Here's the deal - tongue cancer is tricky - even a T1 tumor can seed to the nodes - the scary part about this is if its microscopic it doesn't show up on a scan of any kind, it only pops up once it has reached a certain size. It has happened numerous times where a dr. removes a tumor says you're cured go home only to have a node pop up later. And depending on how aggressive it is at that point it could be a chase to catch it.
Weighing the damage and recovery time of the two I would at this point go for the neck dissection (to be honest in my desire to make sure they got it all I would request both - but that is not an option for you) so being that often the next pace this cancer heads is to the nodes, and that the fallout from radiation can be life long, and debilitating, at this point the surgery would be a good choice.
A neck dissection is relatively painless - they cut the nerves there so you are pretty numb afterwards - they also cut a muscle so your arm and shoulder will be wonky for a bit, but recovery is quick, and other than some swelling (which you can see a lymphatic massage therapist for) and the arm / shoulder issue (which you will regain if you go to physio for a short period and continue to do your exercises at home for a few months) you will walk away relatively unscathed.
I'm 26 months out of treatment - in three days - and my arm is 99% I even play baseball now with no issues whatsoever. That 1% is just because I am a tad weak in my hand and opening really tight jars can be fun - or carrying super heavy bags. Other than that it feels great!
Radiation on the other hand is very much considered the gift that keeps on giving. The fallout includes : long term taste difficulties (during treatment things taste funny then you lose all taste period. It does come back eventually but not necessarily all or normal. My sweet taste is still minimal - not necessarily a bad thing - and salt too - processed foods taste like crap - I can taste the chemicals in them still - I am a vegetarian so I eat pretty healthfully but still some foods are unpleasant.) I think tongue cancer patients may be more affected by this because the rads is often aimed directly at the tongue where most of your taste buds reside. So BOT, esophageal, laryngeal cancers may regain their taste better and faster. Radiations shrinks tissue and causes fibrosis. Likely because you haven't had a neck dissection they will cook at least half of your neck, and your tongue area. This can cause tightening of your esophagus, which leads to difficulty swallowing - particularly dry foods, tightening of your jaw ligaments and muscles which can restrict how much you can open your mouth, and atrophy of the swallowing muscles and / or epiglottis. It also causes damage and compromised blood flow to your jaw area. This can lead to osteonecrosis somewhere down the road. Particularly if you have any kind of dental issues. Often beforehand they will makes sure you are keeping your teeth, and pull any that are sketchy. This is because removal of a tooth post radiation is a special kind of nightmare involving hyperbaric chamber and 20-30 dives. If this isn't done you could end up needing a jaw replacement at some point.
Radiation effects your salivary glands - during the end of rads you are drooling like a mastiff - then at some point post rads you lose all salivary function and its like the Sahara in there. Most people do regain some saliva back but that is dependent on the path of the radiation and your ability to heal. The lack of saliva also effects your teeth. You will be given fluoride trays and be expected to use them the rest of your life if not you will have dental issues. And that leads back to the tooth pulling and jaw replacement and so on.
Also even if you recover okay (I was blessed, I recovered okay without a lot of the nightmares most face) your mouth still tends to be sensitive to certain things - for me it's spice, still two years out spicy stuff burns like hell. Vinegary stuff, mayo, salad dressing pickles, burns and often causes sentive patches. My mouth is very sensitive to irritants of any kind.
I'm sure there are more things I've forgotten to mention - beyond the trauma of the last 2-3 weeks of treatment (which at best is horrible) and the first 2-3 weeks of recovery (radiation continues to work for a least 2-3 weeks post treatment so that is the worst time for a patient.) for rads you may need a feeding tube as well, and depending on your genetics, the path of the rads you, may lose some hair. I lost all of it from my ears down to my nape -and it thinned all over my left side to my crown - it does grow back and really when you are fighting a life threatening disease its nothing, but for a woman it's a hassle.
Most importantly - if they do a neck dissection and somewhere down the road you do have a recurrence you still have radiation as a viable option. They can radiate you twice, but that causes an amazing amount of damage.
Drs sometimes don't give you the gory details - in this case they should - that way you can make an informed decision - and know the lasting effects both treatments can have. Best of luck!
