifying because it is a harder cancer to treat. To be honest even a stage 1 non HPV is scary if the drs don't move on it quickly and do it right the first time.

Hugs and hang in there. I'd be willing to bet his is HPV.

take care

Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan