hello again, i sit here and play over in my head time after time the words of my dad's ENT surgeon.. one thing he did say was that after going in and removing my father's tumor which included 3/4 of his tongue he did have perinueral invasion, but they got clear margins, and lymphnodes were clean.. all of this is so confusing at times and i do need to stop looking on the internet.. can anyone explain to me the positive side of clear margins and clean lymphnodes? i do see by doing some research that perineural invasion is "not good"..
thank you all again!

Ok, clear margins indicate that the cancer was in an area that they could remove it and enough surrounding tissue to get all of the identified cancer, its a good sign.

Clear lymph nodes are a really good sign. If cancer spreads to.the lymph system it can go anywhere in the body in a hurry. Distant mets significantly lowers a patients overall Outlook.

Perineural invasion means the cancer has been found around the nerve, the significance there is it has the tendency of traveling where that nerve goes further raising the risk of metastisis. I had PNI and my tx protocol involved making sure the field of radiation covered the path of the nerve and that most of that nerve was removed during surgery. The removal was an added step as rads actually took care of it in my case.

Hope that helps

Eric

Two out of three is not bad. After my cancer came back and I had the surgery, they only get the bare minimum for "clean: margin and the pathology report showed PNI. Most of the medical articles on PNI are for other cancers but here is a google book link on one about Head and neck Cancer.
What is very interesting is that is debunks the old concept that PNI happened through the lymphatic channels. It turns out the tumor Directly invades the perineural space.
While it is indeed good that the lymph nodes taken out were all clean, it also means they did not have to come out. New posters get upset when I point this out. I was lucky my ENT surgeon already knew that the PNI/lymph node connection was bogus so I did not have one the first time around. Since they had to do "big surgery" (from your signature line - the technical name is salvage surgery), it does make sense to do a modified radical neck dissection and Yes, my good lymph nodes were taken out also - but the original two lymph nodes that the cancer had spread to (that's the N2 in my staging) were totally necrotic (dead) from the radiation and chemo so if the cancer had not come back, I'd still have a robust lymph system.
In my case, the doctors decided to give me a whole second round of radiation and chemo because of the PNI. Otherwise my ENT felt that the cancer would come back yet again. I already had the "maximum" so they did CyberKnife instead.
Don't forget this article's statistics should be put into the context that for individual patients like your Dad and I, it's either 100% or zero. PNI is most definitely NOT a death sentence.
PNI: chapter 33 H&N Cancer
Charm

a great thank you to the both of you! one my dad was first diagnosed there was a trace of disease in one lymphnode on his left side (the troubled side).. the radiation must have got rid of it, because when they took out the lymphnodes and sent them out they were all clear.. Charm, i will edit my signature line, thank you! wink wink
nicki