Jon,
Did they give you a TNM staging and discuss their finding regarding advanced staging characteristic such as extra capsular spread(you might need a PET/CT for this), nerve or structural invasive considerations?

50/50 really isn't what you want to hear so you need to get ready for a fight and have a team and CCC that can take you all the way.

What is their proposed treatment plan, optional consideration and why.

Is the BOT tumor surgically resectionable and/or can they shrink it first with an induction chemo cocktail.

Is this Thailand Cancer Center affiliated with a major US or European CCC's?
Do they follow the multidisciplinary approach - tumor board, etc..?
Are they well regarded and do they have the up-to-date world class expertise and technology in Head & Neck cancer treatment?
Do they see and treat at least a couple hundred cases a year?
Can or should you return to the UK?

I would also suggest you have them test your slides for HPV, although I understand that NORMALLY HPV expresses obvious and large lymph nodes before the primary get big and invasive.

Jon,

I was given a 60% 5 year survival rate by the first cancer doc that saw me post Dx. He was an ENT that did the fine needle aspiration.

It may help to know if HPV is the culprit.

So the surgery is now out?

When are they going to start the chemo/rad?

What type of chemo...Cisplatin, Carboplatin?

What type of rad...IMRT?

Ask about a PEG tube.

Ask about a port.

Look for the vast majority of oral cancer patients the concurrent chemo rad treatment, while not a pleasant thing to go through, is none the less doable as you can tell by all of us still here posting. The most important thing is keeping up with the necessary daily calories and hydration and we definitely tell everyone to start eating everything in site now before the Tx starts. Also keeping a POSITIVE mental outlook can not be anything but helpful during the 7 weeks of Tx and the recovery. We will be here throughout and available 24/7 so don't ever hesitate to ask us anything.

David,
Can concurrent chemo/rad handle tumors in this size range?

I have no idea what, if any, size limits are placed on radiation and BOT primaries. If I were you I would get to Europe's equivalent of a CCC and get another eval and I would do it ASAP.

David,
I was to told about 2cm density can be effectively handled by radiation alone, but different cancers react differently and I don't know if this is correct for HNSCC.

I understand it has to do with the way the core of a solid tumor sustains a state of protective hypoxia which the treatment plan must be able to overcome.

I don't know the effective density that concurrent chemo/rad therapy would add, but I thought for large tumors they first use induction chemo to shrink the tumor and then they use chemo-rad and/or surgery.

I think with large solid tumors in structures like BOT they also have to consider the void that might be left after sterilization by RT.

Well at last I have had the meeting with my dream team, who hope to now cure me or at least give me a 70% chance of 5 years minimum, amazing if I have the money ............They say now the 50/50 chance is if I go back to the UK where I would have to stay from more than 6 months, before I can see a Doctor free, as I have been out of the Country more than 2 years, then I would only be put on a long waiting list, may be 18 months, so then I could be dead, in 18 months, with this fast growing cancer, do it now and a cure can be given, they say! or 70% as I said.

They intend to give me Pet CT.
By making a Simulation to the shape of my face
For the IMRT Tom, to do its work,then they will put all the information into a Computer, to size it all up and the computer then does the operation in theory, all most Space age, then it will line up all the points, for the Tomo Therapy, may be what you guys have had done.

The team says because it has not metastasized, they can hopefully help me, but if I leave it may be not.

This Bumrungrad Hospital is World Class, and has all the latest treatments. all the latest equipment paid for by Dubai Arabs and Mr Taxin the ex Prime Minister, I was told.

http://www.bumrungrad.com/overseas-medical-care/medical-services/overview.aspx

The only problem I have is my medical insurance is very small and I only have minimal money coming in from Teaching here, the doctor said he has other teachers having this treatment, and has done many over the years, it�s not easy, but you can work with it, as in Thailand no work no Job. no Money.

So with that worry and I have to have a week in hospital, so that should be ok. So the first problem is finding the 12000 dollars it might cost, as insurance will only pay less than 1/6 of that, and then make sure my school will let me have 7 weeks of afternoons off...

The doctor said also I have T2 ... N2 stage, whatever that means. And the MIR says its moderate cancer. But looking at others with T1 I'm wondering if im kidding my self or the hospital is

Any advise please! As you can imagine, I�m in a daze with all this information, the doctor was so impressed I knew all the questions to ask. Thanks so many guys.

My ONCOLOGIST was trained by Dr Clifford Chao in Huston Texas.
http://www.weillcornell.org/physician/kscchao/index.html

I am so happy to hear that you have met the "dream team" and that there are other teachers undergoing treatment at the same hospital. The idea of going back to the UK is not good at all. Stay in Thailand and get that treatment going as soon as possible.

Connie

Thank you walldoe

Chemo...of choice is .Cisplatin, they say Carboplatin has not good out come with this; they can use Evbitux but expensive and only less side effects, so not so good, at 3 times more expensive?

Yes unless I have to, I will not be going back to Uk unless I can get this treatment as an emergency. free.

Jon,
You can find a lot of answers by searching this OCF site. There is a 'search function' located at the bottom of the pages. If you search for say 'staging' it will take you to that topic.

If your doctors say that you will need to spend a week in the hospital then is it correct they plan to use surgery to first remove the BOT tumor (a glossectomy procedure) and probably a neck dissection to remove affect lymph nodes followed by chemo/rad using concurrent Cisplatin with TomoTherapy?

TomoTherapy is an excellent modern IGRT-IMRT system and assuming good treatment planning should deliver as good an outcome as technologically available.

Tomo does seem to be a bit easier to tolerate, but this varies significantly based on individual response and treatment planning. Concurrent Chemo can add more complications.

With all that said, Tomo or not, It is not likely that you will be able to work all the way through this (even a limited schedule).

I was fine the first month or so, but the last week of treatment and for two weeks after, working was out of the picture. I was sick the last few day of treatment then totally exhausted for about two weeks. And... I had it easy.

So, hope for the best, but plan for the norm and have some friends and/or family lined up to help you get through this.

Your staging T and N numbers are easy to understand. You can find most of the information you need right on the main body of the web site,

http://oralcancerfoundation.org/facts/stages_cancer.htm