Dear All,

My father's is 66years and has been a long time user of tobacco(Smoking and then Chewing). He had a small lesion on right Buccal Mucosa about 4-6 weeks back, measuring 0.8cm by 0.75cm.

We got a CT Scan and CBP done yesterday. While the CBP was all normal, initial CT Scan impression was "Ploynoidal lesion on Buccal Mucosa with no signs of cervical lymphadenopathy". However, our doctor recommended an immediate biopsy of the lesion and we got that done today.

Based on doctor's visual impression during biopsy, he is about 99% sure that this is cancerous. He has completely removed the lesion as a part of biopsy. However, he has asked us to be prepared for a major surgery, involving complete removal of right jaw portion and a reconstructive/plastic surgery procedure there after, followed by radiation therapy.

I love my father and wish to hear from others who have fought cancer on the following:

i) The staging for now seems T1M0N0, but, will this be clearly determined after the biopsy?
ii) I have read in the forum that radiation is done only once to neck and head region. Please provide your views on whether we should opt for it at this stage.
iii) How soon does cancer progress? How much time do we have for deciding upon the right course of action?
iv) How can we determine if other surrounding areas of buccal mucosa or other regions in the oral cavity have cancerous cells?
v) Have anyone in the forum tried alternate medicine and if yes, is it a risk worth taking?

Appreciate your help and guidance. Look forward to your responses.

Regards
Vithal

Welcome Vithal, and I'm sorry for your fathers diagnosis, and will try to answer your questions as best I can.

i This is the clinical staging T1N0M0, and can be restaged after surgery

II In certain cases, radiation can be given more than once, and is being done more often. I had it 4 times, and going for my 5th soon. Many factors are involved, including the doctors experience, and something you don't plan on doing or want. Your first shot is usually your best shot

iii SCC, non HPV, is usually aggressive, but I'm not familiar with this type cancer,loynoidal lesion, and may also depend on the grade of thr tumor...poorly differentiated being more aggressive, tumor location, size. The doctor will guide you as far as time to decide.

IV they can do a PET/CT scan to see if the is any further involvement, local and distant metastases, in addition too, a triple scope or pandendoscopy of the upper aero digestive tract with biopsies.

V No! I personally wouldn't risk it, but eating a healthy diet, with adequate nutrition, hydration, protein, and fruits and vegetables, can't hurt you. Most CCC have a nutritionist you will see to help.

Are you at a CCC, plan on getting a 2nd opinion? I hope this helps, and good luck.

Hi and welcome and sorry you have to be here.

i) yes... after the biopsy they can tell you the size of the tumor and margins - they can also tell you the aggressiveness. He will also need another CT/PET/MRI... to determine spread (metastasis). They should check lymphnodes, and a chest CT as this is one of the popular places for this cancer to move to. Chances are he's clear but better safe than sorry. Also microscopic cancer doesn't show up on a scan, so hopefully the dr. will be removing lymphnodes too.

2)No... I would go with the surgeons decision. What he is suggesting sounds quite involved I know, however, he likely suspects bone involvement - in the jaw. It is best to do this surgery before radiation and chemo as it is a hard surgery after. Plus chances are this is NON HPV related cancer and that being the case generally the first line of defense is surgery. And you can have radiation more than once. Several people here have had it more than three times. It depends on the amount he gets, and where to, and if he gets a recurrence where it comes back.

3)This cancer can move crazy fast (a good indicator of how fast will be his pathology - you want to know the differentiation - Poorly differentiated means it's aggressive. Get a second opinion, if you need to but make sure it is done quickly. Also try to be treated at a CCC if you can. This is the BEST place to be treated as it offers comprehensive team driven care, and they generally have clinical trials and a whole crapload of newer technology to support the cancer patient.

4)You can't - that is what the pathology is for. They can tell you the margins... clear generally indicates there is no more cancer in the area... however a person's buccal mucosa comprised of all the same cells. So that doesn't mean there couldn't be a patch somewhere else (eyes will help with this... Keeping an eye out for unhealing sores and white patches elsewhere. This is why they generally take out a larger area and radiation cleans up anything stray along with chemo.

5)No alternate medicine is NOT a risk worth taking. It generally doesn't work. I am a strong supporter of diet and healthy habits playing a serious role in healing and fighting cancer. However this should be a supportive measure. NOT a considered a cure. In other words I do believe a rich alkaline diet, with high non meat protein and nutrients will help fight cancer - but cancer is cancer - it should always be combined with proper medical treatment for the best possible outcome. There will always be someone's brother's cousin who was cured eating whatever. We are highly complex biological entities a number of things could happen to "cure a person" and sometimes basic misdiagnosis could come into play.

Hopefully this helped somewhat. The surgery sounds really invasive but a few people here have been through it and are doing really well. He will need care and support but he will get through it... MOSTLY HE NEEDS TO GIVE UP THE TOBACCO.

hugs and best of luck.

Thank you for the quick response.

The lesion was well differentiated in appearance (not sure if it is clinically well differentiated). We are not yet at a CCC, but are considering taking a second opinion once the biopsy results come in on this saturday.

My initial suspicion was Leukoplakia and was in bliss of ignorance and hope that it is not malignant. However, today was hugely disappointing.

Difficult to imagine the pain henceforth.

Thank you for the support Cheryl. I am hoping beyond hope that the biopsy report on Saturday throws some positive surprise. I will update the forum and seek views on next course of action.

Well differentiated is a good. Start. That doesn't mean it won't move quickly. Time is always of the essence. Hugs and good luck!