There is no question that for the doctor performing the surgery, that pre-radiation surgery is easier to accomplish. Radiation alters your tissues, and the term they use most frequently is that it makes them "gummy" to cut through. This is particularly problematic when suspect tissues, which have to be removed, are wrapped around vital structures like the main arteries of your neck. The only reason to wait therefore would be in the hopes that the radiation did everything necessary, and PERHAPS surgery would not be needed at all. My issue with this, is that completely dead, cancer free tissues (nodes which were malignant before radiation), show up just as well as those that have cancer in them when viewed by CT or MRI, and no one without cutting them out, knows for sure if they still contain malignant cells or not. I didn't want to have surgery at all, and when I was offered this I jumped for the option, but I didn't know then what I know now about diagnostic techniques. A fine needle biopsy isn't much help since that little 20-gauge needle could hit a still malignant area or it could miss it altogether. As a side note, every node that was taken out of my neck after radiation was dead as a doornail for malignant cells, and I could have not had the dissection. But there was no conclusive way to know that. Neither the doctors nor I wanted to gamble on something still being active no matter how small the chance.

I should now add this disclaimer to my post. Each surgeon has his own comfort level with what he is willing to do, some I know NEVER cut irradiated tissues, others do it as a matter of course. We all put our trust in these guys to give us the best opinions and choices they can. Some are comfortable with the fact that if a node got nuked into the Stone Age, and a fine needle puncture afterwards didn't show any cells that were malignant that is good enough. They surely make this decision based on tons of experiences that they have had which had positive results for their patients. Others, like mine view this differently. Is there a "right" protocol? Of course not. Doctors are as different in their experiences, opinions, and skills as we are as individual patients.

Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.