My husband is just now in the stage of meeting with a bunch of doctors to move forward with radiation/chemo. . He has also been contacted by a nutritionist and smoking cessation specialist (Wed is a month he stopped).

However, no one mentioned anything about seeing a dentist. I noticed in various threads people speak about getting teeth removed, dental care,etc. Are the teeth removed as part of the radiation or is it generally a surgical thing(or both). Just wondering if this is another step we should look into it.
His teeth are in good shape generally.

Susan,

He should see his dentist for a thorough exam before starting treatment to look for any possible problems and have them taken care of before treatment. Healthy teeth are generally not removed because of RT. Generally having a cavity filled or even a root canal after treatment isn�t a problem, but a tooth extraction would be.

In my case I had a small cavity in one of my wisdom teeth, and they recommended removing all 4 wisdom teeth before RT because to do a tooth extraction after RT can be difficult and cause problems (healing and other issues related to ORN). My wisdom teeth were a tight fit in my mouth to begin with and my dentist felt it was best to remove all 4 before treatment, than to risk needed to remove them after treatment.

Also, they recommend using fluoride trays during treatment and in most cases for the rest of your life to minimize tooth decay due to dry mouth issues. So he should have the trays made before treatment begins (but after any teeth extractions that may be needed).

And it is a good idea to have a good cleaning at this point, because his mouth will be pretty sore for a few months after treatment.

If possible it's best to see a dentist that is very familiar with oral cancer issues. If he's being treated at a CCC they will have such a dentist on staff. If this is not possible do explain in detail his Tx to the dentist.

Radiation can damage the blood supply to our teeth and gums and over time this can lead to infection, etc so it common with the old rad method, RT, they would likely recommend pulling all the teeth in harms way. It was also more common to see poor dental hygiene in OC patients. Now with more refined rad methods, IMRT and Tomo, the damage can be greatly lessened and with the advent of HPV+ SCC less patients present themselves with poor dental hygiene so we now see the recommendation to just pull the teeth that will need it anyway, fill cavities, switch out metal fillings, do a thorough cleaning and add daily fluoride treatments.

I had to have mine removed because of the Rad Seed Implants and the rads and chemo. They hit it right on because my jaw bone is dead as they said it would be. The teeth would have decayed causing infections from the dead bone. Now I am glad I listened to them.

He is being treated at Sloan so I would guess that there is someone on staff. They really do have a very complete list of services. The advice here to go to a a place like that is invaluable given the coordination that needs to happen.

We meet with the radiologist next so that seems like a good time to bring it up.

After reading your post David I tried looking up more about Tomo and IMRT.

Are there particular questions that we should be asking about the types of radiation out there and what determines what is used?

Both are better than what they use to do and Tomo is a refinement over "normal" IMRT. Of course the Tx facility must have either capability for you to have a choice. Four years ago Moffitt only had IMRT, today they have a Tomo machine. Remember the goal is #1 kill the cancer and #2 spare damage to good cells so Tomo's benefit is to further reduce the damage to lessen the long term side effects from radiation.

Thanks David.
your responses are quite helpful.
Just read a bunch of stuff about the Tomo and it looks good. Of course, that was from the company that sells it...

Not sure if Sloan has it but it will go on the question list for Friday.

Is the 7 week treatment standard or is it individualized? I just see that number over and over.

Anything else we should think to inquire about?

Still pretty standard. Remember the maximum radiation they say they can give us is appx 70 to 72 gray (Gy) units and that is typically administered in 2 Gy units daily so 70 divided by 2 equals 35 days which translates to 7 five day weeks. There is and has been for some time the practice of accelerating the radiation in some cases by say doubling up on Friday and reducing the Tx time by 1 week. Most times it's when chemo is not given concurrently. Again goal #1, Kill the Cancer and goal #2, spare the damage to the good cells.

To this end, currently in the HPV arena where previous studies have concluded, at least in the short term, that HPV+ SCC responds better to the typical Tx, some are planning studies to reduce the overall radiation in say 5 Gy unit increments. Planning it may be one thing but getting it approved, funded and full of willing patients may be another.

Susan,

My facility had brand new IG-IMRT machines. They also had a Tomo machine. My RO and the two other second opinions I received preferred the IMRT. I looked into the Tomo and asked about it and they said that they preferred the IMRT to Tomo because it was more versatile (not sure what that means)

I got the feeling that they preferred the IMRT because they just bought them (did they need to pay down that cost?). I might be wrong on that. I was very interested in the Tomo because it is said to have more aiming spots and thus less tissue damage. My RO said this was not the case.

