Hello all,

My brother recently had a tongue lesion excised. The pathology report initially said "microinvasive" squamous cell carcinoma, with negative margins. When pressed what "microinvasive" meant, I was told 2mm of invasion. P16 testing was negative. Stage pT1NXMX.

A post-operative CT scan showed 2 "mildly enlarged" lymph nodes, which the surgeon felt were likely reactive.

Since the excision (4 months), my brother has been healing well, with no new sensitive areas.

The surgeon believes that the 2 nodes on CT are reactive. She feels that a PET-CT will likely result in an ambiguous answer (eg, reactive but cannot rule out metastasis), and thus force her to do a neck dissection, which she feels is not indicated.

I am driving myself and my brother crazy, trying to figure out what to do about those two nodes.

Does anyone have any personal experience, knowledge, or advice that can help me make this decision? What is the morbidity after a selective neck dissection (levels 1-4)?

Thank you
Tom

Better same safe than sorry. What was the differentiation of the tissue removed? If it was poor to moderately differentiated I would push for the dissection. Is he being seen at a cancer hospital? Take care

Why can't they do a FNA and see what that reveals? A simple needle stick and draw and a path report may solve this question.

I definitely agree - better safe than sorry. The only thing that gives me pause are the lingering effects from a selected neck dissection. I want to be aggressive, but not unreasonably so.

Has anyone had levels I-IV taken out? What are the issues after the healing is over?

As for the needle biopsy - I read that the FNA only samples 1mm of tissue, whereas the lymph node itself 10x bigger than that. Perhaps taking it out completely would be better.

I had all zones. I lost almost all mobility immediately after surgery, but with physio, got it all back. Started playing baseball the following spring. I still have some strength to get back, but that's coming with weight training.

Yup! Ditto what she said... Hey Tina how was the scan?

Bah, still waiting on the results. Hopefully today or Monday.

FNAB are very accurate, just as good as a direct biopsy, and had had 7 or 8 myself, which were all on target. There are a number of types of neck dissections, and seven levels, I-VII, to the cervical neck, and depends on the location, type of cancer, which levels, and structures, are removed. Oral, tongue cancer usually involves level I first, oropharynx level II, so these are usually removed in the dissection up to IV or V, but there can be skip metastases or co-involvement with other levels. Every surgery has risks, and mine were positive so far, but all it takes is once to change all that, and our ENT's probably make it seem, sound easy, but it is a complicated surgery with all the vital structures affecting all aspects of life. I had three neck dissections, two were radical, all on the left side of the neck, going for my fourth.

Good luck.

Paul is very fortunate to have gotten such good results with the fine needle biopsy. Ive seen many mixed review of this procedure. I seem to remember some members did not get conclusive results and still had to have a regular biopsy.

Best wishes!

I had a FNAB and a core biopsy (core first). Both confirmed cancer in the node. The core biposy is taken im a similar manner to a FNAB but takes a larger piece of tissue to biopsy. Maybe push for a core biopsy. I would absolutely get a biopsy before a neck dissection.