Hi Everone:
Finally spoken to the doctor who reviewed my CT re-staging photos. I'm been frustrated as the report was very vague.

I've learned that the CT was non-constrast, so she could only measure macro biologic activity. It seems that she could not see any cancer/tumor from the CT scan, although there is a small SUV of 3.7 remaining.

Fantastic!!!!!!!!!!!!!!!!!!!!!!!!! So far, 2 doctors, 1 dentist and 1 CT doctor couldnot see/feel any tumor.

However, I still have to do radiation which will be TomoTherapy. My question is how do you think this will effect radiaton. I start Monday, but I'm just curious of your opinion and/or experience. How will they target the radiation if there is no localized tumor. Do you think it will effect the amount of radiation and/or number of treatments.

Just curious. As you can see, I'm impatient for information.
Always love a good discussion.

Sandy S.

Sandy,
I am not familiar with re-staging, but it looks like the chemo has significantly reduced your tumor (or tumors) so the Tomotherapy can be more effectively.

I would imagine the radiation plan will closely follow the NCCN guidelines for cancer of the oropharynx - http://www.oralcancerfoundation.org/treatment/pdf/head-and-neck.pdf

Regardless of staging, the primary area normally gets the 70gy maximum as do involved levels of lymph nodes. I expect they will program the Tomo to 'paint' any areas where a tumor is, was, or might be. Some uninvolved levels of node will likely get 40-60gy.

It seems unusual to see your bio as stage III with nodes involved. I thought tht normally boosts it to a stage IV.

Don: My nodes were extremely small (8mm) and had little hypermetablic activity so I guess that was the reason my diagnosis stayed at Stage III. Someone please correct me, but I don't think they consider nodes unless they are => 10 mm.

BTW, the re-staging showed no lymph activity. I didn't expect to respond to chemo this dramatically, but I'm elated.

Sandy S.

Sandy,
regarding nodes under a cm not being considered for Oropharynx SCC staging; I haven't heard that before, but I read something similar for lymphoma.

There is what I thought to be pretty good staging section in the NCCN guidelines although it doesn't mention the "less than a cm" issue for Oropharynx SCC - but, I know there is a whole book on staging.

As I said, I also haven't heard the term re-staging used before.

Don:
I just reread your post to me about re-staging and <2cm nodes in staging.

I don't know why they particulary call it, "re-staging," but the chemo results were so dramatic that they did need to get a new picture of it.

After reading the diagnosis for lots of people on this list, I too am surprised that I wasn't given a Stage IV. I don't quite get the node thing either.
Someone must be looking out for me, as I'm surprised that my cancer also doesn't seem to be as aggressive.(Hense, my question concerning aggressive cancer.) Based on my tumor size which was very, very large, I have absolutely no other activity going on in nearby areas (no bones, toncils, etc).

So,I'm not going to look a gift horse in the mouth; I'm going to just accept my good fortune for now. And keeping traveling the road I'm on until I finish radiation.

Sandy

Sandy, it's possible that you have a team of Angels riding on your shoulders like I seem to have. This I firmly believe I have.