The thyroid test in a simple blood test. Make certain they run a full thyroid panel including the TSH level. They should have done this before you started radiation so you know what your base TSH is. If they didn't, get the test now so you have a base for it because at this point it sounds like your thyroid is working fine.

If it does go south in the future, it is treated with a small pill taken once a day. It can take a bit of jungling to get the correct dosage which is why it is important to know what your TSH was before treatment. No surgery is required.

Take care,
Eileen

What Eileen is true except for Stubborn Ass Italian Eagle fans. Those are just taken out back, given a used Atlanta Vick shirt and released but into the woods !!

On a more sane note...without or even with a TSH baseline it's hard to Dx a thyroid problem on blood work alone unless symptoms are present so just be on the lookout for the symptoms of Hypothyroidism like feeling tired, feeling cold when you shouldn't, just to mention the 2 that stood out for me.

David,
My TSH was at 32 and I had absolutely NO sypmtoms. When it got to around 15 on the meds, my only symptom was eating evrything in site. Took more than 3 months to get it back to my normal.

Since it is a routine test and requires no extra blood, if you are asymptomatic, I would have it checked at least once a year when you have other blood work done.

Take care,
Eileen

Hello all,

I'm 55 years old with T1/N3/M0 (Stage 4) SCC of the Left Tonsil (HPV-16 positive). Originally detected 3/20/09 with a 6 cm mass of enlarged lymph nodes. Treated with 9 weeks of induction chemo (TPF) followed by 7 weeks of chemoradiation (using IMRT) which concluded 8/26/09. Now we're considering neck dissection.

I want to note that there are several types of neck dissection. The "gold standard" is a radical neck dissection (RND) which removes the sternocleidomastoid (SCM) muscle, the internal jugular vein (IJV), and the spinal accessory nerve (SAN) along with the lymph nodes. Then there are various forms of modified radical neck dissection (MRND) which remove fewer structures - although they all remove at least a few lymph nodes. <http://en.wikipedia.org/wiki/Neck_dissection>

I recently had a CT scan showing a 2 cm mass still remains. I'm told this mass will contain live cancer cells in about 25% of cases like mine. We're soon going to do a PET/CT and, if this comes back negative, we'll probably NOT do a neck dissection. Its not clear what we'll do if it comes back positive but I think its likely we'll defer the decision and do another PET/CT in late December. Here are some articles I found on this topic:

http://www.ncbi.nlm.nih.gov/pubmed/19358193

http://www.oncolink.org/conferences/article.cfm?c=3&s=47&ss=267&id=1686
http://www.oncolink.org/conferences/article.cfm?c=3&s=47&ss=264&id=1672

http://www.ncbi.nlm.nih.gov/pubmed/17921898?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed

I hope to avoid this surgery altogether. If surgery seems advisable, I hope to preserve the SAN, IJV, and SCM muscle. In my view, these structures are unlikely to harbor live cancer cells and only need to be taken if there is a strong likelihood that the immediately adjacent tissues harbor live cancer cells. Preserving these structures should help reduce long-term side-effects that reduce quality of life. Its my understanding that most modern neck dissections at least try to preserve the SAN.

I hope the above information is helpful to some of you.

Rob

Rob, you are wise to do your homework. You will be better prepared to make a decision after you get the results of the PET/CT. 1. I, myself, so far have been very, very fortunate. I did have a modified ND, and I was very thankful for it! It gave me a great sense of confidence that the cancer had been removed by my original surgery and hadn't spread, and that, then, most of the metastatic pathway had been removed. 2. All cases are different. 3. With all of the treatment and diagnostic testing you have had, and with your living in Boston, you obviously are surrounded by knowledgeable professionals. LISTEN TO THEM. 4......and I am betting that you hear this more than once: Don't play much of a waiting game with SCC. If it were MY neck, I would run, not walk, to the operating room. But that's just me. Listen to your doctors, and while the final decision is yours to make, remember that you are not as prepared to make it as they are. XOXO

Rob,
A PET/CT too soon will more likely show false positives.
It has just been a couple months and that is quite soon.

Yes be careful on a false positive read but with your facts it will be hard to dismiss it as well. Tough decision.

6 cm was huge. Didn't you notice that before?

First of all, never use Wikipedia as a source of information on stuff like this. Unless you are a physician, and can separate the wheat from the chaff yourself, rely upon your team. There is a fine line between being well informed (good) and substituting your judgment, based upon internet information(bad).

If you are treating at a CCC, adopting current practices, they will undoubtedly do an ND that preserves the maximum amount of functional tissue possible. Oftentimes, however, they do not know that until they get in there and see what is happening. Generally, the SCM, SAN and IJV are preserved unless they are structurally involved with tumor cells, or active disease is in close proximity and there is evidence of extracapsular spread.

In my case, I had a bilateral ND, due to the fact that my BOT tumor touched the midline. They removed nodes and connective tissue from Levels I through V, and both submandibular salivary glands, but kept the SCM, IJV and SAN intact.

Truly, the ND was the easiest part of treatment. Anytime they go into Level V, there is likely to be damage to the SAN and related nerves, which can cause shoulder/neck muscle issues, which I have, but is very manageable.

It seems that attitude toward ND is dependent upon whether you adopt the "go for broke" approach, throwing everything you can at the disease, or the "incremental" approach, doing the least invasive treatment providing the opportunity for cure.

That's a very personal decision, but one that needs to be made with the full informed opinions of your CCC treatment team. As others have said, I would not rely solely on a PET at this point, due to the high false positives, but your team will likely tell you that themselves.

Good luck.

I'm being treated at MGH. I think I have a very experienced and expert medical team. While I'm not a medical professional, I am a PhD scientist with a background rooted in applied mathematics (which I use daily for a broad variety of government-sponsored engineering research projects)... so I think I am better than most patients when it comes to understanding the medical literature and separating "wheat from chaff" while reading various sources of information on the Internet.

My original (6 cm) nodal mass came up very quickly in March. The source (left tonsil) was identified in early April as the result of biopsies taken during a pan-endoscopy (which included a bilateral tonsillectomy). A subsequent full-body PET/CT, done prior to induction chemo (IC), showed no activity anywhere except the lymph node mass... not even in the remainder of my left tonsil. I responded very well to IC, which shrank this 6 cm mass substantially... but it was starting to grow back in the few weeks hiatus before I began chemoradiation (CRT). The recent CT observes a "matted nodal mass at left level II deep to the SCM muscle which appears slightly less prominent in size than before measuring 2 cm x 1.6 cm x 3.9 cm" and "at left level IIA, posterior to the submandibular gland, an enhancing lymph node smaller than before, measuring 9 mm x 7 mm today while previously measuring 12 mm x 10 mm." [The comparison is to a CT done in late June, at the conclusion of IC but before starting CRT.]

My next PET/CT is scheduled for 11/02/09... and I understand this is quite soon following CRT (so that false positives are likely). I'm really hoping to see negative results in the region of that "matted nodal mass" as this would tend to indicate its just a bunch of necrotic tissue. But, if the PET/CT comes back positive for this mass, I might ask my doctors about doing a FNA (or a small surgical biopsy) to try and sort out whether or not its a false positive.

Rob
just make sure they keep a close eye on this node,they have a nasty nasty habit of causing more problems than the origonal primary.I personally find it quite surprising that they didn't do a neck dissection N3 is quite a large secondary,and quite a few people here have been bitten on the bum by nodes like this.

have you had an MRI scan? You wouldn't have the same problem with false positives.

good luck in whatever decision they advise next.

love Liz