John,

I read your blog. Looks like you are confronted with the same issue all here have faced at one time or another; how aggressive do you want to get with this disease?

Not an easy question and certainly not any easy answers.

Your blog say's you had the primary removed and it was cancer of the salivary gland in the tongue. A second surgery was then preformed where they removed half the tongue (splitting the jaw to do that) with a free flap from your thigh and had a neck dissection.

Pathology from that surgery was negative and you felt you were done.

Now doctor says margin in tongue was not as clear as he would have liked, and is recommending radiation just to be sure they got it all.

From your blog it looks like they found no cancer in the nodes and you felt that the neck dissection was unnecessary (this happens all the time) I think you also might feel that they did not need to remove as much tongue as they did, as no additional cancer showed up.

I think the fundamental question you are facing now is the issue of the margins they feel they have at the original site and how sure your doctor is about the radiation (sounds like he was unprepared for the meeting he had with you).

I would get a second opinion about the margins and the need for additional radiation. The fact that the neck dissection and free flap did not show cancer should not sway your decision here. It�s now all about the margin at the original site. If you feel the doctor is just throwing the �usual treatment� at you and not looking out for your best interests, find a doctor you can trust.