Hi, this is my first post!

My mother (Bala Saigal, aged 55) has been diagnosed with an oral cancer.

She had an ulcer in left base of tongue for which the biopsy report says Invasive well differentiated keratinizing squamous cell carcinoma... this ulcer was removed by a small surgery and it has healed quite effectively.

Besides, she also underwent a few other tests including CT Scan for neck & blood tests. The CT Scan refutes the presence of any significantly enlarged cervical lymph node and the blood tests are also clear.

The surgeon also used palpation before to find out any indication for the enlarged cervical lymph node and he didn't find any.

From the above mentioned, facts - can the stage of the cancer be ascertained? Besides, how good is the radiation therapy after the ulcer has been removed surgically? Also, how good are the cures for oral cancers these days?

I'm looking forward to your quick response(s) as we are under tremendous pressure & tension..

Arvind

As far as the staging it is best done with the pathology I think. They do use exams , and Ct and Pet scans as well. Radiation all depends on the stage , location and size and lymph node involvement, your surgeon and or an oncologist would usually discuss that with you . Do they say she needs Rad, therapy ? They say that the earlier the better as far as prognosis. but that is with everything. I am so sorry I can give you no specifics ..as much as I would love to ..But we are all different and each case is sooo specific and we all respond differently , I hope this helps and I am sure you will hear from many more people on here ... and there truley are alot of survivor stories , which I find quite encouraging myself. I hope I have helped a little bit.

Shar

Thanks Sharlee,
Finally, I've heard from a person who has undergone the same experience (many thanks to your reply)..

I'm quite ignorant on the intricacies of treatment though I could find out a few things of relevance by surfing through various sites. I'm sure that the TNM specifications are still to be worked out for my mother and the few things I see are (1) tumor grade (G1) and (2) no enlarged lymph nodes.

However, I'm quite unaware whether they indicate anything (based on your response).. besides, the surgeon did prescribe the Radiation Therapy but he reiterated that the cancerous ulcer has been removed and radiation therapy shall still be done.

Does the absence of enlarged lymph nodes point to anything? --OR-- are there more tests (besides, pathological review) to be conducted to work out the staging?

Thanks & Regards
Arvind Saigal

Hello Arvind

Welcome to the Oral Cancer Foundation Forum. You have found a great place for help, support, information and compassion.

I am fairly new here and in the preliminary stage of treatment. I have read much information on this site and others. There are many people who will respond to your question.

I AM NOT A DOCTOR. From the information given, it appears they caught the SCC in a very early stage as you said the surgery was small and healed quickly. All other tests were negative. In surgery they remove as much tissue as required until they ascertain clear margins.( no presence of cancer )

To GUESS a stage I would say T1N0M0. You did not say if your Mom was getting radiation or not. If THE DOCTORS are certain all cancer has been removed through surgery, they may not enlist radiation treatments.

As for "how good" the radiation therapy is, I do not know. There are many forms. It is effective, but there is callateral damge to "good cells".

As for your last question. The key to any good cancer prognosis is early detection. Chances are much better when caught in an early stage, as was your Mothers.

LIKE I SAID, I AM NOT A DOCTOR. But it appears your mothers SCC was caught at a very early stage and had not even affected the lymph nodes yet. I think you can relax a little. But make sure to watch for any changes and be puctual about all follow up visits.

If I may ask, what hospital did you attend in New Delhi?

Feel free to "surf" this forum. There are two search engines here. One at the top, and one at the bottom of each page. They are dedicated to oral cancer.

Good Luck! Petey

First of all, a big thanks for your reply Petey!

My mother is undergoing treatment at Safdarjung Hospital at New Delhi though we have also consulted and discussed the reports with an oncologist from Rajeev Gandhi Memorial Cancer Hospital.

The radiation therapy has not yet started but from what I hear from the doctors -it will certainly take place.

As per your comment, the surgeon did say that the ulcer has been removed with extra cells where he presumed that the cancer could have expanded. However, he also said that radiation therapy treatment is given with a *presumption* that the cancer has gone till nearest lymph nodes and the therapy is given to eliminate any chances of it. Apparently, the CT Scan test indicate that the lymph nodes are not affected.

I'm right now waiting for the TNM specifications to be worked out. Besides, presence of clear margins will also be ascertained with the second pathological review of the biopsy slide (which we obtained from the Pathological labs).

However, I am keeping myself very hopeful at this point of time.. keeping my fingers crossed!

A positive attitude is key as well !!

If you have specific questions about cancer treatment in India, several posters to these boards have family members who have been successfully treated there. You might search (using the search link at the top of each of these pages) for postings from praveen_peddi, whose brother received treatment in India that appeared to be comparable to the best available in the US.

Information about cancer staging/grade is available here , in the main part of the OCF site.

The latest clinical practice guidelines (2007) from the National Comprehensive Cancer Network (a nonprofit alliance of 20 leading US cancer centers), giving the most up-to-date treatment protocols, is available at http://www.nccn.org/professionals/physician_gls/PDF/head-and-neck.pdf (Gary or Brian -- can you replace the 2006 info on the OCF site with this?). Note that this includes treatment guidelines for ALL types of head and neck cancer, so make sure you are looking at the correct page for your mother's type (the type of cancer is listed at the top of each page).

As you will see, the treatment guidelines contain a lot of "or" language, so two patients with the same staging may end up with different treatments, depending on individual circumstances.

I wish your mother the best.

-- Leslie

A query for my own information..

How much is palpation successful in the diagnosis of the lymph nodes involvement? I've seen quite a lot of emphasis given to this technique in the staging information determination.

Besides, is PET Scan mandatory if nothing suspicious is found in CT Scan for neck?

Thanks for your replies!

There are lots of articles written about treatment of the neck where there is no palpable lymphadenopathy. Some adopt a wait and see approach, while others will follow a more aggressive course under the theory that microscopic cancer could exist in the lymph nodes that would not necessarily show up to palpation, CT or PET.

There is very little "mandatory" here. At our support group yesterday, there were several who had a full course of radiation to the neck, even without palpable node involvement. Probably an equal number did not.

Thanks Jeff.

An update -
I just returned from the hospital after an investigation from a specialist. After seeing the reports, he states that the cancer is in the starting stage though there is no indication of TNM specifications written on any document. I discussed it with another physician (not an oncologist) and he asserts that it shall turn out to be T1N0M0 (first stage).

The Radiation Therapy specialist has asked for 6 weeks (5 times a week) = 30 shots of radiation therapy and my mother starts it this Saturday (12th May).

Do you suggest any precautions to be taken before or while she undergoes this treatment?

I really appreciate your response.. Thanks again!

Kind Regards
Arvind Saigal