Hello all,

I'm 55 years old with T1/N3/M0 (Stage 4) SCC of the Left Tonsil (HPV-16 positive). Originally detected 3/20/09 with a 6 cm mass of enlarged lymph nodes. Treated with 9 weeks of induction chemo (TPF) followed by 7 weeks of chemoradiation (using IMRT) which concluded 8/26/09. Now we're considering neck dissection.

I want to note that there are several types of neck dissection. The "gold standard" is a radical neck dissection (RND) which removes the sternocleidomastoid (SCM) muscle, the internal jugular vein (IJV), and the spinal accessory nerve (SAN) along with the lymph nodes. Then there are various forms of modified radical neck dissection (MRND) which remove fewer structures - although they all remove at least a few lymph nodes. <http://en.wikipedia.org/wiki/Neck_dissection>

I recently had a CT scan showing a 2 cm mass still remains. I'm told this mass will contain live cancer cells in about 25% of cases like mine. We're soon going to do a PET/CT and, if this comes back negative, we'll probably NOT do a neck dissection. Its not clear what we'll do if it comes back positive but I think its likely we'll defer the decision and do another PET/CT in late December. Here are some articles I found on this topic:

http://www.ncbi.nlm.nih.gov/pubmed/19358193

http://www.oncolink.org/conferences/article.cfm?c=3&s=47&ss=267&id=1686
http://www.oncolink.org/conferences/article.cfm?c=3&s=47&ss=264&id=1672

http://www.ncbi.nlm.nih.gov/pubmed/17921898?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed

I hope to avoid this surgery altogether. If surgery seems advisable, I hope to preserve the SAN, IJV, and SCM muscle. In my view, these structures are unlikely to harbor live cancer cells and only need to be taken if there is a strong likelihood that the immediately adjacent tissues harbor live cancer cells. Preserving these structures should help reduce long-term side-effects that reduce quality of life. Its my understanding that most modern neck dissections at least try to preserve the SAN.

I hope the above information is helpful to some of you.

Rob