Nelie,
You raise very good questions and only you can ulitmately decide on your plan. My oncologist basically told me it was up to me what tools I wanted them to use in the arsenal. Now my cancer was more advanced than yours but it was well contained and there was no lymph node involvement. It was also a polyp type of tumor which further made it easier to treat. Stage II you are on the fence as you already know (and have been informed from your medical team). It's all about the risk/benefit and what statistical odds will additional treatment obtain for you.

Many here would suggest hitting now with all you've got. Waiting until a recurrence happens (if it does happen) can have disastrous results.

The problem that must considered is that chemo doesn't have a great impact on head & neck cancers by itself. So in the case of a multi-modality treatment such as surgery and chemo, most of the benefit would be from the surgery. In the case of radiation and chemo there is a adjunctive and synergistic effect in which the chemo can actually add as much as 13-16% to your 5 year survival odds which is a considerable number.

Then there are the risks from radiation. Aren't you glad you asked?!?!? The advantage of going to the CCC is that they have seen many cases like yours and have a good feeling about what works from experience. Your doctors seem to be right in line with giving you sound advice.

Gary, Yes, my doctors here are giving me good advice--they just differ (the surgeon and the radiation oncologist)in what they think I should probably do--and they both respect that it is my final decision.

I just talked to the radiation oncologist (who is the one who thinks I should hold off on radiation for my mouth)here and he gave me a good overview of the pros and cons of having radiation for the mouth at this stage. He was really helpful (including in telling me there is no good information on how much radiation with stage 2 SCC lowers the risk of reoccurence). He did give me an example of a case he has seen where surgery was used with no radiation and there were multiple recoocurences (but the first was many years after the primary tumor had been excised) which he thinks would have happened even had radiation been given (he called this a "field effect"). Becuase radiation was not given at first though, the radiation could be used more effectively with chemo to treat the reoccurences. So this is an example of when keeping the radiation as ammunition in reserve, he thought, led to a better outcome.

Is this the RO at Dana Farber?

Here is a link to the NCCN oncology practice guidelines for head & neck cancer. Page OR-2 defines the recommended treatment protocols. This should give you some more questions to ask.

http://www.nccn.org/professionals/physician_gls/PDF/head-and-neck.pdf

Thanks for that link, Gary. Very helpful.

heh. Actually it looks like "adjuvant radiation *optional*" is the treatment protocol in my case, and even for when there is one lymph node involved (I had none). Except that my pathology report from the first excision did mention some possible indication of perineural involvement (but not "invasion". I'm glad DF got sent the pathology slides.)

Gary, does "RO" mean the protocol? If so, I don't know what it is at Dana Farber. Obviously there isn't one protocol for what to do in a case like this at Roswell Park. What I really want to know, if Dana Farber recommends it, is *why*. Beyond whether it is their protocol.

"RO" is an abbreviation for Radiation Oncologist.

If it were me, I would place most of my faith in the CCC. Once again they have the most experience. At stage 1-2 a "door number 1" - "door number 2" choice. Once again, not trying to scare you but, tongue cancers can be more aggressive. Hopefully you'll be armed with all of the good questions by the time you go to Dana Farber.

I had to choose between a 14 hour surgery and radiation or Chemo and radiation. Statistically, the outcome was actually a little higher with the latter protocol. With my late staging, radiation wasn't an option.

Oh! Sorry I didn't get "RO" (feeling silly)

The radiation oncologist I've talked to already is at my local hospital but he actually was hired by, is on the staff at, and works in consultation with, Roswell Park in Buffalo, which our local hospitals cancer/radiation facility is now affiliated with. Roswell Park is one of the comprehensive Cancer Centers on the NCI list. It was other people on the oral cancer team at Roswell Park that he consulted with who were split 50/50 about whether I needed radiation.

So actually after going to Dana Farber I really will have some kind of feedback from two CCCs.