My mother had a surgical biopsy today on a possibly recurrence . We are concerned because from the beginning we had several opinions from different Oncologist . One of these doctors said from the beginning that my mother needed a surgical biopsy and that the first shot at surgery was the best shot of getting it all out. How ever the Oncologist we chose just did a biopsy right in his office. Now it seems like a recurrence is happening . It seems that all the cancer wasn't removed the first time . Could a difference in the biopsy have made a difference on getting all the cancer out of my mothers jaw. Excuse me if this is a silly question

Hopefully it's not cancerous based upon saying, "possibly a recurrence." A difference in biopsies can matter, sometimes, and maybe not, but is an important aspect for it being done correctly, and it's pathology also. The doctors know best, and usually want to remove minimum of tissue, but enough surrounding for clear margins, the entire lesion or part of for testing. In the office setting, it sounds like it could have been exisional, an incisional, punch biopsy or a FNAB, not being familiar with the particulars with the case. An incisional is preferred over an excisional, to remove a sample, rather than the whole tissue not knowing clear margins at the time, and then having to go back later if it wasn't all clear or recurred. Even if everything was done right, it could be synchronous, monochronous or a secondary cancer from the "field cancerization" and that's where sometimes radiation or Chemoradiation is used to get more of a larger area.

Here is an OCF link describing the different type of biopsies to help better understand than I can explain.

http://www.oralcancerfoundation.org/discovery-diagnosis/detailed-biopsy.php

Good luck with everything.

[quote]Could a difference in the biopsy have made a difference on getting all the cancer out of my mothers jaw. Excuse me if this is a silly question[/quote]Not silly at all. I hope there is no recurrence. Either way I really encourage you to not look back other than to tease some learning for a future lesson.

Coulda-woulda-shoulda is a very slippery slope and what was is what is now. It becomes an endless game of second guessing and only causes unneeded stress and anxiety.

A surgical biopsy is a standard of care technique to establish the presence of cancer. So be glad now an accurate status will be determined.

The other common method is called a FNA (Fine Needle Aspiration), basically stick a needle into the suspected area and test the extracted material. My understanding is this is more prone to not finding cancer cells.

Best hopes for a clean report.

Firstly a surgical biopsy is never intended to get it all out. It's basically intended to take a sample of tissue to determine malignancy. Sometimes if it's a very small growth or area they will try to cut it all out. But usually after that you will get results stating margins as well as type of growth (so did they get a full sample with clear margins (a normal set of cells surrounding the tumor) - and was it cancerous? That's what the biopsy is meant to answer. If it's small enough and clearly doesn't belong there it should be removed. Ideally - the first time out. Damage it by not getting it all and it tends to spread more quickly. The problem is in the early stages abnormal cells all look alike in the eyes of a surgeon so they usually have to take a sizeable chunk. The other thing is after this the persons lymphnodes need to be closely watched because even in its smallest size these tumors can seed to the nodes of the neck so at the first sign of swelling they have to be seen immediately.

Ultimately it's a 50/50 split.

Have a normal biopsy and get the results - then - if cancer is detected it should be followed up with surgery and a partial neck dissection.

This seems to be most effective,

Hugs

Cheryl Thanks for your response.
We received the biopsy results yesterday and it is positive for cancer. Surgery is scheduled for next Tuesday. We are very upset because all the cancer was not removed the first surgery. I remember the Oncologist telling us after the first surgery that he had taken as much as he could but he also mentioned that he froze one end. I don't think there were ever any clear margins. Cheryl with the biopsy that was just taken could the doctor see where the clear margins are for the upcoming surgery or does this take place while in surgery ?

Hi,
Even though the surgery may not have got all the cancer, the full set of radiation treatment would kill it. Since there was question about clear margins, the full radiation treatment was pretty much scheduled.

More than ever, gather good questions and take good notes as recurrence creates more complex treatment options. There are numerous survivors here who have had recurrence and treatments and an excellent source of first hand experience and ideas.

Wish you the best, Don

If your surgeon is good he should know what to cut. Usually they are aided by a ct scan - I would not want to be a dr relying on potential clear margins based off a previous surgery - it's best to know what to cut. Some CCCs have a newer technology where they can see the cancer in real time. (While they're cutting) my dr. Pioneered this technique. Some still do it the old fashioned way based off a scan - and then cutting a larger area than shown on the scan. This definitely has it's draw backs. Ask your surgeon what he bases his surgery location on.

Did your mom have a neck dissection with her previous cancer? If she didn't I home they've schedule her for one as well.

Hugs

Thanks Don and Cheryl for your advice.
After my moms surgery on March 25/2014 she had 35 RAD treatments. Taking the last two weeks twice a day. I doesn't seem like the radiation helped at all. Here we are 6 months later and a recurrence has happened. A new surgery is scheduled of next Tuesday 9/23/14. The Oncologist informed us If she doesn't have this surgery she only has 6 months to a year to live. Or with the surgery it is only a 15 to 30 percent chance that the cancer will not come back and then there will be nothing they can do. This is so heart breaking. I guess we have to hold on to any percent chance to keep my mom alive know matter how small. Hopefully after this surgery she would get a different treatment plan that can hopefully stop any further recurrence .

This is one of the reasons a CCC is soo important. I've mentioned it before and I know people say radiation is radiation, and admittedly there some cancers that are very resistant however I firmly believe the rads dr. Does matter. its all about skill - experience and mathematics. Knowing what to hit, where to paint - and predict potential spread. Hopefully you mom will beat the odds.... Hugs and blessings to you . I do know how you feel - I've been there and it's very hard.