Glen is asking the question that NEEDS to be asked. I'm, as he says, a little fried also. I had micro mets to one node, top of the chain, but I had a full course of Radiation and it wasn't a decision to make...........my doctors gave no choice. Knowing what I know from this board, I wouldn't think of passing by radiation if I had nodal involvment.

Gino,
Keep in mind also that there is a time frame when radiation is most productive. You don't want to go to long with all this.

FWIW, and I know it's a totally different cancer and probably not all that comparable, My dad is a 22 year survivor of colon cancer, had microscopic mets to one node that showed up in a careful pathology report, was advised, similarly to Gino, that radiation was optional, opted not to have it, and seems to have come out OK so far!

He may have been just lucky, and this was 22 years ago so he might get different advice these days, and I know it's a different cancer.

But it's also really possible this is a gray area when the mets are really microscopic and in one node that has been removed. Right after I had my neck dissection but before the path report ahd come back, my ENT actually mentioned to me this possibility and that if they only found "a few cells" it "would be a difficult decision" that I'd have to make.

I didn't have to make the decision about radaition because of that, as it turned out, but it makes me beleive many people think this is a gray area.

Nelie

Hello everyone,

Thanks for all your suggestions/input. Frankly, I've been "fried" for quite a while. My doctor (the surgeon who operated on me) has changed his mind three times in the last month and a half. He went from telling me the pathology report is clean and that nothing else was needed, to telling me that there is micro cancer in one of my lymph nodes and hence I need radiation, to telling me that others have told him that radiation might be too much and that his recommendation might have been overly aggressive and unwarranted. As I also said in my previous post, even the radiology oncologists seemed rather unconvinced about radiation--it's ultimately a "judgement call."

In short, making a decision is taking long not because of some capricious tendency on my part, but because I've been given mixed messages.

With respect to Glenn's question, it is a good one. It's something I would like to know myself. How many people with micro cancerous cells in one node who avoided radiation have done well? As far as I know, the research varies. Some studies find that radiation is a good idea, other studies suggest that radiation is overkill and of no real benefit.

I can say I am a candidate for IMRT radiation, and, judging from the feedback, the effects might not be that dramatic.

I'm in the process of scheduling an appointment at Anderson for a second opinion. Please, if anyone has been treated there and cares to recommend a particular doctor, let me know.

Gino

If I had KNOWN malignant cells, even in a small amount, ANYWHERE after treatments, I would want them gone by whatever seemed the most effective mechanism. They are not going to go away by themselves, and they will reproduce apoptosis immune daughter cells until you have something of real consequence to deal with. At that point you have the devil to dance with.

My RO at MDACC was Kian Ang MD. The whole team there is great but this guy is the head of the radiation group. Dr. Kies is an oncologist that sees new referrals to the head and neck group and will likely be the person you talk to for a 2nd opinion. It really doesn't matter who you see, you will likely get a group opinion on on your situation.

Gino,

I'm fairly sure I know the answer to my question, no one has passed on radiation if there is cancer in their nodes. Some have passed on surgery, but not radiation. My point was that no one here should be telling you anything to dissuade you from seeking additional treatment, you need the second opinion ASAP. The target time for radiation is 6 weeks, 8 tops. I don't like to keep brining it up, but according to the staging protocol you appear to be higher than stage 1. I'm sure that the fact that it it a "micro met" may be a mitigating factor, but once it is in a node you are generally higher than stage 1.

Glenn

Hello again everyone,

the real issue here is that if do decide to go with radiation, there is a very high probability that we'd be "mopping where there is no dirt" (to use the words of the radiation oncologist I've been consulting). So, Brian, I really DON'T know if there are any malignant cells in me--no one does. If I did, getting the radiation and anything else I'd need would be a no brainer.

The prospect of going through a harsh, physically grueling treatment for no reason, especially when it can cause permanent damage, is just very difficult to accept.

I had a long talk with the head of radiation at the CCC where I'm being treated, and he repeated over and over again that he is not able to give me a solid recommendation of whether or not I should get radiation. In effect, he made it abundantly clear that any suggestion he (or anyone else) gives me would be purely speculative and not grounded on anything factual/objective/scientific. Ultimately, therefore, it is little more than a judgement call.

He also mentioned that while radiation is usually started 6 weeks after surgery, up to three months is acceptable.

I will decide after I see the people at Anderson. I just hope I'm able to see them soon.

Gino

You know, for a group that tries to avoid "absolutes," there is quite a bit of determinism in the latest replies. Glenn, unfortunately, no one can really be sure (or even "fairly sure") about what the correct answer to your question is. There is just no real basis on which to be "sure."

Brian, two top doctors at a CCC have told me that even if there ARE microscopic malignant cells, it is not clear whether or not the immune system can get rid of them. There is absolutely nothing "black and white" about this, which makes it particularly frustrating.

Gino

I would be the last one to suggest that ANYTHING about cancer or its treatment is black and white, and have frequently stated that there are no absolutes. I merely stated what

I did not mean to come across as hostile. Please know that I value and appreciate everyone's feedback.

I have called Anderson for a second opinion and given them all my information. I was told that they need all my medical records before they can even give me an actual appointment. I was also told that, for a second opinion, I should plan on staying in Houston for about 5 business days.
My medical records were sent to them on Friday, so I'm hoping this whole process will be quick, as I don't have much time.