Thanks for all of the input. I am guardedly optimistic, and the team at the CCC really seems to know their stuff.

The theory expressed to me for doing an aggressive bilateral neck dissection at the outset is that, assuming that most of the nodes are negative, and no huge surprises on PET (i.e. distant metastases) is that they can then target the radiation on the primary and immediately adjacent structures, reducing morbidity and side effects. They also do not "use up" the possibility for radiation tx of the neck down the line should something else pop up.

What I can't understand is why my ENT did not catch this sooner. After a CT scan showed a suspicious area in 2004, he did a PET, which was characterized as negative at the time. I have returned annually since then,having a flexible nasopharyngoscopy on each visit, with the most recent being last June. My cancer is well-differentiated, so how could it have gone from nothing to Stage IV in 9 months? Troubling . . .