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ChrisCQ Offline OP
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Just got the Dana Farber Pathology Review comments of my biopsy.

A few more tidbits of information:

SUPERFICIALLY INVASIVE SQUAMOUS CELL CARCINOMA, WELL DIFFERENTIATED
keratinizing type (0.1 cm in greatest dimension).
No lymphovascular invasion.
No perineural invasion.
Margins appear negative for carcinoma and high-grade dysplasia.
Tumor is <1 mm from nearest peripheral edge.

-----------------------------------------------------------------------------------------------------
My attempt at digesting the above:

Superificial; Good
Invasive: Bad (but good that it is just superficially invasive...)
No Lymph Invasion: Good
No Around the Nerve Invasion: Good
Margins apparently clear: Good
Tumor less than 1 mm from peripheral edge: Bad

I guess the kertinizing OSCC is a good subgroup (except for a tendency to escape undetected even low grade on occasion?) in general.

Would be kind of nice to tell the first doctor he cured my cancer with a tiny biopsy slice...but the whole "field cancerization" thing and the adjacent suspicious textured and firm areas has me doubting that outcome.

I could stand to lose about 60 pounds, just not all 60 pounds in my tongue.

Scratchy throat still off and on...hoping just the dry winter air. Tonsil crypts appear kind of white mucousy looking; but might just be a virus or something, that or reacting to me now on red alert for any lymph nodes and rubbing my neck up and down a couple times a day. SMH.

So yeah I think this is a very minimal procedure planned, only thing that may complicate it if is if he finds things he doesn't like on the scope and starts taking stuff out.

I wonder about pre-approval, as far as I am concerned I'd like him to take as much as any thing he wants to nice and early, even if that does mean I wake up and then find out they took more, and I am now in a hospital for days/weeks.

Get it done while I am out; I mean you can kind of mentally prepare for the stuff you describe NELS, I mean to at least be aware that it'll be a rough go.

Not even January 20th yet. February 20th seems like it is YEARS away.

So yeah I don't thing the Mrs. would buy into the "but I gotta bulk up now honey!" before surgery...unless something complicating happens before the planned date.

I guess because it is caught so early no diagnostic imaging or blood labs is being done yet, or perhaps now the the pathology review is completed they may have some ordered? To be determined.

Maybe on the phone appointment 2 weeks before the scheduled date they'll tell me I need to go in for some blood work/imaging or whatever, or maybe only after the next bit of tongue surgically removed gets its final pathology report.


11/07/2019 Moderate Epithelial Dysplasia of right lateral tongue
1/01/2024 Focal microinvasive squamous cell carcinoma right lateral tongue
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Good stuff, thanks for sharing. Overall, it sounds like you are on this early with a good team.

The waiting really sucks. I recall when I got my surgery date and it was a week earlier than we originally planned. Soon as I hung up the phone, I ran around the living room screaming "April first, lets's gooooooo! Cut this f@##in crap out of me! Let's goooooooo!" while I pounded my fist on my chest. My wife was staring at me from the couch wondering what the heck? This lasted a good 30-45 seconds before I could calm myself down and clarify everything for her. I tear up now just typing this and remembering how good it felt to have a date and plan.

Hang in there Chris. You got this!

Nels


OC thriver, Tongue Stage IV, diag 3/12/20, surg 4/1/20, RT compltd 7/8/20
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ChrisCQ Offline OP
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No further cancer found; just more pre-cancer

PATHOLOGIC DIAGNOSIS: A. RIGHT PARTIAL GLOSSECTOMY. LONG STITCH-ANTERIOR, SHORT STITCHSUPERIOR:

CLINICAL DATA: History: Tongue dysplasia.

Squamous mucosa with MILD-TO-MODERATE DYSPLASIA.

Margins are negative for high-grade dysplasia and carcinoma.

GROSS DESCRIPTION: Part A is received fresh, labeled with the patient's name, medical record number, "Right partial glossectomy. Long stitch-anterior, short stitch-superior" and consists of an oriented mucosal excision (1.7 (anterior to posterior) x 1.5 (superior to inferior) x 0.7 cm (superficial to deep)), received with a long stitch designating anterior and a short stitch designating superior, per the surgeon. The mucosal surface is purple-tan and smooth, with an ill-defined white, superficial, pale area (1.1 x 0.6 cm). No definitive lesion is grossly identified. The pale area is located within 0.1 cm to the anterior margin, 0.3 cm to the superior margin, 0.5 cm to the posterior margin, 0.1 cm to the inferior margin, and 0.5 cm to the deep margin.

