Ok, here's the deal (my best Ross Perot). PET/CT found small uptake spot on rt lung. Needle biopsy confirms malignant and of same type as original cancer of five years ago (SCC), but cannot confirm it as new primary (1A), or as a late-occuring metastatic growth from the original BOT tumor. Tumor has characteristics of both.

One very good oncologist wants me to repeat the Head and Neck chemo regime - assuming the worst (metastatic disease) and hitting it hard ASAP. Though his Tx plan would be to do it all in two, inpatient sessions, three weeks apart. Taxotere, Carboplatin and 5FU (?), and possibly Erbitux. Then, perhaps do a lobectomy to remove the tumor.

Another, very good oncologist, wants me to have the surgery now. Check the lymph nodes along the media stynum, if clear, go in and lobectomy the site. If nodes are bad, insert a port and send me home. Start essentially the same chemo, but scatter it out over 6 three week cycles as an outpatient. The pathology reports on the lymph and or tumor could/would modify the plan, and give us good data about whether or not Erbitux would work (the tissue can be tested for that expression).

The first plan doesn't make sense to me and seems fatalistic. The second plan makes sense and seems proportional and more flexible. Yes, I know I have to choose, and yes I know about more opinions (getting another on Wed), but what would YOU do???? Opinions large and small please. I value your input, and promise not to come back and haunt you if your idea doesn't work!! Ha. Tom J

Choice number two hands down. More invasive? Yes. But immediate resection of the primary (Get that cell generating puppy otta there) and important definitive information about local spread that is the most dangerous component, the mediastial nodes, is immediately at your disposal. You well know lymphatic involvement means a highway to other locations, and vital organs. The sooner you know that is a possibility, the sooner you can derail it, or prophylactially prevent it with chemo. In either case chemo cocktail remains the constant.

Variation three, there is no down side (if the nodes are involved) to doing that lobectomy anyway while he is there. Why put you back together and leave it behind as something else the chemo has to deal with and is still spinning off daughter cells?

Agreed - # 2 For all of the reasons Brian mentioned.

Kevin

I would certainly go with #2 in a heartbeat. Brian expressed it beautifully. Best of luck!

Remember what your teachers used to say. If you are unsure of an answer, go with your 1st choice. Since you feel that option #2 is best - go with it. Also consider the advice of friends who have been through this. Brian's reply is on the button. A 3rd opinion?? Why not check with a doctor who you consider a friend.

Best wishes, Malka

If it were me, I'd vote for Brian's #3. I'd want that puppy out of there. My husband had half a lung removed 40 years ago (not cancer) and has no had ill effects. The surgery and the recovery were awful, but I'm certain methods have improved since.

Take care,
Eileen

Yes, get the tumor out of there as soon as possible and find out what else is going on in there with the surgery THEN hit your system hard with the chemo. That would be my choice also.

And Tom, I am SO sorry you are being hit with this again. It sucks.

Nelie

Seems we're all in agreement - order a No. 2 with chemo on the side.

Donna

Thanks Gang! I concur. I'm going with the surgery first. Its scheduled for 7:30am Monday, the 24th. Heck of time to go into the hospital. If the lymph nodes are involved the procedure will stop. Taking the tumor does a fair amount of damage and prolongs my recovery time. If the thing has already spread, one tumor, more or less, will not be my only problem. Faster recovery from less surgery gets me into chemo sooner and maybe even back under the ray gun. I got another PET/CT today and the original site is still the only thing glowing - all good.

Have a wonderful Christmas. Travel safe, be happy and do good work. Be strong, Tom J

Tom,

Good luck on Monday my friend. My thoughts and prayers are with you all the time.

Jerry