I would be very interested in what Sloan has to say about this issue, as I was never fully convinced that IG-IMRT was better than Tomo. Please post and let me know their opinion.

BTW I know that I am now post treatment and this is just curiosity. I also know that my case is not the same as your husbands, and my results are great so far so no complaints but still curious.

I will let you know Fri. after we meet with the radiologist.
After reading about the Tomo I was ready to go out and buy one.

I find it interesting that your RO preferred the IMRT. The Tomo kind of sounded like the grown up version of the IMRT. Same benefits with less side effects...so now I'm pretty curious myself about it.

David, are you saying the standard is based on the safest amount of radiation that can be given? Part of the throw the whole kitchen sink at it approach? Given what I've read here, I'm getting that being aggressive right out of the gate is important.

As of now, they are not suggesting any surgery for my husband. Not that I wanted him to have any but it made me a bit nervous given the treat it aggressively suggestions.

When I asked why he wasn't suggesting it, the MD said location and size were factors. I figured since he was a well known surgeon and wasn't suggesting cutting I should let him do his job and take his word for it.

Susan,

Please add a Signature Line so we can all see the Dx and progress when we respond to your posts.

I'm not a rad expert by any means but when I said standard that means very aggressive in the OC treatment arena. because it is supposed to be our lifetime maximum to that area. That's why we are sometimes told that we can not be re radiated if the cancer comes back.

Re the surgery part, it depends on where the cancer is and how large it is. In my case Moffitt said that my nodes were small and that the radiation should kill the cancer so they wanted to wait until post rad to see if surgery might be necessary. I had 3 previous cancer docs that wanted to do anything from a Radical ND to a partial ND but I'm glad I ended up at a CCC and avoided what would have been unnecessary surgery.

Hi David, I was just waiting until Friday to add the signature line.

They said that it's a T2 tumor and that it spread to the nodes on the same side. That was confirmed by biopsy. The nodes on that side were not large. There is a very small lump on the other side. It didn't show on the MRI, "something showed" on the PET. They didn't think it crossed the midline and that the lump might be malignant or might be a cyst.

The MD from Sloan also said it was on the borderline of oral and base. Because of the nodes they decided to treat it as base. I thought that was a bit odd.

Because of the location and size he felt radiation would do it. Of course, he said surgery was an option ,if needed but he didn't see that as the case as of now.

I wanted to ask a bit more about the oral/base thing. At the time of the visit there was some question if it was SCC or not(it is) and we got caught up in that. Of course, more questions came to mind on the ride home.

We see the radiologist Friday, the oncologist next week Thursday. Feels a bit slow moving to me but when I asked the scheduling person they said the MD alerts them if it needs to "move faster" and didn't in our case. They also said they don't let it go any longer than 6 weeks from date of biopsy to treatment. We are still in that time period.

andy was in treatment 3 weeks from diagnosis. BUT...he did 3 rounds of chemo first...then IMRT/CHEMO...so he did not have to get dental work or have the PEG before treatment started.

Susan said "the scheduling person they said the MD alerts them if it needs to "move faster" and didn't in our case.

What MD are you talking about?

I was referring to the Oral Surgeon from Sloan. He has been part of their Head and Neck dept for a long time and was strongly recommended by two MDs we respect. He will be the MD managing the case. We both got a very good feeling from him.

3 weeks is amazing. It felt like we moved very fast from discovering it, through the various tests to getting to Sloan.
But waiting a week and then another week is a bit nerve wracking. On the other hand, Dave is using this time to try and fatten up.
It's hard though because it's not easy for him to eat.

It will remain hard to eat after too. After all of this time I have to force feed myself and eat thru the pain. If I didn't I would have to have a tube. I am back up to 170 but still 50 lbs under my normal weight. Feed that man.

Jim, I had to laugh when you said"feed that man." I'm trying. I'm trying. I don't want to be a pain and nag but he's so skinny to start with I just know it will help if he puts weight on.

He is a guy that loves food and really appreciates a good meal. It's just hard to eat with the sore in his mouth. Can't even imagine what will happen with the radiation since so many folks talk about mouth sores after radiation.

We are trying different things to make it more comfortable to eat but nothing that has worked great so far.
He's drinking so much carnation 560 that I think he wants to barf just looking at it...but he forges on...