It has been suggested that my father have 5 weeks of RT 5x a week but after all I have read about the side effects of radiation (loosing mobility of the mouth, difficulty eating, etc) it makes me wonder if chemo isn't a better option. Sure he would loose his hair (he's 75 and doesnt have much now) and possibly be sick, but wouldn't they both accomplish the same thing? I'm just thinking that maybe the chemo wouldn't have any of the lasting side effects that the radiation would. The cancer was not only in his mouth but in two of the lymph nodes in his neck as well. The doctor feels confident that all the cancer was removed during surgery. Only radiation has been suggested, no chemo.

Anyone have any thoughts on this?

Thanks,

Joy

The surgeons cannot be 100% sure that they got everything, so there is always a follow up treatment. (Unless this is a really small carcinoma in situ or very early stage one). Chemo by itself is not considered by most curative by itself, and chemo/rad is the real deal. See the NCCN treatment guidelines in the treatment secton of the main web site.

No two ways about it radiation is tough...but it gets the job done. Everyone wishes there was a chemo that was completly curative since it does not have the long term qol issues of getting nuked. But that day ain't here.

Hi Joy,

I'm new to this. My husband was diagnosed last month and just recently started treatments.

I did not want my husband to have to go through radiation for the reasons you mentioned above. However, we got more than one opinion, and they all included radiation.

He started his first of 35 treatments this past Monday along with chemotherapy.

In the simplest terms, we were told that the chemo could only weaken the cancer cells, and it was the radiation that had the power to kill them.

My husband's treatment did not include surgery. However, in his situation, he would have had to have RT and chemo regardless. Because of the lymph node involvement, our treatment team couldn't assure us that there weren't microscopic cancer cells outside of the cancer source and identified lymph nodes.

There are so many types of oral cancers, and I know there are different courses of treatment. None, of which guarantee a perfect outcome.

Ask lots of questions of your docs, and consult with a MO in addition to an RO. You might not like the answers...I didn't. But, ultimately, my husband and I feel confident he is on the best treatment path available to him. And, the rest is in God's hands.

Kindest regards,

Joy
this is a difficult decision, you need to have your facts straight before you can address this. With the info provided it is difficult to appreciate what is going on. (please edit you signature).
If you scan the board here, the majority of patients receive radiation at one time or the other. This is the way to go as long as things are local and surgery was not selected or the margins after surgery were questionable or other facors were not good. If it is not local or if it is suspected not to be, chemo comes in (or as an added insurance, depending on the paranoia level). Chemo is also used initially to shrink tumors prior to surgery/RT.
RT is not fun and reading the stories here are scary. The ill effects will also depend on what exactly is going to be irradiated. The newer IMRT offers a lot of selectivity here, although it is a bad idea to be minimalistic.
I am not finished with my RT (15/33) but so far so good, but this is still considered early in the game (see board here). The RO says ... it is going to be brutal, which may sound strange, but we have a special relationship. In addition, to my beard, the mustache is disappearing too (I get to keep the nose hair.. great!). But whether is is brutal or not it IS effective that is why this. Would I do this if it were NOT necessary.... hell no!
IF radiation is something you are going to do get him to get a PEG tube, and get it early on!

On the other hand if you getting a full chemo treatment especially with combination drugs then this is no picnic either.

My advice is to gather all the info. Staging/Surgery/histology/margin finding etc including planned radiation treatment and talk to your provider. (What type of MD is this?)
Ask about benefits and risks of the different treatments. Remember a MO likes chemo, a RO likes radiation and a surgeon likes a knive, because these are their specialities and we all tend to do what we know best. This is a gross (and in many cases unfair simplification).
It would be helpful to get a second opinion (tumor board).

Hope that helps.

Here is the background:

75 y/o male, non smoker/non drinker with stage 4 SCC of the mouth. Diagnosed on 3/21/07, upper maxillectomy, one salivary gland removed and neck dissection performed on 5/23/07 (8 hours in duration). Tumor was the size of a plumb, cancer found in two lymph nodes. Patient suffered MI while in surgery; now has congestive heart failure. Patient now has obturator to cover hole in roof of mouth.

Patient is able to eat table food that has been processed in a blender. 40 pounds lost since surgery date but is now maintaining present weight.

Sorry for not giving a better background in the original post.

Surgery was performed first because it was felt that healing from the surgery would be better if done prior to radiation.

I had no idea of how bad radiation can be when performed in the head and neck area. We meet with the RO in just over a week. I'm trying to understand why things are done so that I can arm myself with the questions that I might not have thought of had I not listened to others who have gone through this before.

I'm not into surprises and I want a very clear understanding of what we about to go through. Maybe a part of me was thinking that the worst was behind us and I just didnt want to accept the fact that we have to go through another difficult leg of this journey.

Today is not a good cancer day for me. I worked in the yard and Dad always came and worked with me, but today I did it alone. I miss him, yet he's still here.

Thank you all for your responses. They have helped.

Hi
It depends what stage the cancer is. Radiation stinks I did better with the chemo the after effects are not as bad with chemo. Radiation screwed up my swallowing and jaw movement.
The jaw is better but the swallowing not there is scar tissue from radiation and if you do not swallow alot during treatment the tissue gets stiff and it is hard to get your swallowing back to what it use to be the nurse told me it will not be the same as before they never told me to keep on swallowing during treatment plus I got alot of mucous from radiation. They say it is the gift that keeps on giving. If he doesn't have to do it I wouldn't but it depends what size the tumor was and what stage he was at.

god bless

katrina

I won't say that radiation is a walk in the park, but I actually thought it was easier than the chemo myself. Other than the awful taste in my mouth and the heavy mucous, I still would prefer the radition to 1 week of non-stop vomiting from the chemo. Once I got the peg tube, eating was less of an issue too.

As Brian already said, for this type of cancer, chemo is not used without radition. When used together, it is thought that the chemo might enhance the effects of the radiation, which is why sometimes people have both.

Pharmgirl, Bottom line is if he has Stage IV cancer, radiation with chemo is the only good option.

It's no fun at all and is hard hard hard on caregivers because it is a lot of long drawn out suffering compared to surgery and the recovery can take a long long time.

But. It's the only option that really gives him a chance of beating this disease. All the long term side effects that this can cause are better than the alternative (and I say this as someone who is suffering from several of them). Muster all the support you can for both yourself and him an prepare for a serious battle.

Nelie

Pharmgirl, I went back and reread your posts about this and I see your Dad has congestive heart failure, which I'm guessing is why they are recommending radaition alone without the chemo. But it might be worth getting a second opinion about that since chemo boosts the effectiveness of the radiation by quite a bit, if he can tolerate it.

By the way, my Dad was daignosed with congestive heart failure (would have need a quadruple bypas after a silent heart attack but had too many other risk factors to find any doctor who would do it)and yet he has stabilized, thanks to all the new meds for this out there, and has lived a pretty good life for the last five years since he was diagnosed, so that is by no means an immediate death sentence in itself these days. Your dad could have radiation, recover from it, and have several more good years even with that diagnosis.

Nelie