Hi I'm new to the board.

My Dad (who's 69) finished his 7 week treatment on June 2; 35 rads and 3 chemo's cisplatin; for base of tongue SCC and nodes. He did pretty well.

We got the results; the dr said tongue tumour is gone and nodes have shrunk 50% (based on MRI and CT scans done 2 months after treatment and a scope in dr's office).

I see on the CT scan (which was done one week after the MRI) that a few of the nodes shrunk a bit more. The largest node is 1.9 cm and the smalles 5mm. The rad dr said nodes could continue to shrink, but not sure.

The surgeon says he should have a neck dissection. Mod radical on one side and mod mod on the other side.

The surgeon explained that the large nodes could be negative or positive and has no way of knowing unless he does the surgery. On the other had I read so much about PETs and how they can determine whether the surgery is needed or not.

Canada doesn't recognize PET scans. My Dad had one prior to treatment; which along with the other scans, determined the primary.

My Dad is going for a PET scan at the private clinic again.

So confused. He's not sure what to do. Well I guess after he gets the PET he can think better.

Any information on the surgery would be greatly appreciated.

Thanks!

Hello and welcome Lisa.
Based on our experience, I think I would listen to the surgeon. My husband's primary as well as a cancerous lymph node were not picked up by the PET scan.

The neck dissection sounds alot worse than it is, for most people. My husband passed out in the surgeon's office when they first described the surgery to him. But, chances are, your dad will think the radiation and chemo were alot worse.

Perhaps a second opinion would help with the decision.

Best,
Anita

Hello Lisa,

Regarding the nodes, especially the 1.9 cm one, you may want to ask the doctor, if it could be biopsied through Fine Needle Aspiration (FNA).

The FNA is done by penetrating the node with the needle of a syringe and than extracting some of the node cells with the syringe. Usually 3 to 4 biopsy samples are taken. The cells can than be evaluate for cancer by the doctor.

FNAs however are not 100 percent accurate because the biopsy samples could be taken from a part of the node where there are no cancer cells.

There are benefits to the neck dissections:
1) The nodes are removed and with them any cancer cells that they may contain.

2) A pathologist will evaluate the nodes for the presence of cancer cells which will be used for staging the disease.

3) Survival rates improve when neck dissections are done and this is purely statistical.

Lisa, my husband had a radical neck dissection left side 9 days after he finished chemo/radiation treatments. I was very worried about him having it, especially so soon after treatment, but he came through it very well. He was talking right away, and up and out of bed the next day, and his surgery was 8 and a half hours.
My best wishes to your dad for a complete recovery.
Michele

Lisa, my husband had a radical neck dissection left side 9 days after he finished chemo/radiation treatments. I was very worried about him having it, especially so soon after treatment, but he came through it very well. He was talking right away, and up and out of bed the next day, and his surgery was 8 and a half hours.
My best wishes to your dad for a complete recovery.
Michele

Hi, Lisa B. Just wanted to add that of all the procedures John has endured, the neck dissection [twice] was the least troublesome. Some major swelling that dissipated fairly quickly [he looked worse than he felt], the scars are now pretty much invisible. As a caregiver,I would say, "better be safe than sorry" Amy

I wanted to echo what some others have said... the neck surgery compared to radiation was an easy thing, and I would opt for it to be sure. A PET scan this early after treatments is likely going to show hot spots as residual inflamation and healing is still taking place this soon after his other treatments, so it may not be of diagnostic value in determining if those nodes are cancer free or not.

Hi Lisa, although we didn't know it at the time the neck dissection was nowhere as bad as the chemo and radiation. Jack healed very well from that and it turned out to be a good idea in his case.

In the beginning it looks awful with the staple sutures, but they come out, incisions heal, and the neck tissue fills back in. You really have to be right on Jack's neck to see it now particularly when he wears shirts with collars. Most people don't get that close.

There's post operative pain that he used percocet for but nothing as bad as the peak of radiation. Good luck to you and your Dad.
Regards JoAnne

Thank you; everyone for the info and well wishes.

We were told by the surgeon that the FNA is not accurate enough; and I know when they first did a biopsy to find the cancer in the first place; the needle biopsy showed nothing so they did an open one (local freezing and cut it).

PETs: How long do you feel after treatment should one be done? We were told you can't do one until 2 months after treatment and it's been just a bit over that now. (June 2 finished)

My Dad developed another sore throat and horse voice a couple of weeks ago and that's been worrying him. The dr's just say it's from the rad. We figured it was from the air conditioning.

Well my Dad is recovering from the treatment and doing pretty good. Heck he's down 50bls (but had extra weight on him to begin with). He's still a bit tired; as I'm sure you all know oh too well.

It's upsetting because they didn't mention surgery to us and last week when we got the results that the tumour is gone and nodes shrunk; my Dad was very happy and we celebrated. Now they tell us about the surgery so we are just a bit upset and confused.

The dissection is both sides. You read so much and it scares you; but as I found when I did my research on the treatment, it's best to talk to people that have been thru it; rather then all Googling ha.....Some articles say do the wait and see approach. Some say remove them; some say get a PET; some say PETs are not that great.......oh it's so confusing at times. And then the dr's say do surgery but that they have no idea if it's necessary or not.

Thanks for listening!
I'll share this info with my folks.

Wondering what is everyones age who had it done?

Lisa
([email protected])

feel free to email me with any info that you think would be helpful; and I'll check back here for threads.

What a great site!

Lisa,

My modified neck dissection on the right was for levels 1,2 and 3. I was 45 when it was done and had no problems post op other than a weak shoulder from favoring that side. It would bother me enough every once in a while that I took pain meds and the day off from work, but come to think of it, that was when I moved my daughter off to college and while the ache was real in my shoulder, the one in my heart is probably what kept me home!

Sincerely,
Lisa