Hello all,
Here is a question that may seem silly. However, I wonder about the answer and would like to pose the question. My SCC was discovered as a lump in the neck one month after removal of my tonsils. My close friend's SCC also manifested itself one month after major surgery to the face. Is it possible that trauma (surgery) to the head triggers some sort of response in the lymphatic system that causes the SCC to start growing? Has anyone else had this experience? I know that my cancer was caused by HPV and likely would have shown eventually, however, I can't help but wonder about the connectivity and reactivity of the lymphatic system, squamous cells, and HPV.

I am interested in this question both theoretically and practically. Prior to my diagnosis and treatment, my Periodontist wanted to do some oral surgery to treat gum recession. Has anyone had this type of surgery done after recovery from IMRT? Would it be silly to even think that I might have sufficiently recovered to consider moving forward with gum surgery? The last thing I would want to do would be to trigger some sort of interaction with HPV and the lymphatic system.

For all new members, this is just a hypothetical question. I just am asking the question.

Thanks again. I love this website.

Frank, I think that is a very good question and I sure will watch for the answers you receive. Good luck with your treatments and I'll send you a few of my angels to sit on your shoulders.

It's a reasonable question. I think if you consider the known pathways of metastasis of oral SSC, that some plausible answers might reveal themselves. This is the way it was explained to me, by a viral oncologist.

We know that SCC does not arise as a primary lesion in cervical lymph nodes, but it is the site of secondary lesions and disease. It is on a well established pathway originating from other lymph tissues in the oral environment, and the place most likely for regional metastasis to occur. The tonsils themselves are part of system of lymphatic type tissues that are charged with the removal of the debris of cellular battles, infections and the like, along with other oral structures like the lingual tonsils on the periphery of the left and right posterior tongue and even the lymph type tissue which covers the base of the tongue, and are all connected. The detritus they collect moves in one direction - oral to cervical to clavicular to thoracic.

We also now know that HPV is attracted and prospers in these same tissues. Oral HPV infections are, as in most HPV transfers, an issue of epithelial surface cells coming in contact with similar tissues or with free virus in other fluids, and not as in some other viral infections a result of a "infected" fluid transfer (blood, semen, saliva). Think of a virus floating in a medium or residing on the surface of a tissue, vs. a virus living within the cellular structure of a medium. Children in grade school easily transfer benign HPV's to other children,s hands just by touching each other, no fluid involved. Those HPV's manifest themselves as benign warts. So the primary cancer site is intra-oral, the secondary metastasis is further downstream in the cervical nodes. If left long enough, it will progress further down the pathway into your chest.

If this premise is true, it is most likely that SCC was in your tonsillar tissues prior to being further down the known path in the nodes. When your tonsils were removed the cancer cells already resided in your cervical nodes. That a surgery released it to move is perhaps not impossible, but less likely than the very common occurrence of a primary spinning off micro mets for protracted periods of time (many months), before those small few cell size mets grow and prosper enough to actually be seen by any scanning technology that we have or other discovery method. While the spin off of micro mets is an on going process, the actual formation of a regional, new cancer site takes a long time to occur. I urge you to read this page on the main OCF web site http://oralcancerfoundation.org/facts/metastasis.htm which I wrote several years ago, but still describes the process properly in detail. So I think that what we see as a normal spread pattern, with occult disease already in the cervical nodes at the time of your tonsil removal, was the most likely, because it happens with regularity in most patients with regional spread.

As to the perio surgery, I am assuming that the periodontist wishes to graft tissue to overcome cervical mucous membrane recession. Since all of us with some degree of xerostomia have this problem, and it leads to chronic cervical caries issues, (which leads to crowns being done again and again as more teeth succumb to the problem) I would be curious to see how this works. Now ten years out and chasing cervical caries no matter what I do to prevent them, I would certainly be interested in some kind of solution. The perio people that I have talked to that are familiar with radiation patients, are not hot to do the surgery. The first reason is there is a loss of micro vascularization in those tissues, and because of that, healing may be a problem. The second is that the acute dry mouth that I have would only eventually impact the tissue around the cervical line of my teeth in the same manner again. So a lot of work and $ spent, only to end up in the same place again. If you choose this route, I would appreciate you continuing to post on it so we may all learn from your experiences.

As to the surgery triggering something negative more than this, I would put that out of your mind. If that were true, the many people that have various small surgeries intra-orally would be having recurrences associated with them, and that is not clinically seen.

Frank,

The most common Dx of an oral HPV+ SCC patient is brought about by the discovery of nodal SCC before any other symptom presents itself. By the time I was Dx'ed with no clear visual primary Moffitt put me under to located my primary. I was told (and shown on the monitor while the scope was in my throat) that my surgeon thought it was either my BOT or Tonsils and I even went to sleep thinking I was going to have a tonsillectomy. Lucky for me I woke up to being told that the first spot he bio'ed was my BOT and it contained SCC (here's the main purpose of my comment in case you were wondering??) BUT it was so small that he thought that my immune system had almost cleared it BUT it the SCC had escaped earlier to lodge in a node or 2. Still have my tonsils BTW.

Thanks for the responses,
I made an error in my original post. My SCC was actually discovered as a lump in the neck one month after removal of my WISDOM TEETH. I too still have my tonsils because when I went in for a tonsillectomy they were able to remove my primary (8 mm only) with clear margins. Sorry for the error in my initial post, thinking one thing and typed another... Thanks for the feedback.