Hi Liz,

Are we talking about "functional MRI" or "standard MRI"? My understanding is that standard MRI will provide anatomic information not significantly different from the CT scan I already had. Like a CT scan, I think standard MRI cannot distinguish between necrotic tissue, edematous tissue, and cancerous tissue. I think a PET/CT can distinguish between necrotic tissue on the one hand, and either edematous or cancerous tissue on the other hand. Thus, a negative PET/CT reliably indicates only necrotic tissue is present while a positive PET/CT indicates that either edematous or cancerous tissue is present.

My understanding is that a CT scan merely tells the doctors there is an abnormal lump of tissue present and does not distinguish the state of this tissue (necrotic or edematous or cancerous)... its based on how well this soft tissue blocks x-rays and I think it blocks x-rays about equally well regardless of the state.

My understanding is that the standard MRI provides similar information... but its based on the density of hydrogen atoms in the tissue (many of these hydrogen atoms belong to larger molecules) with a higher density providing a stronger MRI response. Perhaps there is some difference in hydrogen density between necrotic tissue on the one hand and either edematous or cancerous tissue on the other hand... in which case the standard MRI might provide similar information to a PET/CT... but its my impression that, in order for a standard MRI to reduce the "false positives" problem of a PET/CT, there would have to be a detectable difference in hydrogen density between edematous tissue and cancerous tissue. While I suppose such a difference in hydrogen density might exist, I don't know enough to know for sure that it does... my "wild guess" is that any such differences are small and would be an unreliable means to distinguish these two kinds of soft tissue.

But I'd also make a "wild guess" that its theoretically possible to design a specialized "functional MRI" scan (which focuses on something other than simple hydrogen density) to reliably distinguish these two kinds of soft tissue - whether anyone has tried to design such a specialized MRI scan (and whether its gone beyond a research exploration to reach clinical practice) I do not know.

Does anyone know what an MRI can do that a CT scan or a PET/CT cannot do?

Rob

My PET/CT report is done and, while I've not seen it yet, I'm told that it shows positive for a "persistent" node within that large (2 cm x 3.9 cm) mass.

At my request, my ENT surgeon has agreed to perform a needle biopsy, but he recommends surgery regardless of the biopsy result (since a negative biopsy could well be a false negative). I think he would have recommended surgery even before the PET/CT, based only on the previous CT.

One worry is that he's not sure he can spare the IJV or the SCM muscle (and still perform an oncologically sound procedure). Further, he indicated there is risk of damaging the SAN because of the location of the persistent node.

I'm still undecided, but open-minded. I have a meeting with my whole medical team scheduled for this Friday. I'll be interested in what they say... as well as seeing the report from the PET/CT and from the needle biopsy.

Are there alternative treatments to surgery? Would some additional radiation treatments (focussed on the lymph nodes, instead of the tonsils) make sense?

I also wonder about the potential for residual disease that might not be addressed by surgery.

Anyone have any thoughts about all this? What are the long-term downside effects of losing the IJV and/or the SCM muscle? What about the SAN? Where can I learn more about what to expect?

Rob,

You can always get another opinion but time is of the essence.

Rob had his internal jugular vein removed and he had no problems at all with that,his muscles were reasonably undamaged.Surgery sounds like the very best course for you,i personally wouldn't waste any more time prevaricating ,these monsters grow quick.

Rob

My personal experience is that PET/CT scans are worthless except for plotting your radiation field. I am clearly biased but with your obvious research skills, you probably have already found the studies and reports on PET/CT scans problems, especially for base of tongue cancer. As for lymph nodes, my MRI reports did identify "necrotic" tissue and the subsequent neck dissection confirmed that impression.
Have you explored a different ND surgeon? My understanding is that it is like prostate surgery, some "great" doctors are quite good at consistently not having nerve and muscle injury that other "good" doctors routinely inflict. I can relate to your concerns as I simply refused a neck dissection the first time around, but caved in when the cancer came back a second time and I was having so much horrific surgery that the neck dissection was minor. Oh, and my doctor did avoid all damage to all the muscles and nerves but she does many many NDs a year. good luck
Charm

"Prevaricating"??? I think you meant something else (like Procrastinating). But no matter, I'm disappointed that it seems my chemo-radiation hasn't been definitive... I expected (and I think the doctors had expected) that it would be. I'm also a bit surprised/shocked they have so quickly suggested surgery - the possibility had been mentioned earlier, but they (the doctors) made it all seem so remote that I'd put it out of my mind. Sure it was a possibility, but it never seemed likely.

Sigh. I'll have the biopsy, talk with all the doctors, and let you know what I decide. Thanks for the replies and comments. More are welcome.

I had a ND among many other things done with my first surgey in August. The doc removed 3 non cancerous nodes. The scar is barely noticeable. I have peace f mind that the cancer didnt spread to other areas. Best of luck with your decision.

Charm,

Thanks. Yes, I am considering 3 different surgeons. I only know one of them; he's a nice guy and I feel he did a decent job on my pan-endoscopy (and bi-lateral tonsillectomy) last April... but MRND is a lot more complicated. The other two were recommended by my RO, and they both belong to the same institution as my RO. So how do I go about choosing among them?

Rob

Rob

You can start by asking how many neck dissections each surgeon has done in the last few years and if any of them had "complicated" ones like yours and how it came out. Of course, you might not get any useful responses but generalities. I often wished that hospitals would keep statistics on their doctors that they provide to patients: Dr X has done 100 NDs, Dr Y has done 10 NDs etc.
One other source may be local magazines: the Washingtonian runs a "top doctor" issue every year where it surveys doctors to ask them which ENT, Cardiologist, Gastro, etc the doctors themselves would go to. They publish a short bio on each winner. That made my choice easier as my ENT surgeon had been a winner for cancer surgery each year plus her husband had oral cancer so she empathizes with her patients' travails and is very sensitive to minimizing side effects of surgery. She backed my initial decision to refuse the ND the first time around,

Rob,
Are you being treated at a major Cancer Center?
In any case, a second opinion may be wise.

As I recall, a ND when nerve or vascular invasion is involved can be a real game changer, so I would want the surgeons to be very experienced with those complications.

I have been told when one doctor recommends another it is usually a good sign.

I had a node near the Carotid that they were concerned about, and despite scans, were not sure until they got in there.

I was given worst and best case scenarios, and I think even the best case scenario sounded worse than it has actually been. I hope that hold true for you.

Also, two ENT surgeons performed my SND.