Thank you Christine, thank you Mamacita, thank you all. Nothing could be more on point than what you are seeing and saying.
Here's more detail which'll help you understand how the treatment situation looks from my point of view. First the surgeon is on a different island than the chemo and radiation doctors and the patient, and those two doctors are not located near to each other. The surgeon did a fine job from all that I can see. I know the radiation doctor is a good one, so I have no problem with his work.
As it went, the surgeon only recommended radiation, and passed the reference to the radiation doctor. The radiation doctor upon seeing the pathology and whatever reference materials came, he suggested to the patient that chemo be included. The chemo doctor now in the loop is historically very slow to move, and so it is in this case. His expertise I assume is fine, but I don't know. There is another chemo doctor on this island.
On the more specific level, I know that most oral cancers are of the squamous cell variety. And radiation is a prime treatment. But the pathology here indicates small cell neuroendocrine cancer, which is quite similar to a common lung cancer type but is not common with oral cancers. My supposition is the uncommon nature is why the pathology (after surgery) indicates it arises from an unknown primary. The pathology report indicated it's poorly differentiated with a brisk mitotic rate. Patience is not a good option here.
My background with this sort of cancer comes from my sister who had bladder cancer 3 years ago with the same pathological type, small cell neuroendocrine. Her case was the subject of a weekly doctors workshop where the surgery was performed, and they recommended a heavy cisplatin based chemo treatment. She was referred to the same chemo doctor that my friend is waiting to see at this point. I was able to get the referring doctors to agree to take her themselves, off-island, if this local chemo doctor couldn't get her started within a few weeks. He didn't and she went off-island for her chemo and it completely did the trick and she is cancer free at this time.
Back to my friend... He is not isolated, his wife and grown daughter are with him and he has lots of good social and family friends and support. They are not in a space where they are prone to evaluate treatment specifics themselves. Only the daughter is truly computer literate. They want to trust a professional, but they are also unhappy with the slow pace at which things are progressing. I'm also a friend of the wife's brother, and he is helpful to me regarding how much to push and when to leave things alone.
I think this should just about complete the picture. Thanks for your concern. My sister and I spent serious time on the bladder cancer support network that was very helpful to us at that time.
