Mark, staging is not exact especially because we don't know yet how many nodes are involved. It seems that staging is somewhat of an art best left to the professionals. As far as treatment options go, stage three and four are fairly much going to be handled the same way. Radiation and chemo and then surgery, radiation and chemo alone, or surgery then radiation and chemo. The surgery first option probably results in more permanent side effects especially when the tongue is involved. Very good results are being reported with radiation combined with Erbitux, and this is pretty new stuff. Others have had very good results with radiation combined with other chemo agents that augment the effects of radiation alone. If he is seen by a ENT surgeon first chances are good he will hear "surgery first" That is why he needs to be sure that he is seen by people that are aware of the current trends and are very experienced with this kind of cancer. For now focus your energy on getting him to the level of expertise that will work best for him.

Another thing you could consider doing for him is in regard to finances and services for him. The treatment he will be receiving will result serious fatigue and probable lost time at work. He likely will qualify for SSDI, Gary here posted a link to the section in the SSDI rules for this specific cancer. Many people didn't qualify the first time they tried but armed with the correct information he should get 18 weeks minimum. Be sure his medical coverage is up-to-date and provisions are made to pay the premiums for the forseable future. Many loose their job over this and then are faced with paying COBRA rates for insurance. The complete treatment can run $100K to $200K (perhaps more) so loosing insurance is a bad deal. If necessary, start conversations with his creditors about extending time. If he has family of his own, preparing them emotionally and mentally for the upcoming battle would probably be of benefit. If you do what you can to lighten any load so that he can focus all his energy on beating this cancer he certainly would be better off.

Take care

Mark, 21 Year survivor, SCC right tonsil, 3 nodes positive, one with extra-capsular spread. I never asked what stage (would have scared me anyway) Right side tonsillectomy, radical neck dissection right side, maximum radiation to both sides, no chemo, no PEG, age 40 when diagnosed.