I asked my husband's ENT at Hopkins what he would do if one of the PET/CT scans came back with a "suspicious" area -- that is, a hot spot in a later scan which had not been present in an earlier one. He said that first, he might do an MRI to get an idea of what was going on the soft tissue and also, biopsy the area if accessible (which BOT would be), before proceeding.

However the ENT also said that he was not a great fan of PET scans since, even with an acknowledged top expert at Hopkins reading them (who only reads H/N and brain PETs) there are enough false positives that our ENT doesn't get panicky if something like you describe shows up. He does check it out thoroughly of course. However he has done surgeries based on PETs which showed no cancer, and has become a skeptic.

Athough Hopkins had initially told us they would do PETs at 1 and 2-year points , they have changed their protocol on this. Barry is now 2 years out from dx. and sees one of his Drs. about every three months (in part this is because of the vaccine trial he's in) -- and has a physical exam only. He had a diagnosis like your husband's, had chemoradiation and tonsillectomy only. He was HPV+.

(Which brings up the point, since your husband has a tonsillar SCC, and the majority of these appear to be due to human papilloma virus in non-smokers, has he been tested for HPV? This is important, it affects prognosis (better) and recurrence rates (lower). In fact our RO told us two weeks ago that all centers should be testing for this, although it does not *at this time* affect initial treatment it may in the future. As it is, our ENT no longer does ND in HPV+ patients who have shown a complete clinical response to chemoradiation. It is medically useful, says our RO, for centers to know which patients fall into which category, it will provide useful information on efficacy of different treatment approaches for these biologically different cancers.)

Gail