Hi
I am from Toronto and am just wondering where you are going for your treatments. I hope you are going to Princess Margaret, as it is a CCC like those in the US.

From your two posts it seems that the only doctor that he has been seen by is a surgeon, which of course means that the treatment plan is going to be surgery. Here in the states and predominantly in Canada, some combination of multiple treatments is becoming the norm. Surgery alone is only used in very early cancers by many institutions and with chemo and radiation in others. I hope that you are getting opinions from a treatment team (here in the US referred to as a tumor board), where doctors from different disciplines, (not just surgery) decide together what is the best course of action. That usually ends up with the best ultimate results.

You must have misunderstood the doctor, I have never heard of a graft being used for a neck dissection. And 40 is avery young man. He can tolerate (unless there are confounding other problems) physically any of the current treatments that they have to choose from.

Ching,

I would highly recommend another visit with the surgeon prior to the scheduled surgery date. As others have said, grafts are generally not needed for a neck dissection but they are used to rebuild the tongue. I suspect that's what the surgeon was talking about. If that is the case, is only one surgeon doing both parts of the surgery? I had two surgeons - the ENT who removed the cancerous tissue and a reconstructive/plastic surgeon who rebuilt my tongue. I met with both before my surgery and was able to ask many questions about what to expect during recovery. I spent about 10 days in the hospital, including 2 or 3 days in the trauma ICU ward. It wasn't easy and any one who says this isn't serious just doesn't know what they're talking about. This is a very, very serious cancer.

- Margaret

sorry my bad. skin graft is for the tongue not for the neck.

We're in vancouver. Not sure if vancouver cancer agency is like CCC... the surgery will be done in the general hospital.

I'll be sure to ask about the treatment team when we go in next week.

Ching - it is a serious illness - it's cancer - I had a tumor on my tongue - the size made it stage 2 - 2.5 cm x 1.5 cm - from my CT and MRI scans I had no lymph node involvement - I will find out for sure today as I have my first post op check up. I had the same surgery as your husband will be having. It was a 10 hour surgery - part of my tongue was rebuilt with a graft from my wrist. I was in the hospital 10 days - I have heard of shorter times - I am not sure why - I think it's dependent on the dr. And the medical system in the country you live in. Possibly insurance related - however - I am three weeks post op and feeling good. I am not 100 % yet but operating at about 85% - my speech is still off because my tongue is swollen, my neck and shoulder are still stiff and numb - but I've had no real pain - even post op. They had given me morphine for the first 48 hours but it made me a space case - and since I wasn't in pain I asked them to stop. From that point on I had a couple of Tylenol 3s before bed. And by day 7 I was off pain meds. That said - everyone has a different pain tolerance - it's a big surgery - by no means is it an easy recovery - but things will improve daily. The wrist (my graft site ) is the worst of my scars. It has healed well but it's just ugly - but there's no real pain there either - the range of motion of my neck wrist and shoulder are still not perfect but I imagine a few months from now they will be fine. I am eating well (normal foods, small bites, though some foods like rice are unruly), and speaking with a lisp, but I think that will heal in a few months as well. everyone is an individual and I'm told I heal quickly, but hopefully this gives you some idea of what to expect with your husband. Take care and my thoughts and prayers are with you.

Hi Bethers0808 -

No, you're not scaring me. I prefer to know the facts beforehand so anything is good.
They didn't biopsy the lymph nodes, but through the CT scan, it showed at least one lymph node infected. I'll ask for the deepness of the cancer today with the oncologist.
He's being treated at Vancouver General Hospital, in Vancouver Canada. The date of his surgery is next Tuesday. It'll take about 10 hours or so followed by approximately 5 days in the hospital. The feeding tube is G2 Tube. From scanning a couple of posts, I see PEG and NG but not G2... That'll be one of my questions today.

I do have other questions if you don't mind..
1) some people told me I should monitor him at night too in case he chokes and can't breath. They said that if he has a hard time swallowing after the surgery, and he has phlegm build up in his throat, then there's a danger of him not able to breath. I don't even know how to begin to help him on that front. Is it to keep him not lying flat and have large pillows so he can kind of sit up while sleeping? sorry this may be a very dumb question.
2) he has allergies. in the morning, he spends a couple of minutes clearing up his nasal cavities as well as his throat. with the neck dissection, will he still be able to clear his throat?

thanks so much for your advice!

Thanks! I think I really need to record or tape the appointments with the surgeons.. Because the length of the cancer on the tongue (the Primary) is 11mm... but it's considered stage IV... I'll have to get all the facts straightened out today...

also, would the grafting part on the tongue be able to replace the part that's taken out or just partially? If you don't mind me asking, how long does it take to be able to speak or make some sounds afterwards (like uh-huh, or uh-um)?

i'm thinking after he comes home from the hospital, that I'll give him all liquids and then blended juices from potatoes, or fruits and veges, and then work it up to small bites of solid foods.

Thanks so much and hope your post op check up goes well!

Okay - I was eating solids by day ten - omelets etc...(but I am told this is a little earlier than average. Rice is still hard because it's messy - and gets everywhere mashed foods too, then with limited tongue mobility cleaning the stuff out of your mouth is a task - I used to take a swig of water after each mouthful to swish it around and clear out the foods and help swallow. It takes time to figure out what works but usually it's easier to chew and swallow on the unaffected side.
Usually staging is based on size and I am sure If i am wrong someone here will correct me But it also has to do with how involved the cancer is. If there is at least one lymph that's visible on a CT scan - then there are possibly more
and that I believe does change the staging.
The grafting replaces what is taken out it's usually quite swollen. For the first couple of weeks making it hard to eat and swallow. Plus there are stitches inside his throat and and on his tongue as well as on the outside of the neck. Whether he will be able to speak is dependent on whether he has a trache put in temporarily or not - facing a ten hour surgery with a reconstruction my dr. Wouldn't do the surgery without one. This was the worst part for me. The trache they put in in the OR allowed me only to breath through the trache hole - with that in I couldn't talk - have a pad and paper nearby so he can write his requests. On day 3 they changed my trache to a fenestrated trache and from that point on I could talk (though it was very mumbly) and breathe through my nose and mouth.
Day 5 they removed my hrache completely and i was breathing through my nose and mouth but found it more comfortable to sleep if i was laying on my side and with some pillows and my head elevated that way my tongue could loll to one side making it easier to breath. You should ask the dr. if he will have a trache in.
I found the soft diet to be a pain and opted for small bites of softish foods like egg, soft small veggies, half grapes, berries etc.. I avoided seedy things though because those things can hide in your mouth. Juices and stuff are great - but if he's swallowing without pain and his good side has mobility then he should be okay with small bites as well as the juices.
I would play it by ear - see how he feels and what his pain level is.

Thanks so much - My post op was good - I have to have radiation and chemo but my dr is using it as insurance as he believes he got it all so I'm good with it. Best of luck with your hubby it's not an easy surgery but with your help he'll do well because you sound like a very supportive caregiver. My though and blessings are with you.