Pete,
I have always wondered, if the cancer doesn't collect in the lymph nodes, where else does it go?

I imagine it goes to OTHER lymph nodes -- They don't try to take them all out, just the ones likely to be compromised by the cancer site(s) -- All I know is basically what I'm told or read through OCF.

Of course, Dr Haakenslash and his team of Cutthroats may have been biased because he apparently needed the former node sites to tie in the blood vessels for my free flap <grinz>.

Most cancers will go to (or metastasize to) the lymph nodes that drain the site where the original cancer is located first. The cancers can also go through the blood stream to farther locations in the body, but will usually show up in the lymph nodes first. Which is why the lymph nodes are looked at first, if they are negative then there is very little chance the cancer spread anywhere else. That's why I'm not comforatable with doing nothing if there's the slightest sign of it already in the lymph nodes.
I'm being seen at Aurora St. Lukes Medical Center in Milwaukee, WI. But we've been in contact with a few medical professionals across the country. In case you didn't look at my profile, I am an OBGYN dr and my husband is in general Internal Medicine, so we have some resources to tap, and I have trouble not answering medical type questions, although this is certainly not my specialy. And this is such an uncommon cancer that we had not really encountered it before. Although I did have one patient with it who was having trouble getting her doctors to pay attention to her. Now I kind of understand why, and am glad I encouraged her to keep asking and seeing different drs until she felt comfortable with the answers she was getting. I'll keep you all posted with my progress as things play out over the next few weeks. I think I need to heal from my surgery before anything else too invasive should be done, also my oldest daughter is getting married on Jan 17, 2009, so want to put off anything that will interfere with her day. Thanks for all the support.
Lucinda

The first and most obvious answer to this is relatively simple. What is the purpose of the lymph system and the nodes that it contains?

Humans have approximately 500-600 lymph nodes distributed throughout the body, with clusters found in the underarms, groin, neck, chest, and abdomen. They act as filters or traps for foreign particles and contain white blood cells. Thus they are important component in the proper functioning of the overall immune system, and themselves part of that system.

When a lymphocyte recognizes an antigen which has responded to an immune system threat, B cells become activated and migrate to germinal centers. When antibody-producing plasma cells are formed, they migrate to the medullary cords. Stimulation of the lymphocytes by antigens can accelerate the migration process to about 10 times normal, and in that migration to the collection points of the nodes, result in characteristic swelling of the lymph nodes.

They are in the simples terms, part of a group of mechanisms that draw pathologies, and the detritus of our immune system battles, out of our bodies. Most do not realize this, but this entire lymphatic system is constantly filtering and removing the negative from us. Even the tonsils, now so often a place of primary/original location for SCC of the posterior mouth, are themselves part of this lymph system (this includes lingual tonsils and tonsilar tissue on the base of the tongue). It is logical for the detritus of the battle between our immune systems and pathogens which it protects us from, even common bacterial infections etc., to drain into the lymph system for further neutralization and removal from our bodies, enlarging the nodes in the process. The cervical nodes of the neck are the closest location for oral cancer to metastasize to because it is their job to be collecting this cast off material in the first place, as the immune system response in our mouths produces by-products that need to be eliminated.

In another post, some asked what might a primarily malignancy do besides this, and the answers are primarily two. One is that it might stay localized and invade more deeply into the nearby anatomical structures, into muscle or osseous tissues. Though in the long run detritus from this process will likely still end up in the cervical nodes and in extreme cases drain from the body through open fistulas. If the primary disease is near major circulatory system components, it may become removed from the loco-regional area via the blood, transported to other vital organs, which is of course how oral cancer kills us, usually not in our mouths. Primary means of metastasis of the disease from our oral environment is either the lymphatic system or the circulatory system which are of course each connected to the rest of our bodies. Single or multiple major vital organ malignant involvement is end stage oral cancer development.

All this of course an over simplification of what is a very sophisticated system, and entire books are written on how all this operates.

I think I need to go to med school if I am going to continue to post here. LOL

Just kidding but I do find all the knowlegable posts very enlightening but it doesn't help me with the tax laws one bit.

David,

The only help for the tax laws is another Boston tea party.
Isn't today about being thankful that we live in the land of the free and the brave? We have to be brave because nothing is free.
We had a CPA who intended to write a book about the IRS. he only got as far as the title: "My Hand in Your Pocket."

Lucinda,
I hope that you get anwers soon. The explanation from your doctor seems strange. Why ignore something because if the particular test had not been done it wouldn't have shown up?

Well I can't figure out how to do my own taxes, even with Turbo tax asking me the questions, nor with all the new air pollution equipment attached to my car engine figure out how to tune it up - (something I always did myself as a younger guy). I guess we live in a very specialized world. But never consider smarts in one area to equate to intelligence in generalg.... when you consider all the people and professionals that participate in general private aviation, doctors still have the highest rates of aircraft accidents when flying their own planes. Pilot error is still the largest category of accident cause, not mechanical failure.

I lived in Germany for six years and when I came back to the states I was telling everyone what a GREAT tax system we had, inexpensive and simple!

The German taxes are so complicated that either your employer or the German version of a CPA does them -- No one that I ever met did their own, not even the owner of a tax franchise doing US taxes for gummint people. The highest tax bracket in the system was 65%!! Almost double our current high! In addition, Germans paid a national sales tax of 15%!!

A German local postage stamp cost MORE than a US overseas stamp.

BTW, did you know Canadians have to pay tax when they buy postage stamps?

Talked to my dr today during the stitch removal and got a better explanation. Since the cells were well-encapsulated, there are no good studies showing that rad tx improves survival. However he did encourage me to get more opinions as he said the rad oncologist he talked to was admittedly very conservative. So he is going to talk to a different one at the same hospital and I am probably going to see at least one, and maybe 2 from Milwaukee and Madison. He was very open to getting more opinions, as any dr should be. He also agreed with me that the rad tx would not hurt my chances of survival, just no proof that it would help, so as long as I am willing to put up with the side effects, it was my choice.