The remaining cut surfaces are tan-purple and dense. The specimen is inked as follows: Superior-red, anterior-blue, inferior-green, posterior-orange, deep-black. Gross photographs are taken. The specimen is serially sectioned from anterior to posterior and is submitted entirely and sequentially per the diagram. A1: Anterior margin, perpendicular, 3 fragments. A2-A3: Central sections with pale area, multiple fragments. A4-A5: Posterior margin, perpendicular, multiple fragments each.


—————————
So that is good news.

A little confused for clinical history why they coded it as “Tongue Dysplasia” vs. the Oral Squamous Cell Carcinoma from the immediately preceding biopsy and that pathology labs own verification of diagnosis of the slides.

The Surgeon on my initial consult, even before the pathology review was ordered by him, had said responding to my asking, that an over-diagnosis (calling severe dysplasia cancer or something to that effect) was highly unlikely. Then the Dana Farber associated pathology at Brigham and Womens reviewed the slides and concured it was oral squamous cell carcinoma; superficially invasive.

So I gather this larger chunk they removed around the tiny cancerous bump (about like a large pimple) from the last biopsy was just pre-cancerous.

The biopsy only had 1mm margins, so they wanted to remove more from around where the cancer was found and to ensure there were no other cancerous areas.

I gather Dysplasia means potentially precancerous in this context; the cells have intracellular changes heading towards cancer and the architecture of how the cells are laying on top of each other is also disordered and heading towards cancer.

My previous lesion jumped from moderate dysplasia to cancer; skipping the severe and in situ and going straight to a microinvasive cancer. So while good news, and glad to be rid of that dysplasia I realize this will need to be closely followed.

I see the surgeon Wednesday 2/28/2024.

I am guessing this likely means no further treatment necessary for now but will know more Wednesday.

This is the part that makes me nervous; not giving it any missed opportunities if any of the cancer cells did move over the 7 months the cancerous lesion was undetected between when it first became sore around May 2023 and when the biopsy was taken Dec 14 2023.

Surgeon didn’t biopsy anything else, retromolar trigone had some patchy leukoplakia “more consistent with Wickham striae”.

My throat has been scratchy and dry basically since the tiny biopsy 12/14/2023 up until this 2/20/2024 surgery.

Some minor neck, ear, and collarbone fleeting burning/crampy pain that goes in fits and spurts. Armpits have some palpable lymph nodes maybe almond sized. No nodes identified in neck of jaw region. Near the corner of my right jaw, along the thicker neck muscle some soreness but cant feel any lymp nodes.

In a weird way I was hoping they would find just a tad more superficial cancer or something that would warrant PET/CT imaging to rule out any covert neoplasm elsewhere.

I just dont like the idea of cancer having been hanging out on my highly vascular and vesseled tongue for 7 months.

I am glad to be spared any more disabling treatments but at same time am disappointed in myself for not squeking louder last May and getting it biopsied ASAP, despite reading as much on here as I had about early intervention being so crucial.

I was also having night sweats in January pretty bad for a couple weeks.

Off the pain meds now, what 6 days after. Actually stopped the pX meds Saturday and nothing at all starting yesterday, besides popcicles and iced smoothies.

About an inch and half of mattress stitches. Mild discomfort eating and of course soft foods and no spices.

So I’d feel better if they kept looking; but not sure how medically justified PET/CT would be.

Also not sure why some armpit lymphnodes are nearly almond sized.

I’ll be disussing all that with the Dana Farber ENT Surgeon Wednesday.

So I am thankful and guardedly optimistic while not wanting to be lulled into a false sense of everything can be ignored now.

Thanks for any two cents any of you all might have.

Thankful for the greatly skilled medical professionals and the great care I have access to.


11/07/2019 Moderate Epithelial Dysplasia of right lateral tongue
1/01/2024 Focal microinvasive squamous cell carcinoma right lateral tongue
Joined: Aug 2020
Posts: 143
Likes: 34
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Chris,

Thanks for keeping us updated. Overall, good news here. The swollen nodes in your armpits are of concern and you are right to get that checked out. I learned the typical path for oral cancer is mouth to nodes in your neck to lungs. But, hey, this is cancer.

Keep pushing for answers!

Best regards,
Nels


OC thriver, Tongue Stage IV, diag 3/12/20, surg 4/1/20, RT compltd 7/8/20
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