Brian: Thanks for your reply. We do go to the Memorial Sloan Kettering cancer for our treatment. That's where my mother has been treated for all these years and had all her surgeries. It looks like (based on what doctor is telling us), that if there's no lymph node involvement and did not spread beyond the mouth, surgery and radiation or the combination of both are our only options for treatment - I asked him again and he confirmed. He sent us to the radiation oncology specialist at the center for her feedback and opinion. When she heard that my mother had 3 surgeries before (that was before the 4th), she was convinced that my mother needs to do a radiation of the area of her last surgery, whereas our main doctor (oral cancer surgeon/oncologist) felt that because you can do it only once and it's not clear where the radiation should be done, she should not do it - difference of opinion.

The 4th time it recurred in different area of the mouth where there was no indication at all that it can recur or appear (few inches from the place of initial surgeries). So, if we went ahead with the radiation as the radiation oncologist suggested, it would be done in a place where the cancer did not recur and we would lose radiation as a last resort for treatment.

We just visited out doctor again at SKC. He agreed with that assessment. He is saying that it's very difficult to pinpoint where my mother would need a radiation since you cannot radiate the whole mouth. He recommends a surgery again, and see how it goes and what the pathalogy report says before recommending radiation.

My mother's concern is that she already feels a lot of pain (both physical and emotional). The thought of another surgery in her mouth brings her to tears. And the idea that she will have additional burning pain in her mouth due to radiation, plus burn spots on her face, don't look like a good prospect. Even now when people are noticing some changes in her appearance, she feels really bad and depressed.

But most importantly, we are not sure what we should do after the surgery. The doctor is saying that maybe we should consider radiation because cancer recurred so many times, but he is not certain about this. He is saying: it's great that we always catch it at the superficial level, but it's unusual that it recurs time and again. His words were: "you can only do radiation once, and what if she gets something on her tongue or another side of the mouth in few years?" He is saying, let's make that decision after the surgery. It's a pickle...