This is probably a stupid question at this point it is too late anyway but it is on my mind. I have been reading so much about nodes being removed to be checked for cancer. When my husband was diagnosed they said he had a T4 base of tongue with no node involvement. I remember the ENT feeling his neck for nodes but how do they know that for sure without removing them and checking. If it was early they wouldn't feel anything. Why do they check some and not others. I remember the RO saying it was very rare for T4 not to have nodes involved. Can anyone answer this...

Kerry,
Someone will correct me if I am wrong but here goes. My head & neck surgeon told me that they can palpate or feel, an enlarged node that is 1 cm (about 1/2") or larger and it is characterized by an "almond" shape. It feels different than a knot in a muscle (which we have lots in our necks, especially if you use a computor a lot.

MRI's and CT's can typically detect a tumor only down to 2mm (I don't know what their accuracy is in relation to nodes). Sometimes there are particular nodes that they will remove and test and they are known as "sentinal" nodes.

If they suspect a node they can also perform a fine needle biopsy.

I was stage III/IV and had no node involvement. I too was surprised but grateful, that there was no involvement.

Was his tumor well differentiated? Focally invasive? These are possible explanations why they didn't remove the nodes.

During radiation treatment they will often irradiate the nodes as well for prophylactic reasons.

The definition that I have of a T4 is that it is over 4cm and has started to invade the deep muscle tissue and/or bone. So i just assume that means it is poorly differentiated. What does focally invasive mean?

Stephen did receive radiation(XRT) on both sides to treat the nodes but I've read that radiation is not as effective in the nodes. False info?

Thanks for responding Gary. I can always count on you...

Kerry

T4 is based on size, it may or not have spread -- if it started on the tonsil (common, esp. with HPV+ tumors) it might well spread to the base of tongue. It may be moderately, well or poorly differentiated, that is based on the cellular appearance in the pathology exam.

Well-differentiated means the cells are still close in appearance to the normal tissue type, with more-or-less normal nuclei and mitotic figures -- and poorly differentiated have a lot of abnormalities -- multiple nucleii, perhaps no nucleii, abnormal mitotic figures, etc. The "rule of thumb" is that these latter cancer cells are more able to invade other tissue types, while those which still well-differentiated have problems living outside their originating tissue. However, many HPV+ cancers (which usually present first in tonsil and/or base-of-tongue) are poorly differentiated and these actually seem to have a better prognosis, and respond better to treatment (per recent studies). My husband Barry's cancer was moderately-well differentiated, but strongly HPV+, so there is obviously variation.

If the radiation plan delivered the usual 66 cGy (or above) to the nodes then they should respond as well as anywhere else, per our ROs.

His MO and MO (and ENT) did not recommend additional surgery just to check the nodes -- it would have been done only iff his first PET/CT scan had revealed residual disease.

Gail

Kelly,
"Focally" is an adverb from the word focal and means, in terms of cancer, limited to a specific area.

"Invasive" a stage of cancer in which cells have spread to healthy tissue adjacent to the tumor.

Differentiate: In cancer, refers to how mature (developed) the cancer cells are in a tumor. Differentiated tumor cells resemble normal cells and tend to grow and spread at a slower rate than undifferentiated or poorly differentiated tumor cells, which lack the structure and function of normal cells and grow uncontrollably.

Staging:

Stage III: The tumor is larger than 4 centimeters (about 1.5 inches) in size and may involve a single lymph node on the same side of the neck.


Stage IV: The cancer has spread to tissues around the lip and oral cavity (the lymph nodes in the area may contain cancer); the cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that is larger than 6 centimeters (larger than 2 inches); or the cancer has spread to other parts of the body.

- Key word in staging definitions "may".

Here's a link to a dictionary of cancer terms:
http://www.cancer.gov/dictionary/

I sure hope you heard wrong because I had RT/ct only. Other advanced stage survivors here have had the same protocol and doing fine.

Gail
If you go on to American Cancer Society under oral cancers T4 is a tumor that has begun to invade adjacent structures and is not just based on size. If you have a T4 tumor it is Stage 4 with or without node involement. Stephen has base of tongue, not tonsil.

Actually, the same information and definition is on this websites homepage.