I would like to discuss my fathers case and would appreciate your opinion on it.
My father was diagnosed with squamous cell carcinoma of the lower buccal mucosa of the left cheek last year in July and was operated for the same. The operation involved wide excision left cheek lesion+radical neck dissection+reconstruction of palatial flap. The lesion was excised with clear margins of 2 cm.The dissected tissue was sent for histopathology testing. Sections from the tumour showed features of well differentiated squamous cell carcinoma. All the resection margins were free from the tumour. 3 out of the 13 dissected lymph node showed tumour deposits (2 level 1b lymph nodes and 1 level 3 lymph node).
He subsequently received radio an chemotherapy six weeks after the operation for 6 weeks i.e 5 chemo cycles and 30 radio cycles.
The patient was normal after that but noticed a small growth in his front of his left ear (parotid region swelling) in december which gradually progressed to grow in size and became painful. Following this FNAC was performed which showed atypical pyknotic squamous cells suspicious of metastatic squamous cell carcinoma.
For confirmation PET-CT SCAN was performed which showed focal abnormal increased FDG uptake in the enlarged lymph node in the superficial lobe of left parotid.
Now the physician has suggested to do superficial parotidectomy.
But I would like to know
1. Is metastasis to parotid gland common in lower buccal carcinomas?
2.Before giving radiotherapy PET -planning was done
And it showed no areas of neoplastic lesion. So how did it reccur?
3. What should be done further to prevent such recurrences?