Part of the problem, I think, has to do with the evolution of the term "CCC" as used on these boards.

When I first joined seven years ago, new members were encouraged to seek at least a second opinion, if not treatment, at a comprehensive cancer center (CCC), meaning an institution where each case would be considered by a dedicated team of multidisciplinary specialists working together to determine recommendations for treatment -- a "comprehensive" approach, as it were, rather than the patient having to find an ENT surgeon, an MO and an RO (along with ancillary personnel if needed) on his or her own and hope that (a) they knew something about head and neck cancer and (b) they would talk with one another. (Mamacita, from the way you describe it, I'll bet that your 500-bed "non-CCC" teaching hospital actually is a comprehensive cancer center, using this definition.)

Over the years, the emphasis here has switched to getting to an "NCI-designated CCC" -- which is a very specific term that has nothing to do with patient care or a team approach to treatment and everything to do with an institution's research interests. Granted, NCI designation can open the door for patients to a wider variety of clinical trials and make more research funding available. And in general, academic institutions, like the NCI-designated centers, attract top-notch clinicians.

But in NCI-speak, designation as a "comprehensive cancer center" means that the facility has made it through a rigorous years-long process that examines the quality and scope of its research in three specific areas (an NCI-designated "cancer center" focuses its research in one or two of those areas). Remember, too, that institutions choose to apply for NCI designation; some places may think it involves too much time, bother and expense and don't even start the process. For example, my first comment on this topic, back in 2007, was on a thread wondering why Stanford wasn't on the NCI list (though it is now). Friends of a good friend of mine traveled from the Middle East to be seen by the HNC team at Beth Israel in New York City, which is highly regarded for HNC and isn't an NCI-designated facility.

It's certainly easy (I'm not blameless here) to simply post the link to the NCI-designated CCCs/CCs and say "You should go here," since the odds are overwhelming that any facility on the list -- with the obvious exception of those that do research only and don't treat patients -- will approach each case in a "comprehensive" (as explained in the second paragraph) manner and that its head/neck cancer department will see far more cases than the average community hospital. Perhaps what we should be doing is encouraging new patients or members of their families to use that list (or the list of facilities that comprise the National Comprehensive Cancer Network, which actually does relate to patient care and devises the annually updated state-of-the-art treatment protocols) as a starting point for their research, and not necessarily as a final destination, and to make sure that wherever they are treated, their case will be considered by a team of specialists with experience in HNC.