Karyn, I am a stage II who ended up choosing to have rad and chemo after surgery. I think the advisability of doing surery first, and the sense that there is some choice involved in what you do about rad, is a bit different for Stage IIs than for people in the more advanced stages (as in Gail's case) because it is possible that in some cases, based on the pathology report from the surgery, radiation isn't warranted. And surgery alone is less likely to cause permanent problems because the tumor is smaller.
One thing to be aware of, and I'm not saying this to scare you but just so you know, there's about a 30% chance that even though you seem to be stage II now based on CT scans and whatever else they've done, they will actually find some cancer cells in your lymph nodes when they do the neck dissection. Of course if they do, that wpould indicate you should have radiation. If they don't, it's a sign you might not need it.
However, even if you have clean nodes (I did) there are other aspects of the pathology report that some doctors feel indicate radiation and chemo. These aspects are things a lot more reliable than your age in indicating a more aggressive form of cancer. One is how well differntiated the cancer cells are (with poorly differentiated indicating more risk), one is the thickness of the tumor (and I don't know how thick is an indication of more risk--just that my tumor was on the edge of being too thick for comfort), one is whether there is perineural ivolvement or whether the tumor is growing around a blood or lymph vessel.
I had enough of these risk factors that when I went for a second opinion at Dana Farber in Boston (the number 4 CCC in the country), I was told in strong terms that I needed to treat the cancer aggressively and have radiation as well as chemo (it is now standard in Europe for people with high risk stage II to have rad and chemo, based on some good solid research, though it is not standard here yet).
Before that second opinion, though, I also got an opinion from the rad oncology team at Roswell Park (also a top CCC though not as high in the rankings as Dana Farber) and they were close to evenly divided about whether or not I should have rad. So if you are getting mixed opinions--which isn't uncommon for Stage IIs, I would definitely try to get a second opinion and try to get it from the best experts you can find.
From the reading I've done, there's not good evidence that young people with oral cancer necessarilly have more aggressive cancers. However, I do think there's a good argument to be made for treating the cancer aggressively, if there's doubt, when you are young and healthy simply because you want to live a loing life and you are strong enough to recover from aggressive treatment.
Make no mistake--the treatment is rough, I'm 2 and 1/2 months past and I'm still feeling pretty bad--but I'm young enough (46) I want to live many years and this was my best bet.
People will be ehre to support you whatever decision you make. My personal bias is that you should choose an aggressive treatment that gives you the best chances of never having to deal with this disease again.
Nelie
