My 76 year old dad, in late/end stage COPD, lung cancer survivor since 1994, had oral cancer surgery on 8/12/04. He had problems coming off, ended up in a specialty hospital and has been doing well being weaned off the venitlator. In fact he's been off since last Sunday, though he has not been able to build up much time with the talking valve let alone having the traech capped off.

First bad news was yesterday. Finally got the path report. The surgeon (head of the department at Loyola University Medical Center in Maywood, IL), thought they had gotten the entire tumor and Dad wouldn't need any further treatment. Wrong. According to the path lab report, the tumor"of posterior oral cavity was infiltrating moderately differentiated squamous cell carcinoma measuring 2.6 cm in maximum dimension; surgical cut margins, negative for carcinoma. It also indicated that the margin base of tongue, posterior shows focal high grade dysplasia (cancer in situ), and last, but certainly not least, that 2 of the 32 lymph nodes that were removed "contain metastatic carcinoma with estranodal extension- salivary gland tissue with no specific pathologic changes.

Well, since I live in south Georgia, I faxed/e-mailed a letter to the surgeon asking 1)if I was correct in assuming that that meant he HAD gotten the entire tumor; 2) whether there was any way of determining whether and how long it would be before the carcinoma in situ became invasive, and 3) if I was correct in assuming that the lymph node involvement with the extranodal extension was the biggest problem, and the reason they were suggesting radiation, and then went on to ask questions about how much time radiation/cancer may buy and at what cost to his quality of life.

I haven't heard from the pulmonologist yet, but the pulmonologist told my mother those were all good questions that needed to be answered, but that the surgeon needed to answer them for the most part, but that the one thing HE could tell us was that NO, they did NOT get all of the original tumor - He also told mom, dad, and my brother that my dad has pneumonia in one lung, and that the reason they are planning on sending him home in two weeks is that they feel he will be well enough to not be medically in need of their services anymore, but too weak to go for radiation, but that medicare and his insurance won't pay for rehab hospital if he's going to have radiation therapy (not to mention that if he's having radiation therapy he probably won't have the strength to do rehab. He can barely do rehab now as it is... he managed to keep the talking valve on for an hour and a half one day, then an hour the next - now he's down to 10-15 minutes before the monitors start blaring because his 02 saturation has gone done so much ...

Not really sure that I have a question - just needed to "talk" to someone who would understand what is going on. I tend to be a pessamist/drama queen so I am anticipating that this is a precursor of what is yet to come and that while radiation may be his only hope of knocking out the disease ... for a while ... that it will take what little quality of life he has or may het build up to away, and I don't feel like he'd be able to recoup to even get back to this point again ... Sigh. Not anything I can do; not my decision, even. Just rambling and venting ... thanks for providing a forum in which I can do that ...