stage 1. Hi grade cancer.
Lesion 1cm on the soft palate noticed 3 months ago.

Had biopsy and CT Scan. No MRI. So far they felt it'd be a waste of time and money as the tumor is very small and lymph nodes look ok. Does this make sense.


Have no insurance so probably will use one of the county hospitals in Los Angeles. The residents would perform the surgery and be supervised by more experienced surgeon.

Is the care in county and state hospitals inferior to well known hospitals and cancer centers? Should I try to somehow be seen in those hospitals instead?

So far I've seen a resident and will be seeing others: dentist, radiation therapist etc.
Recommended treatement so far:
Surgery and possibly radiation.
Neck dissection not recommended at this point.

I feel some intermittent minor pain (difficulty swallowing) in the throat intermittently but docs see nothing in throat with the light.

Any advice is welcome.

I do think that you should try to get treated at a cancer center. Have you looked into this program?

http://www.ochealthinfo.com/medical/msi/

Well the county hospital systems vary widely in California. I had a good friend who got treated for stage IV small oat cell lung cancer at Highland hospital in Alameda County and she received state of the art treatment and the latest chemo cocktails. She is a three year survivor (small oat cell is one of the most lethal cancers - 5% 5 year survival rate). She also received brain radiation as a prophylactic measure as brain mets are very common with this form of cancer. It had also metasticized to the esophogus and they treated that with radiation as well. They faithfully followed the NCCN guidelines and most of the docs had their training at UCSFCCC. Many of the county medical centers are teaching hospitals as well. They aren't all bad.

If you don't own property why not get on MediCal and get treated at City of Hope?

Is there a way to evaluate the county hospitals. Which one would be recommended?
Are any in Los Angeles ok? e.g. USC, Olive View UCLA...

Would city of hope only treat me with Medical. i.e. do they have any other programs/studies and how would I find out.


Is there a way to find approximate cost of my treatments.

Since this is a stage 1 (small) tumor is this considered a simpler, more routine, easier procedure/surgery with possibly optional radiation and therefore I don't need the better hospitals with the most advanced equipment/best doctors.

trt, In my humble, but experienced opinion, anyone with any kind of Head and Neck cancer diagnosis needs the best docs,most advanced treatments and hospitals available. Amy

USC is a private institution and not part of the state system. UCLA is one of the top ccc's in the US. Go to the resources page on the main web site and look at the link that says best hospitals. This is an independent report issued each year that lists the top 50 in order of best to worst on many criteria. UCLA is very near the top. There are hundreds more that do not even make the list.

Your reasoning is wrong in some of this. Just because a lesion is not visible to the naked eye in a throat scope does not mean it does not exist more deeply in the tissues. Scans of different types look for different things, some scans are better at soft tissues, some better at masses, some better at hard tissues, some look at things at a cellular level, independent of the type of tissue. Having cancer of any stage and stating that you think that going to a lesser hospital than one with a cancer center as an integral part of it is OK, makes no sense. It is the training and experience of the doctors that will make a difference in life and death and not equipment. The best docs are at the best facilities; they are in demand and can pick and choose where they wish to work. A casual attitude about who treats you and how seems incongruous with a diagnosis of a disease, that given the right set of genes in you, can run like wildfire or not, and certainly takes too many lives every year regardless of the stage it is diagnosed at.

ok, thanks
I was not referring to USC and UCLA but the county hospitals that are affiliated with USC (LAC + USC) and UCLA (Olive view); there are others.

e.g.
http://www.usc.edu/schools/medicine/patient_care/hospitals_clinics/lacusc_medical.html

Typically it's a training ground for residents who perform services under supervision. The patients are very low income typically without insurance etc, the hospitals are not pretty and the waiting periods are longer. What I cannot determine is whether the quality of surgery is the same. I am assuming it's not but I could be wrong.


I looked at the list of best hospitals starting with Sloan Kettering. I did not see City of Hope or USC on it.

Is City of Hope comparable to the better ones.

What about Massachusetts centers for head and neck. Would it be Dana Farber and other Harvard related as the best ones.

City of Hope is a CCC amd certified as such by the National Comprehensive Cancer Network (NCCN) as one of its 17 or so member institutions. CCC's will always be our first recommendation for treatement. I would start immediately start calling these hospitals and see what they will accept. Institutions that receive public funding (UCLA) and federal grants typically have to be a little more flexible in their admission criteria.

Please - head Brians advice about your reasoning - it could get you dead. This is not like a flu vaccination - as has been previously mentioned, the head & neck is one of the most complex areas in the body. Not to scare you but there is a reason why out of 30,000 new cases each year there are 9,000 deaths. Get the BEST medical care you can - the life you save may be your own.

USC does, by the way, accept MediCal and Medicare.

UPDATE:
diag is carcinoma ex pleomorphic adenoma
mixed benign and malignant tumor.

It's gotten a little smaller and less tender.

It's unusual because this tumor typically is much bigger and occurs in major salivary glands and mine is on the palate and minor salivary glands. They are still sticking with the original diagnosis but will examine the tissue again once removed.

Right now it seems that surgery itself would do the job and that radiation would not be required.
Use of obturator, flap or graft.

Resident feels that there is a very minor chance of it also being in the bone of hard palate in which case a small part of it would be removed.

They feel that everything should go fine and that the resulting cavity would fill with scar tissue with extremely small chance of complications like infection, velopharyngeal insufficiency, recurrence, incomplete resection.

Has anyone here had this particular tumor and surgery?

I assume the recommendation is still to go to a CCC.