Hi Timm
Glad to hear that there were no nasty surprises with your husbands surgery. And in the scheme of things, there was some quite good news with the staging being downgraded to a less severe level (all too often it is the other way around).
It is often difficult to interpret what we are told as it is not easy to remember all those numbers when one is not even sure what they all mean. You described the tumour and nodal involvement as below which I have taken to be the latest and most accurate description of your husbands diagnosis.
[quote]Primary tumor on base of base of tongue removed & smaller than thought pre-surgery & tumor in lymph node removed. 23 other nodes removed showed no cancer. Clear margins after surgery.[/quote]
This reads to me that there was nodal involvement ("tumor in lymph node removed") but had not spread very far (" 23 other nodes removed showed no cancer"). If this is correct there would be a number after the "N" and likely a 1???
The National Comprehensive Cancer Guidelines for your grade of oropharyngeal cancer recommends surgery as one of the options (radiation being the other). My read on this is that chemoradiation is NOT recommended for low level tumours (T1) but have attached a link to the guidelines for you to check for yourself (or use it as a discussion point with your oncologist). I think if the grade of tumour is higher, or nodal involvement more extensive, chemo plus radiation is recommmended
http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdfYou and your healthcare team have selected the surgery option and the next recommended step where there is "one positive node with no adverse features" (which in your case refers to the tumour that was removed from the lymph node which had no extracapsular spread) is to "consider radiation".
I would hope your team could quote this stuff in their sleep so for them it might be fairly simple. However, they need to bring you up to speed and help you to make decisions that you are confident with so you probably need to be very clear on how big your husband's tumour was, confirm that the nodal involvement was minimal and ask questions around what other options there might be. Get the doctor to write your husband's staging on a piece of paper if need be (but remember sometimes it changes as more information is uncovered).
Well done on picking up a BOT cancer at such an early stage! All too often these things have progressed to T3-4 before anyone notices anything wrong and as you can appreciate, makes it much harder to treat and leaves more damage behind than a smaller tumour such as a T1 which has better outcomes than the more advanced tumours.
