Kathy,

You already received sound advise, most notably to get a 2nd or even 3rd opinion.

I would like to mention I had radiation 5 times, with 3 different types of radiation; IMRT, IORT, and Proton Radiation in the course of 3 years, so the time in between does factor in, usually no less than 6 months time span, and the patients age, health, location of tumor, amount of prior radiation, doctors experience, etc. do factor in, but with different modalities they may be able to squeeze in more if it's necessary.

I've also had 7 recurrences, so I understand your situation. it was mentioned at one point I had persistent cancer and radio/chemo resistant for whatever reasons resulting in the cancers return.

As far as the lymph nodes, Christine pretty much summed it up, there are 7 neck levels, l-Vll, which cancer metastases usually follows a certain flow based on the type of cancer. As mentioned, there are over 300 lymph nodes in the head and neck, mostly microscopic, and are usually removed in lymph chains or levels like in the radical and modified radical neck dissection or sometimes it's limited or select neck dissections. Even after I had a radical neck dissection, lymph nodes were later found in subsequent surgeries, so I'm not sure they always get them all. There can be "skip metastases" where cancer skips a level to another, as mentioned. Basically cancer can go anywhere, and with neck dissections, it disrupts the lymph pattern, so i heard cancer can go anywhere.

From your signature, and postings, the positive lymph node was remove. For any recurrence, surgery is usually the first preference, and based on other negative features, with radiation or Chemoradiation.

On the pathology repor they would indicate some other negative features such as LVI; lymphovascular invasion, PNI; Perineural Invasion, and such usually involves radiation and possibly chemoradiation suggested.

Not sure if they tested for HPV being the oropharynx was involved, Ebstein Bar Virus if the Nasopharynx was involved, but this may not alter the type of treatment at this point, but can in other matters.

I'm not a doctor, but if it were me, and I've been there, I would be looking for the best doctors and cancer center I can find who are experienced with this.

I hope this helps, and if you have any questions, just ask.