Nelie:

I can't speak about "all cases", I can only say that in my case, I was told by several ENT's, RO's and MO's that surgery would NOT have been their choice of 1st line in my case. Several also said that "surgery is not our usual first line in cases like (mine)...", and that sometimes surgery is used for "salvage", post tx.

Even the surgeon I saw yesterday at Stanford states that he thinks the surgery was not the best choice for 1st line.

But, today, I am nearly 100% functional post-surgery, so I guess I am not complaining.

There could have been serious complications, or QOL issues, but my surgeon was really good at what he does, which may be why he advocates surgery first so much...I don't know.

I do know, that the pendulum is starting to swing the other way, and the old routine of cutting first and asking questions later may be shifting too.

As you problably know from your fight with breast cancer, that not too long ago, the standard of care for breast cancer was radical mastecomy, whereas now, these are rarely performed, in favor of lumpendectomy.(sp?)

I wrestled with the paradox of surgery first for a couple of weeks, and finally decided in the interest of time to get it overwith.

I didn't want to "start all over" with some other team and waste another 2 weeks.

Now, I am glad I did on one hand since I got useful pathology information that I would have otherwise not known, and debulked the cancer from my body.

THE GOOD NEWS is!!! that the surgeon at Stanford said he thinks the remaining tissue seen by the RO's is most likely scar tissue, kerantized(sp?) tissue, etc, and not neccessarily cancerous cells. So, I am relieved by this and am hoping he is correct.