Seeking advise�

My mother in law has had SCC of neck/lymph nodes (primary tongue). She is 71.

She took Erbitux and radiation first, then she was operated on (neck dissection, right side) which was followed with 10 more sessions of radiation and one dose of Cisplatin split in 4.

Some time later she developed strong pains in her shoulder (same side). Docs did not know aht it was. They did CAT/MRI/PET and finally samples for biopsy.

Looks like the cancer came back in the same spot on the neck - based on the biopsy results.

PET did not show other presence� from what I understand.

Now�

The surgeon says that they do not re-operate in the same spot in these cases. She was already been given all the radiation she can take. So she may me given more chemotherapy.

Docs are very pessimistic.

Why can�t she be re-operated if the area is still small?


What else can we do?

We are getting a second opinion at Dana Farber, hopefully next week.

Please share your thoughts.

Maxbaxter

Max it is very difficult to operate on tissues that have been radiated.Healing is a nightmare and at her age the skin is already very fragile,i would imagine chemo will be the treatment of choice.

Max,
I think getting that second opinion from a major CCC is a really good idea.

Could her shoulder pain actually be due to the ND? It commonly is.

Salvage surgery on lymph nodes in cases of a recurrence following TX is routine.

Although I don't know your MIL's specific health; it is often correctly stated these days that Seventy is the new Fifty.

Don and close to 74 is the new 24 LOL..

No matter how old you feel,look and act,nothing can stop natures process.Skin gets thinner and drier and doesn't heal so well bruises appear at the slightest touch,and recovery from invasive procedures is much tougher.I understood from the post that the lymph glands had already been operated on and radiated,so i would doubt that any further surgery in this area would be advisable or even possible

Cookie
After any surgery, it is much more difficult to do a second surgery in the same area because of the fibrosis from the first surgery. It is also more difficult to do surgery after radiation because of fibrosis.

In general, radiation causes more problems because there is more fibrosis in the region than there is after surgery.

In this specific case there might also be other complications such as invasive spread, but Max only stated the recurrence was small. Getting a second opinion from a major CCC is advisable.

My CCC routinely handles these with salvage surgery followed by chemo. Currently chemo alone has no track record for stopping SCC.

We have five major CCC's in San Diego and several research CC's that they work with - most notably the Salk Institute and when ever possible, salvage surgery followed by chemo seem to be standard fair for those in my support group who have had to deal with recurrence.

I appreciate and understand what you are saying don,but you haven't commented on the facts i was actually referring to which was diminished blood flow and frailty of the skin and poor healing that occurs in the older patient,plus the added complication of already radiated skin being very very difficult to cut and heal.I would agree a second opinion wont hurt at all but in my experience nursing postoperative patients with these problems the outcome is not as easy to predict as it can be in someone younger,and i think that may be why the surgeons are shying away from that option.Of course nowdays 70 is no age,but much as we all like to feel that no matter what the numbers may say everything feels the same on the inside it isn't,and the older we get some of our options become limited.I intended merely to offer an opinion as to why the doctors came to their decision.

I think I would rather die trying with additional surgery or radiation, etc than just concede the battle to cancer because surely she will die if the cancer has come back and nothing is done. JMO

I understod they were offering chemotherapy.

MaxBaxter,

Good luck at Dana-Farber. That's where I was treated and the H&N team there is excellent. You might also want to talk to Mass General. The head of that program was my Medical Oncologist at Dana-Farber and moved over last year as I was finishing my treatment. She's really terrific.

- Margaret

get a second opinion! we had positive experience at MGH with their H&N team. Also had a phenomenal surgeon, Dr. Zeitel
Dana Farber has a good reputation as well. Not far from RI.
Good luck

Now this discussion I have enjoyed reading more than most. This one is lively and makes a lot of sense. Thanks all .

while cookey has spelled out the hazards that probably prompted these doctors to forego surgery, I would get a second opinion from a CCC in light of my own experiences. I turn 62 next month and my skin was so damaged by radiation and Erbitux that I needed special burn dressings that needed changing twice daily and were so painful I make sure to leave them in my signature. Plus I had "maximum" radiation on my neck (72 gy). Yet none of that stopped my CCC team from surgery on the exact same skin and spots in order to tackle the recurrence. True the aurgical pathology report noted the [quote]dense fibrosis, atrophy of skeletal muscle tissue and intimal thickening of vessels, with total luminal occlusion most suggestive of prior radiation therapy[/quote] but that did not stop them from giving me even more radiation with CyberKnife and more chemo with cisplatin. As David pointed out, sometimes extra risk is worth the chance. I am waiting with bated breath for next week for the results of my six month post surgery MRI . On the other hand, my skin has not recovered from the neck dissection and the pain and healing have been much slower than when I was just 60, so at 71 more surgery could be daunting. Still, second opinion seems warranted.
Charm