The article is written based on individuals that have had a positive intraoral diagnosis, in which neck involvement appeared not to be present, using conventional scanning technologies. Subsequent surgeries or development of disease yielded the findings over the period that the population was watched. While you would assume that a neck dissection would remove all possible risk, there are possible other issues. In my own case, the nodes were bilaterally involved, even though my primary was just on the right. If I had been found as a stage three, and not a four, those two nodes on the left would have not been developed enough for a scan to pick them up in all likelihood. Second, and this is informed speculation on my part, there is no evidence that nodal involvement is the only place that neck mets go to. We know for sure that the disease can reside in a variety of tissues, muscle, bone, adipose, etc. and while I think it is well understood that nodes are the most likely location for it to go, I am far from certain that this is the ONLY place it goes. A neck dissection in which known mets are not being removed, but for surety sake is being done, only takes out node chains. Could it still exist in that location as a micro met? Your question is a good one and I will pose it to some doctors in next weeks phone conference with the advisory board.

Brian...you were going to pose this question to the Advisory board. I am curious to hear what their current thinking is on the subject of radiation/no radiation for stage I and II OC's. Thanks.

I am afraid I cannot give you anything that is back and white nor supported by concusive peer reviewed published data that will lead you to a personal decision. Uniqueness of each patient and their disease, (separate from staging) are involved in this decision making process, and no one that I talked with indicated that any absolute rule applies.

I'm pretty sure that the 30% of occult mets to lymph nodes applies to patients who have had CT scans and physical exams but NOT a neck dissection. That's what my ENT told me when I was diagnosed as stage II but hadn't had the surgery yet. After I'd had the neck dissection, he said my risk of occult mets was much lower and it was clearer I was a stage II, but, since he had only done one side for the neck dissection, there was still some risk it had spread to the other side and I needed radiation on both sides to be sure to eliminate that risk.

But Brian is right that the lymph system isn't the only way cancer spreads. It can spread along nerves and through the blood as well. That's why, even though I had no node involvement after a neck dissection, it was recommended to me that I have rad (and chemo although that was an aggressive recommendation)--because the tumor itself had perineural involvment and also vascular involvement which suggested I was at risk of spread through those alternate routes.

Nelie