Respected Sir/Madam.

My father is 61 yrs old. He had cancer in right lateral border of tongue (T1 lesion) and doctor has done wide glossectomy(T size: 1*1*0.9cm) on 15 March'11. Then in August right level 1 lymph node appeared, then doctor did right MND.
The report is as follows:

Clinical history: Wide glossectomy on [15.03.2011]
Now right level I lymph node.

specimen: Right MND.

Gross: Recieved Right MND specimen measuring 9*7*4 cms.
Level I: Salivary Gland is grossly unremarkable.
Eight lymph nodes are dissected, largest measures 1.5*1.4*1 cms. Cut surfaces is firm, whitish.

Level II to V: Eight lymph nodes are dissected, largest measuring 1.9*2*0.9 cms. Cut surface is firm.

Microscopy: Right MND:-(K/c/i wide glossectomy)
Level I: Salivary gland is unremarkable.
One out of 8 lymph nodes shows metastasis of squamous carcinoma with perinodal extension.

Level II to V: Eight negative nodes.

Impression: Right MND:-
Single metastatic node with perinodal extension.

After above surgery, he got 1 cycle of adjuvant chemo from 18th Sept to 21st Sept (5 Flurouracil 1200mg and cisplatin 120mg over 24 hrs infusion for 4 days). Doctor has recommended 2 cycles but he was not mentally and physically prepared for second cycle. Now here in lucknow (our hometown) doctor recommended radiations and they have now started on 19th Oct using Co-60 teletherapy for 30 days. He has much pain and hardness in submantle region in neck and difficulty in swallowing now he is also taking painkiller. He also has bad breath.

When ultrasound(HRSG) report came, it says that �A lobulated hypoechoic mass lesion with breakdown areas measuring 30*25mm is seen in submantle region. Both submandibular glens,carotid arteries, internal jugular veins are seen normally.�

Does it mean that cancer is spreading, or post surgery effect? Doctors are saying that they will wait and see the effects of radiation, then they will decide whether to give electron beam or surgery to cure the new swelled node. Please help me out. Is this proper treatment for him?

Hi Hasim, as I had mentioned during series of PM few months back, a second opinion would be better as Chemotherapy alone was never a good option for Oral Cancer (as suggested by your chemo doc in Mumbai). Your doctor in Lucknow seems to be more resonable to recommend Radiation for 30 days. None of us here can certainly say that the new lesion is cancer. You should check with doctor if an ultrasound guided FNAC can be performed to confirm.

If it is indeed cancerous, radiation can damage. Again, gold standard is concurrent chemo-radiation, so see if you can get a second opinion as it is never too late.

It is difficult time for you and your dad. All the best for the treatment.

Welcome, Hasim. I agree wish Eshwar. The tx so far seems unconventional and another mopinion may be called for.

@Eshwar N ,yea u were right. but we got confused since at that time the doctor who was saying radiation told us that we'll have to wait for six days then she can begin the process and she was treating it as a new type of case thats why we preferred mumbai where the case was old and they knew it well and said to start chemo immediately.

FNAC is suggested by pathology, but the doctor refused to do. She said that she'll wait till end of radiation and then if it persists then she'll refer to electron beam treatment.

what do u mean by "radiation can damage it"?

The pain and swelling near nodes is not reducing.....half of the radiotherapy completed.

New CT scan report of Head and Neck has following report:

An ill defined heterogeneously enhancing soft tissue attenuation lesion [measuring approx 3.2*2.2*2.0cm in size] is seen involving inferior aspect of anterior and mid part of left lateral border of tongue. The lesion is infiltrating adjacent gingivo glossal sulcus and floor of mouth. No obvious bony infiltration is noted. No obvious extension into gingivo buccal sulcus is seen.
Few rounded to oval soft tissue attenuation lesion S/O lymph nodes with short axis diameter upto 1cm are seen in left Ib and II.
Nasal septum is deviated towards left side.

I would talk to your surgeon - or perhaps another surgeon (second opinion) . Firstly - normally tongue cancer (oral tongue - not base of tongue HPV +) should be treated with surgery first - as in - remove ALL the effected tissue first. When he presented with more cancer almost immediately following his initial surgery - that tells me 2 things - they didn't get it all the first time ( I'm going to quote an actual oncologist here. Recurrences especially those that are close together like that - mean they didn't get it all in the first place. ) Secondly normally tongue cancer (not HPV related base of tongue) but oral tongue can be aggressive, everything should be done at the outset to stop it in its tracks. Sometimes they'll send a person home after removing a T1tumor and say your okay, but with the extra nodes coming into play so shortly after, there should have immediately been a set up for chemo and radiation - and fast. Not a little bit of chemo, then rads. it's almost like your dr was trying to minimize the treatment from the outset (which could very much be related to the patient being reluctant - only you would know that). But now your saying, there's another mass in the tongue and more nodal involvement. The rest of the rads may take care of it as radiation is cumulative, but I would ask what the follow up treatment is if it isn't... And I would get a second opinion since your treatment so far hasn't really followed the standard. Cathi here had a tingue tumor and it was treated with 3 rounds of induction chemo and then radiation and chemo combined - shes faured very well, but they moved very quickly with her. By all means finish the radiation, but definitely get a second opinion, and some answers - Good luck... And take care.

@cheryld Thanks a lot for your concern.
Yea actually the report after the tongue operation was negative therefore we can say that operation was successful but after that operation the doctor took a long time without chemo or radiation which in turn became dangerous as nodes developed and then after MND report came positive and then chemo started after one month. So its a long time gap maybe that is the main reason to develop again in tongue. We left that surgeon and now the treatment is under other radiotherapist.

That's great!! Hopefully hing will get sorted out! we always think drs know what's best and hey have our best interest at heart and I'm sure they care - but sometimes they move too slowly. Good luck,

The main thing is the doctor is saying that we have to wait till all the radiations will be done but the bad smell and the infection in the base of tongue is increasing day by day.
So is there any other option to stop it?

Are they treating with antibiotics...? a bad smell is bad... usually a sign the infection is progressing... all in all it's best to finish treatment first but... make sure all your ducks are lined up. Ask now... what is do the have planned if the radiation doesn't work and make sure it's in place at the end of treatment. The problem with stuff like this is after radiation it takes a while to heal, and surgeons don't like working with radiated skin... it doesn't heal all that well or takes far too long, and that again leaves the patient open to infection. etc... Start asking now and make sure you get an answer, or hear that they have a plan in place. good luck and take care.

Thanks a lot......i'll ask the doctor about the post radiation treatment. Yes you are right because only 10 days are left to complete radiation.

No antibiotics are given. Only pain killers are given.

Hashim, kindly discuss with your doctor for antibiotic for oral infection/thrush as it can get terribly bad and your dad will be in more pain.

If required, look at possibility of admitting him to hospital for 3-4 days as it will help him and he'll be able to managed early weeks of after treatment issues.

thx Eshwar N

my dad completed 30 radiation of 46Gy in 23# @ 200cg/# and five more to go.
He was admitted in the hospital last week since he was feeling weak. Now the swelling and hard portion in the base of the tongue is reduced after radiation that is why doctor increased 5 more radiations to improve it.