I didn't read the article yet, Don. There is extracapsular extension and extracapsular spread, which difference I'm not fully sure about or just means the same. Maybe one is more wide spread than the other or one is more concerned with the nodes?

I have extracapsular spread, for lack of better words, which could be from the primary or nodes. I was told in laymen's term it's "Roaming" and "Free Form Cancer" basically cancer not lymph nodes or primary, and can go anywhere, and did. My lymph's from the Radical neck dissection levels II-V, had no nodal extension, negative margins, but cancer was found in my neck muscle from surgery...not a good sign, but it was taken out..a good thing. 5 months later I had another recurrence, the two suspected lymph nodes were in level III, V, but after removal were found not to be lymph nodes, most were removed anyway, but was "free form cancer" or "roaming cancer" or extracapsular spread for a better medical term I could find. The FNAB of the suspicion had confirmed it was metastic, but not that it wasn't a node. Positive margins, perineural and lymphovascular invasion was also found from the biopsy, meaning cancer was likely to spread along the nerve, blood, and lymph line, and did in less than a month to the edipermal layer of skin in level V, and had further surgery, radiation, and more chemoradiation. I have another suspicion on my last PET a few weeks ago in Level III, and have to get a FNAB with sonogram on Thursday, which again says a node? I had cancer in the same spot 3x, surgery 3x, radiation 3x and is close to the carotid artery, so wondering also.

Anyway, to answer your question they may be able to tell, not for certain, but by diagnostic scan due the lymph shape, size if its has signs of ECD or other. An MRI is good to see if there is nerve, vein involvement, but as usual, nothing is confirmed without a biopsy, I guess. A biopsy of the node or even primary may tell if it's out of the node or primary, or has other involvement.

Even with ECS or ECE, PNI, LVI, does not mean cancer will return or spread just that it may or will likely based on the percentages. Usually more surgery is done, if possible, more radiation, chemo to help prevent the spread. I think PNI has worse prognostic factor than LVI.

As I mentioned, most post treatments scans are clear, I believe in the hight 90% range. HPV HNC has a lower rate of recurrence, 15%, compared to non HPV, which is much higher.

The p before the TNM classification means pathological, A c means clinical, and a s means surgical classification.

Good luck with your PET. All I an say between now and then is go to the festival on Sept. 7th smile


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs