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n74tg #173147 10-26-2013 09:50 AM
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Just returned from Dana-Farber (CCC) in Boston for dental consult in H & N cancer department. This dentist works almost exclusively with oral cancer patients. I will write a more detailed summary later, but regarding wisdom teeth, which is my husband's immediate problem, this was her advice:

Current guideline is that heathy teeth are NOT removed prior to rad. The decision regarding wisdom teeth is less clear. If a wisdom tooth has never been a problem in the past, it is usually left alone. If there have been flare-ups in the past, it should probably be removed before tx.

As Cheryl pointed out, extractions prior to rad, run the risk of delaying cancer treatment, especially if complications develop. This dentist sees 3-4 patients a week with infected/damaged teeth post rad. Not just wisdom teeth, but all teeth (especially molars) are at risk.


CG to husband, dx @ age 65, nonsmoker/social drinker. Dx 5/08 SCC Stage IV, BOT T1N2aM0. 33 IMRT - completed 9/12/08. Induction Chemo (Cisplatin, Taxotere & 5FU), plus concurrent Cisplatin.
1/09 PEG removed; 5/09 neg PET/CT; 5/10 PET/CT NED
Dental extraction & HBOT 2013; ORN 2014; Debridement/Tissue Transfer & HBOT 2016
n74tg #173150 10-26-2013 12:15 PM
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One comment on aggressiveness: One of my docs told me that most HPV positive disease was poorly differentiated and it doesn't have much significance for HPV positive disease vs HPV negative.


Andrew
age 25

early 10/12 - enlarged lymph node area
01/13 SCC of L tonsil, L BOT, 2 L lymph nodes
stage IVa, T2N2bM0, HPV+

2/13 2 doses cisplatin big bag, 2 doses weekly cisplatin + 35x IMRT
4/13 TX finished
7/13 PET/CT - NED!
n74tg #173187 10-28-2013 06:24 AM
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I would get a 2nd opinion from a dental oncologist re the extraction. Most prefer to remove teeth (that need to be removed) before radiation so the BIG ? is does it need to be removed. if you are going to need to have it removed sometime in the near future I would get it done now.


David

Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
n74tg #173204 10-28-2013 01:25 PM
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Okay guys here's an update:

Wisdom tooth will NOT be removed. When dentist checked the margins she said it had improved over past visits, so in light of everything else she can live with not removing it. She also took an x-ray of the tooth and was satisfied with it's under gumline appearance. We did make the fluoride trays, they will be ready Thursday so I can pretreat for about 4 days prior to onset of rads.
She also gave me about a dozen 2oz sample bottles of old formula Biotene dry mouth rinse and gel, the formula with lactoferrin, lysosome and sweetened with xylitol.

That means rads start on schedule, Monday, Nov 4th, a big relief as I still don't like my tumor path description...invasive and moderately differentiated.

In every piece of good news there also lies the bad (how's that for Zen duality Bart). After letting the throat culture grow for 4 days (two 48 hour periods), nothing has grown, ie infection is not bacterial in nature, that's why augmentin didn't work. So, it's likely viral and only thing we can do is let it run it's course. I've asked, there are no anti-virals to treat this. I know she got a good culture sample as I could see the green @#$% on the swab myself.

So, my week 3 treatment symptoms (sore throat, but not dry mouth) started 2 weeks prior to first rads, ain't life great! Let's hope it cures out prior to rads so I can get at least a little of the honeymoon period.

This too shall pass.

Tony


Last edited by n74tg; 10-28-2013 01:40 PM.

Tony, 69, non-smoker, aerobatics pilot, bridge player/teacher, avid dancer (ballroom, latin, swing, country)

09/13 SCC, HPV 16, tonsillectomy, T2N0.
11/13 start rads, no chemo
12/13 taste gone, dry mouth,
02/14 hair slowly returning
05/14 taste the same, dry sinuses, irrigation helps.
01/15 food taste about 60% returned, dry sinuses are worse in winter.
12/20 no more sinus problems, taste pretty good

n74tg #173215 10-28-2013 07:20 PM
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Good to hear rads will start when they were originally scheduled.

Fingers crossed that your throat improves real soon.


36, female, left tonsil HPV+ SCC, T2N1
8/28/13 SCC in left tonsil
9/12/13 surgery:TORS and selective neck dissection (levels II-IV), 23 nodes removed
9/18/13 post surgery biopsy: 2mm clear margins, a 7mm lymph node positive in level IV, no ECL
10/28/13 rad begins, 30 treatments, tomotherapy
12/09/13 radiation ends!
2/10/14 papillary thyroid cancer
2/26/14 PET shows clear neck other than thyroid cancer, but with high uptake in an ovarian cyst
2/27/14 thyroidectomy
3/5/14 pelvic ultrasound



n74tg #173217 10-28-2013 07:37 PM
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Yeah! Good luck.


Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan
n74tg #173306 10-30-2013 05:23 PM
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You've got the idea, Tony, perfect attitude.

The ability to see the humor in the darkest of situations indicates perfect mental health. You will float through this as long as you keep that attitude!

And with this post, you've made my day! Thanks, Compadre!


My intro: http://oralcancersupport.org/forums/ubbt...3644#Post163644

09/09 - Dx OC Stg IV
10/09 - Chemo/3 Cisplatin, 40 rad
11/09 - PET CLEAN
07/11 - Dx Stage IV C. (Liver)
06/12 - PET CLEAN
09/12 - PET Dist Met (Liver)
04/13 - PET CLEAN
06/13 - PET Dist Met (Liver + 1 lymph node)
10/13 - PET - Xeloda ineffective
11/13 - Liver packed w/ SIRI-Spheres
02/14 - PET - Siri-Spheres effective, 4cm tumor in lymph-node
03/15 - Begin 15 Rads
03/24 - Final Rad! Woot!
7/27/14 Bart passed away. RIP!
n74tg #173398 11-01-2013 07:13 PM
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Thanks Bart, Cheryl, Ambra; always good to hear from you.

The viral infection symptoms just got worse and worse, hurt all the time, wanted to sleep but couldn't; so called the clinic to discuss. They hooked me up with an ENT appointment this morning.

The doc said whatever green crud was there at time of culture is gone, throat is clear, surgery site looks to be healing normally with some granular tissue present but explainable since all the tumor wasn't removed.

He asked if I was having any fever (none) and noticing no swelling in the area concluded all my pain and misery is caused by the tumor tissue itself. He actually used the term angry tumor (don't laugh). Best course of action at this point is start rads on schedule Monday and take these really good pain pills I'm going to give you so you can sleep at night (but don't drive). He also gave me a bottle of chlorhexidine gluconate to use on the teeth.

I guess I'm satisfied as I can't argue with any of the things he said. I did ask if it could have been staph to which he replied it would have grown on the culture and thus been identified.

If you guys know anything that I obviously don't please speak up.

thanks
Tony

P.S. Oh, and I got my fluoride trays today also, really comfortable. Dentist says I can sleep in them if desired to better treat the teeth. Any reason not too?

Last edited by n74tg; 11-01-2013 07:15 PM.

Tony, 69, non-smoker, aerobatics pilot, bridge player/teacher, avid dancer (ballroom, latin, swing, country)

09/13 SCC, HPV 16, tonsillectomy, T2N0.
11/13 start rads, no chemo
12/13 taste gone, dry mouth,
02/14 hair slowly returning
05/14 taste the same, dry sinuses, irrigation helps.
01/15 food taste about 60% returned, dry sinuses are worse in winter.
12/20 no more sinus problems, taste pretty good

n74tg #173402 11-01-2013 07:58 PM
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Posts: 94
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I am not laughing at all at the angry tumor. Makes total sense.

Well, at least they seem to have a better idea of what might be going on. I am very curious to hear what you are told about sleeping with the trays.

Hope you have a nice weekend and manage to relax before Monday.


36, female, left tonsil HPV+ SCC, T2N1
8/28/13 SCC in left tonsil
9/12/13 surgery:TORS and selective neck dissection (levels II-IV), 23 nodes removed
9/18/13 post surgery biopsy: 2mm clear margins, a 7mm lymph node positive in level IV, no ECL
10/28/13 rad begins, 30 treatments, tomotherapy
12/09/13 radiation ends!
2/10/14 papillary thyroid cancer
2/26/14 PET shows clear neck other than thyroid cancer, but with high uptake in an ovarian cyst
2/27/14 thyroidectomy
3/5/14 pelvic ultrasound



n74tg #173404 11-01-2013 09:08 PM
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Tony
.......so funny you mention an angry tumor! The day before my surgery, my surgeon looked at my tongue and commented that my tumor was looking especially angry. I commented back that of course it is.....it's being evicted tomorrow! LOL.




48 yo female, quit smoking 4yrs ago, light drinker, Stage 2 SCC, Bx3, Dx 8/22/13, surgery 9/11/13. Partial glossectomy, bilateral neck dissection levels 1-4. Tongue reconstruction with flap from forearm. 87 Lymph nodes CLEAR. Tongue margins good at 1 cm. No further treatment planned. Monthly monitoring planned for upcoming year then periodic monitoring for next 4
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