Hi Becky:

This is Kim borrowing Dave's screen name because mine is having computer cookie issues today. The reason you are picking up discrepancies in treatment plans for people with head and neck and especially oral cancer,is because the abyss is wide and provider preference as well as treatment protocals differ.Institutions that are research-based versus those that are surgical teaching facilities also muddy the waters.

Dave and I both are nurse practitioners and are familiar with the lingo and the hierarchy inherent to medical providers. We found it very overwhelming to navigate through options, weed out provider personalities (some good folks and some pompous asses looking to make Dave a new study number). You may have read some of Brian Hill's posts where he delineates the massive spectrum of options and opinions that exist mostly for the folks with Stage 3 cancers. There is also great debate about how you deal with nodes, does size matter, and does number matter.

In short, there are few absolutes in the treatment world.

I can give you a few helpful rules of the road though. In general, it is easier to operate on non-radiated tissue than radiated tissue(it loses it's pliability) which is why some people have the surgical procedure first. Some tumors aren't easily accessible at first surgically due to size and location and need to be shrunk by radiation first before surgery can be considered.
The overall health of the person prior to the diagnosis matter as well as other medical problems (like lung or heart trouble) that may make the person a poor surgical candidate.The immunosupression caused by radiation and massive weight loss can complicate surgical recovery as well.

You will also notice that there is much debate about the addition of chemotherapy to the mix. In most cases, if a non-surgical cure is sought, radiation and chemo are used together. In advanced cancers and/or those with multiple of bilateral node involvement, chemo may be offered as an adjunct to radiation.

The crucial point to make sure is that radiation is done to both sides of the neck down to the level of the clavicle in addition to targeting the location of the tumor.

The one thing that most practitioners don't recommend is a surgical only cure (no radiation to treat possible distant metastasis) unless the staging is VERY early which is pretty uncommon because there are few symptoms.

There is also hot debate about the efficacy of bone scans, abdominal scans, and PET scans which is a story for another day.

My best piece of advice is to have treatment at a credible facility that has a division devoted to head and neck cancer. Ask lots of questions at each juncture of the treatment process and get 2 or more opinions if needed from different providers. You will notice that most surgeons vote for cutting and radiation docs vote for radiation as you would expect. If needed, take films for another opinion to a different facility from the one in which you are being treated.

For the record, my fiance Dave had a 3-4cm tonsillar mass with one node positive. He was in excellent overall health and very fit. He was offered the option of a chemo and radiation course at Dana Farber here Boston or a neck dissection followed by a graft then radiation. We sought a few opinions who said chemo was not needed. We opted for the surgical route followed by radiation probably somewhat because as nurses we were more comfortable with the concept of removing the diseased tissue.I was also neurotic and made Dave have a chest CT and abdominal scan even though many providers told us it wasn't indicated with only one node positive. Well, if it's a question of me freaking out or being assertive-don't mess with me because I needed that peace of mind even more than Dave did.

Lots of folks on the forum have had success with the option of chemo and radiation and are doing very well without the downside of surgical scars.

My final thought is that the real key is getting complete state of the art treatment in a credible place with tight, vigilant, follow-up. And, as I am very fond of saying-Be the Driver of the Bus You Are On Because You Are the Most Interested in th Destination!

Best,

Kim