Dear friends,

I finally got the results of the pathology report. The margins around the tumor all came back clean. However, of the 46 lymph nodes taken one did come back positive. The ENT surgeon stated that it was "encapsulated" and was the closest node to the tumor. He does not believe radiation would be indicated at this time. I will be having monthly appointments with him to check up on things and I know it would be that long before my tongue is healed enough from the flap to endure radiation.

My question is this: should I be considering radiation anyway? I would love to be able to forgo it but I don't want to have a recurrance. Any advice or suggestions would be greatly appreciated.

Peace,

Fr. Mike

Congratulations, Fr. Mike. That is good news!
I had similar results and went for radiation with no hesitation and agitated until I got chemo too. Why? Every long-term survivor I was aware of had undergone the 1-2-3 treatment. Scientific? Of course not, but I feel that I have utilized every option available to me. Early on, I decided my job was not to spare myself discomfort, but to do everying possible to absolutely destroy the cancer. So far, so good (grin). However,I think discussion with one or more doctors will give you much better information than I can on which to base your decision. Again, your news is wonderful and thanks for posting it for all of us to see.
Joanna

OK, so now you are a T2N1M0. An ENT is a surgically oriented doctor and his preference is based on his education and personal experience. You need a consultation with a radiation doctor to give you a balanced perspective. You have no doubt read my many posts here regarding recurrences and how I feel that that is a misnomer for what is actually an occult metastasis that rears its ugly head later. Combined therapies have better long-term outcomes. I offer you this quote from the Journal of the National Cancer Institute just a couple of months ago.

"Treatment of the neck is a highly controversial point, but many authors feel that elective treatment of the neck is indicated even for T1 neoplasms based on the incidence of occult metastases, 20-33% in most series, as well as the poor results with a later salvage procedure. ***Most authors advocate elective treatment of the neck for stage II disease (T2N0) for the same reasons, and the incidence of occult metastases in this group is even higher. Supraomohyoid neck dissection is often the procedure of choice for management of the clinically negative neck, with radiation being reserved for those patients with lymphatic involvement, especially if there is evidence of capsular invasion.*** The problem of understaging has been frequently cited in reference to carcinomas of the oral tongue, and reports may be found addressing specific factors which may indicate those patients with early lesions most likely to harbor occult metastases, and thus be the most likely to benefit from prophylactic treatment of the neck. Such factors as depth of penetration, histologic grade, perineural or perivascular invasion have all been investigated but none are widely accepted to have reliable prognostic value."

(The marked emphasis is mine so you don't get lost in everything else.) The point is, up to 33% of those with no visible cervical involvement harbor a metastasis in that area. You have one for sure, though caught early. Just because current scanning technology, MRI and CT, do not see it now, does not mean that it isn

Congtatulations Father Mike, It's hard to understand why all the different treatments for similer problems. From all the information i've read so far I am surprised the doctors are not suggesting radiation. My nodes all came back clean yet radiation was suggested after the surgery. I don't want to take the easy way out as I'm told there is no easy way out. I will do everything I can to increase my chances of wiping out the cancer.

Joanna, You must have lobbied for chemo as it sounds like they didn't suggest it. I have similer thoughts as you do, an all out assult on this cancer. Both my surgeon and rad on'gist have not mentioned the need for chemo. If it improves the chances to wipe out any cancer why are they not suggesting this option?

It was explained to my husband (stage 4 tonsil cancer with 3 positive nodes) that the chemo was given concurrent with radiation to enhance the effects of the radiation. Made the tissue more responsive is kind of how we understood it.

Daniel, there is a recent study, quoted here on the forum, purportedly showing there is no benefit to concurrent chemo. My decidedly unscientific thinking, however, kept going back to the long-term survivors who had chemo, so I wanted it too. You've heard of visualization, I am sure, and while that poison stuff was being pumped into my veins, I could "see" it attacking any stray cells that were not wanted. (One has a lot of time on one's hands while getting chemo.) To their credit, the ENT and the Rad Onc are both believers, as was the Med onc who supervised the drugs. I lost my hair, all my white cells, and was urpy some of the time, and I would do it all again if need be, but then I am a kind of all or nothing person anyway, so this schedule fit for me. Bottom line, there is "proof" either way about it being effective, so I lined up with the long-term folks (grin).
Joanna, long-term wanna be

Fr. Mike, While it may be a "setback" for you it could have been much worse and so I am happy for you!

As to the other comments about "stomping out" the cancer and why some treatment options are not suggested, remember that both radiation and chemo can potentially kill the patient as well as the cancer (that may be a 100% success rate by some statistics ) so especially with chemo not showing a huge benefit it may not be worth the risks in every case.

More for us to have to ponder! Do the best you can to live.

Remember that there are two different kinds of chemo. One which is given during radiation to enhance the effects of radiation, one that is given after radiation to deal with distant mets or more advanced disease. Those that get the second type are usually stage 3's and almost always 4's. Anyone whose doctors believe that radiation alone can knock this down with a little help, gets the first kind. I chose not to have chemo. It wasn't offered to enhance the radiation, and at the end, all the MDACC docs thought that I could do without it. I went with their call, they are the experts that have kept me around on this side of the grass. As early as your cancer was I would opt for IMRT but not chemo. And as a side note, while it has been said here before, and mentioned again by Mike that radiation and chemo can kill you, this is an exaggeration of the point. Volume of exposure is what allows us to tolerate these poisons being introduced into our systems. No one is going to die from the treatments. They may make you sicker than hell, and you may wish to die (like me), and they may cause some nasty long-term side effects, but kill you? No. I know that Mark did not mean this literally, but you wouldn

I am the one receiving concurrent radiaton and chemo to cure my stage 4 cancer. Unlike Joanna I didn't lose any hair during treatment and like Brian, the chemo effect made me very very moody and the wish to die was dominant at that time. I was so restless that in one minute I liked to lie down but by the time I lay on bed, I wanted to go back to the sitting room.A feeling that still makes me scared even now.Since I knew it was only a temporary effect, I fought my way through.I never doubt the effect of chemo on my type of cancer as I always claim myself to be the most cooperative patient. I trust the team of doctors know what suits me best.

Karen stage 4 tonsil cancer diagnosed in 9/01.

And just to futher confuse the issue, I had a combination of both of the kinds of poison chemo drugs that Brian describes -- at the same time! It was the "all over" one that caused my hair to fall out. I was SO lovely (grin).
Joanna