I have my surgery scheduled in 6 days and am having 2nd thoughts on the decision . I see the rd oncologist tomorrow morning at 7:45 and get his opinion. (Brian, They do the IMRT type at the cancer center I am going to.) If my chances are the same with surgery vs rd, why would I choose the surgery?
How do they determine the odds of one vs the other or is it just an opinion? My wife the nurse
wants me to have the surgery but and I am confused. It is MY decision, It is my body. I want to avoid the surgery if possible. But I want to make the right decision the first time. Dan

Again, no one can predict your odds accurately either way. As I have said on the board before, I am not a proponent of single solution treatments for oral cancer unless they are extremely early stage one cancers. The chance of an undetected micro met in the surrounding tissues is just too high. Take the consult, hear the perspective, weigh the choices. Radiation has long term consequences, which with the use of IMRT are greatly reduced. But it is accumulative during your lifetime, and it is not a pleasant thing to go through, though again, IMRT patients have an easier go of things than those that get field radiation. Surgery may get all the CURRENTLY detectable cells and have clean margins but miss something like a micro met that will come back and bite you later. Larry Sharp comes to mind, read his journal in the patient stories section of the people part of the web site. Carcinomas in situ do the best with single treatment plans, older cancers do better with combination therapy...statistically. And you know what I think of statistics. They don't necessarily apply to you. Now, are you confused and uncertain enough? Of course you are confused and uncertain...who expects these kinds of decisions in their lives, and with no hard rules, what are you to do? It is a completely normal reaction. You will have to go with your gut feeling about what you have been told, what you are willing to go through, your confidence in your doctors, and the doctor's recommendations. There are no absolutes or guarantees in cancer treatment. Once you decide, don

daniel bogan,....I preseented with one 4 cm. lymph node and an unkown primary,after neck dissection,and follow-up pet/ct scan I had 6 cancer positive nodes,all small but deadly.I worried about disfigurment-not really important anymore...the scarring is minamal,but getting to live priceless!...susanlaura

Dan, I`m going to put my 2 cents in here......Packer had radiation first, then surgery, he should have had the surgery first.......surgery is a lot more difficult after radiation as it causes changes to tissue, bone etc. He can have no more radiation, so we are limited in treating reoccurance........Dee

Dan,
I agree with Dee. My mother opted not to have surgery except for a radical neck followed by a full course of radiation. As it turned out she needed the surgery a few months down the road and recovery was prolonged and much more difficult because of the changes that were caused by the radiation treatments. Best of luck!

Dan,

All of us, with the exception of Brain maybe, can only offer opinions based on how our course of treatment went. From what I have pieced together from your posts my case was similar. I was diagnosed with left tonsil SCC with spread to the tongue. I had one node suspect and post-dissection pathology confirmed 2 of 30 removed to be positive. The none surgical option was taken off the table when they "felt" it in my tongue and I had the mandible resection to gain access to the site, functional neck dissection and forearm free-flap. It was not a real problem because I had already convinced myself that I was going to go with the surgery/radiation deal because I wanted to be aggressive. Now, my thoughts. Firstly, the surgery, properly done in an otherwise healthy person, is not bad and you heal nicely, and with the exception of the one on the side of my neck, you really have to be looking for the scars. Secondly, the radiation sucks and you will be getting it either way so don't think you will be getting off easy by passing on the surgery. Finally, there are no easy ways out of this so don't look for one and don't get sold on one, it is not there.

Some other thing to keep in mind. "A little longer than without surgery" is a good thing (from your post). On working; I went back 5 months post-op 2.5 months post-radiation. I'm a Police Officer so I don't think you should count work out at this stage. Looking forward to getting back to work was key in my recovery and the actual act signaled a major personal victory for me.

Lastly, and to all(you thought this would never end), on IMRT. I probably don't have the background for this so it is a question posed as a comment. I was under the impression that IMRT was only effective against a clearly defined tumor. It seems that in most of the cases on the board the radiation is used to "mop-up" the area and therefore field radiation should be better. I would like to hear more on this since many new comers seem to latch onto it as an option(I don't blame them) that, in most cases, does not really exist. I would worry that the cancer could pop up in a salivary gland I avoided by using IMRT. This is NOT a knock on people that have had IMRT, I just want to understand the deal.

Glenn

Glen, I had IMRT by choice and the issue is fairly complex. I had an SCC, polypoid, well differentiated, focally invasive tumor attached to my right tonsil with no mets and it was a perfect candidate for IMRT. The doctor helping me with the decision just happened to be one of the best in the world and a professor (and written textbooks) on the subject at the 7th highest ranked hospital and an NCI/NCCN member. Not all cancers benefit from IMRT. IMRT can be repeated, maybe not in the exact area, but if the parotid gland out of the original field was involved they could go back and radiate it. IMRT was originally developed to minimize tissue damage for prostate cancer patients. Since then it has found, and continues to find many other efficacious applications as well. There are many articles about all of the facilities that are retrofitting or replacing their accelerators to add it to their bag of tricks. I would bet money that ALL of the NCCN hospitals have it and everything seems to trickle down from there.

I might add also that the IMRT was directed to a number of areas of interest besides the tumor.

I chose IMRT a. Because it was state of the art, b. I was a perfect candidate for it and c. I wanted to preserve at least some of my salivary function. and d. My team was unanimous that it would give me the best long term survival and quality of life. I might add also that, although I had chemo too, it WAS the primary treatment modality.

I don't think that my suffering was that much different from someone who had XRT. The studies I have read vary wildly about peoples reaction to it. IMRT was first introduced in 1995. I am sure that many doctors are still unaware of its existence.

I can expand on this idea more later, but I wanted to put up a quick post on this subject of IMRT. IMRT in Brain cancer treatment is very localized and precise, usually treating only the tumor itself. In oral cancers it is used differently. It is used to avoid vital structures where possible that are not involved in the cancer, i.e. salivary glands, nerve bundles, major vascular structures. But this does not mean that all the surrounding structures are spared getting nuked. One of the most knowledgeable radiation oncologists I have ever talked to explained it to me this way. The radiation doctor, in planning the areas to be treated, now has to know anatomy as well as a surgeon. He is able to map within millimeters, an area of exposure, and at the same time vary the levels of radiation given to that specific area. Oral cancer

Hi Daniel,


My two cents...worth...

I keep reading your message, and all I keep reading is second thoughts, second thoughts, that is wanting me to ask you. Why are you having Second Thoughts? Something is not right just yet, then. Not ready yet. You must wait then. I'm not familiar with your situation, but have you had many opinions on your condition yet? Are the (Drs.) all in agreement with your treatment? When you have several opinions, and they are all in agreement, then yes, you would tend to think ok they are all on the same page. You have to trust your own thoughts and ask why am I questioning this and then go searching for the treatment that you want to have done and when you feel that it is right in your own heart then you go with it. Hope this helps and doesn't confuse you...best of luck, I will keep you in my thoughts...XoX Flo - Never, give up, this may be your moment for a miracle! Keep in touch! :rolleyes: