So sorry to read about your recurrance. In answer to your question about how you will know if the cancer is gone without surgery, I think the answer is that you will never "know." But I've read enough on this board to believe that even with surgery you never really "know" either. From what I've read, it seems that each case is different. There are so many variables in the mix. My advice is to find a doctor that you believe is knowledgable and one that you can trust to look at your case and your particular set of circumstances. Make sure the doctor knows what is important to you. For example, living to see another month or year is of utmost importance to some. For others, it's quality of our time on earth that matters. Some will avoid death at any cost; others believe there are things worse than death. If there are several options for treatment, ask him what he would do if he were in your place. Ask him to explain his answers fully.