Hi Team
My father went Oral Carcinoma treatment in Pune India. I will brief you about the treatment.

Initially in APR 2012 ulcer and white patches were found on the left side of the tongue. So we went to general surgon and did operation. But he removed ulcer locally.

However later we went to IN JUN 2012 Cancer surgeon and he operated to remove lymph nodes. After this my father went IMRT and 2 doses of Chemotherapy. After this we did MRI SCAN which is as expected. And treatment is finished on OCT 2012. After this we were following up with doc on monthly basis.


But after 5 months of treatment now my father complaining about pain in same left side of the tongue. So Doc suggested to do MRI and PET scan. MRI and PET Scan report is showing small tumors in left side of the tongue and no traces in rest of the body.


Doc is suggesting to go chemotherapy doses and later he will decide whether to operate?


Kindly advise when this is 100% cure and my father will be out of treatment. I love mu father much and dont want lost him....

Hi Rahul,

I am no doctor and have not a long history here but my view is the first surgery did not get it all and the surgeon did not have clean margins to ensure he got it all. The rads should have killed what remained but it appears not and this is the place of the recurrence so this makes sense.

Chemo, from my understanding kills only small cell cancers. If the recurrence is large enough, what this size is I do not know, but at some size of mass, chemo does not kill the cancer, it may shrink it but not kill it. So only doing chemo now seems inadequate for the given state of the cancer. Waiting to do surgery seems like losing time rather than doing it now or going back and hitting it with rads.

But as you mention he already had IMRT, so there are limits to the amount of grays one can be given to the same place.

Good luck,
Don

Hi Don

Thanks for your reply. But can u suggest what could be the plan of treatment now to get cured 100%.

There is no guarantee of a cure - sadly. To me though it sounds like he needs more surgery. If you have cancer centers in India go to one. Someone there may be able to operate. It's hard operating on a radiated mouth as there are problems with healing but unless they are willing to do more radiation, to me it sounds like the best option for a cure sounds like surgery. Best of luck. Eshwar - one of the caregivers here may have more advice re drs and hospitals in India, but from what I know chemotherapy alone will not cure this cancer.

Hi Cheryl
Thanks for you reply. Actually the PET Scan report is showing cells only in left part of the tounge. There is no traces in other parts of the body. Doc here in Pune is suggesting to under go 2 Chemo doses then he will decide whether it is operable or not.

However I am going to TATA Memorial Hospital Mumbai tomorrow for Doctors consultation on this. Then we will decide how to proceed on this. Let us hope there should be some way to cure this.


Kindly help suggest me high level plan of action now.

Welcome to OCF! This site is made up of patients and caregivers who help to provide medical advice and support. Unfortunately we do not have medical training so can not develop treatment plans. While we strive to always give correct medical info, it is always advised to seek out the best doctors you can.

I have sent you messages, please click on the flashing envelope next to the "My Stuff" tab. This will help you learn how to navigate the forum.

I have also sent this over to a member from India who is very good with advice. They should contact you shortly.

Best wishes!

Rahul,

Typically if you can see cancer on the PET with SUV higher than low values (don't ask what is low, still trying to find this magic threshold) , then my understanding is that chemo will not CURE (i.e. kill completely) those cancers. Make sure to ask more about the PET and ask about the SUV value and if they feel that chemo will KILL it or just manage it (i.e. reduce its size or keep from growing).

If he says it will not KILL it then you are not on a curative path. If they say it will kill it then, just out of personal curiosity, quote that portion of the report that describes the parts that "lighted up" on the PET. Include measurement and SUV.

good luck,
don

Hi Rahul, I hate to say this but the first surgery by a general surgeon complicated the case! Ideally, partial glossectomy + selective neck dissection followed by concurrent Chemo-Radiotherapy for 4 weeks should have been a planned course of treatment.

As you have mentioned, visit Tata Memorial immediately. Your father certainly needs second opinion. Cancer is such a disease that nobody can guarantee you 100% cure. Doctors (in India) would not share too much of details so you would need to interrogate them and understand what is the course of treatment and the effectiveness.

If chemotherapy remains the immediate option, kindly discuss the possibility of induction chemotherapy (Docetaxel + Cisplatin + 5FU), which probably will give him better chance. There is a possibility that this is what oncologist in Pune would have planned.

You have not mentioned the size of tumor, so there is a possibility that if the tumor is large, the doctor is looking at shrinking it with chemo so that they can save more tongue and get sufficient margins as well though healing would be an issue.

Radiation may not be an option as your father would have already received 60 Gy during the initial treatment.

Not to scare you but it is going to be tough road ahead. May god be with you and your father. I have shared my number on PM, feel free to call should you need any guidance.

All I can say is. " never say never or give up". Some of us have many surgeries , scans and scopes but the more they do they worse you feel. Good luck to your dad and you. Has the Dr biopsied it?

Hi All

Thanks for replies. I have visited TATA MEMORIAL HOSPITAL. They looked in to files reports etc from beginning. Based on latest MRI and PET Scan reports, they told to have Biopsy before further treatement can start. It's high possibility they will start Chemeo based(palleative or curative) on Biopsy reports. Also they are going to do Biopsy under minor OT under oncosurgon observation. Radio and Surgery options are not applicable now.

Also I would like to update that I am from Engineering backround and dont know much of the medical terminologies in detail. However my younger bother is Intern Medical doc here(just completed MBBS) here in Pune. I will ask him to more specific details from reports in this forum.


Thanks
Rahul.