Thank you for your response, gmcraft. He received two courses, one for 46 grays from 5/31/17 - 6/26/17 and second one for 66 grays from 8/1/17 - 8/21/17. They just started him on radiation as the main treatment as surgery was not even considered. I think it was mainly because they don't have skilled surgeons that know how to do oral surgeries or they thought surgery would be too aggressive. They could however refer him to other medical centers with skilled surgeons, but it wasn't done. And I told him to go get a second opinion, but he unfortunately didn't.

I did speak to my brother and he wants treatments and wants to get better. The thought of removing the whole tongue does scare him and it is not something he wants to do. But given only the surgery gives us a chance, however small (surgeon said less than 20%), at the cure, I don't know if we really have many other options. I believe it is a comprehensive cancer center, ranked about 40th in the country. The head and neck surgeon did discuss it with medical oncologist, but didn't really present any treatment options saying that surgeon is leaning away from the surgery due to risks and the oncologist doesn't think there are any other good treatment options given his advanced stage. I don't know what other specialists he needs to see. And yes, agreed, Keytruda is more palliative, which is what the oncologist said, she doesn't think it would be very helpful in his case. We also talked about clinical trials, and she said she doesn't think he would qualify because of his liver problems. I'm assuming we could still try to apply but that will take time and at the end he might not even qualify and his cancer keeps growing and spreading. Maybe you are right and we should try to get a second and even third opinion. I'm thinking to try another large center in Los Angeles who ranks much higher that one in San Diego. If they tell us the same thing, that surgery is not recommended, maybe we just accept it then and try Keytruda as palliative measure. Or if we're lucky, maybe they will do the surgery. It's just hard to hear that there are no treatment options for someone as young as he is. His heart is strong, he does have liver problems which creates risks for the surgery, but no other health problems. I guess the surgeons don't want to deal with someone who may die at the operating table even if it can offer the chance at cure. I also understand the surgery is risky but so is doing nothing. Ultimately it will be my brother's decision if he wants to go through the surgery if we are lucky enough to find a surgeon who will agree to do it. I'm in no way going to force him to do something he doesn't want. I just want him to have a chance to live and find a doctor who can give him that chance.

Thank you.