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rsce313
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by rsce313
rsce313
Hi All, just joined the forum. My husband had a partial glossectomy on April 13th with multiple problems - two episodes of significant post-surgery bleeding and brain swelling. Tumor was T2N0M0, moderately differentiated, tumor depth of 8 mm. He has now recovered and eating well. Since surgery we've received three different medical opinions as to follow-up treatment and don't know what do to. 1) Elective lymph node dissection of Levels I to III on side of neck where tumor existed, biopsy the nodes for microscopic cancer, followed by radiation to tongue; radiation to neck would be considered if any cancer found in the nodes 2) do nothing further, take a wait and see approach 3) no lymph node dissection but radiate the tongue and both sides of the neck.

The tumor surgeon went after close margins - only 2 mm, but margins were clean, no neural invasion. However, 3rd opinion doctor said she should have went after 5 mm margins. Does anyone have advice? We have an appointment with his internist in two weeks to discuss the three opinions. He is 56 with significant heart problems - two years ago had aortic valve replaced, single coronary bypass, an ablation and correction of an aortic root aneurysm. He also has COPD. I think two of the doctors are concerned about complications from the dissection given he had problems with the glossectomy.

I've read everything I can on here about diagnosis and treatment. Just at a loss at this point.

Thanks.
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by Brian Hill
Brian Hill
These are difficult choices given his medical history. Exacerbating underlying health issues by doing something that may not be necessary you certainly do not wish to do. And there is no absolute guideline here. He has tests/scans that show this had not yet spread to the cervical nodes of the neck. But we do know that before visible in a scan, micro Mets to that area are possible. So an absolute idea and plan isn’t possible. In most people the recommendation of a modified neck dissection that went after the nodes just in case would be common. But putting him through another general anesthesia to do this even just for the nodes and no muscle or other soft tissue removal, will certainly be a stressor. Perhaps you could see if they would be willing to do a more minor surgery to just remove the sentinel nodes for examination. If there is spread to the neck, no matter how small, it will end up there first. If it’s present, you can choose to move forward with an additional surgery, or radiation. That’s a short and smaller idea that would give you reasonable information before going all in.

I am not a fan of radiation for and area without conclusive malignancy, especially the neck unless it was part of the original tongue treatment plan. There are structures there like the carotid arteries that in his situation you would think they would not wish to damage. Because Proton beam radiation has gotten less expensive and covered by more insurance, when it comes to the tongue if they decide to more forward there with radiation, you might consider pushing for that. There is less collateral damage, and it can be highly targeted. The overall gy’s of radiation would probably be lower, an added benefit down the road when you consider radiations life long impact and propensity to cause its own significant problems years down the road.

Since we cannot know the specific certainties, I would just like to say we have had people, especially with collateral issues, decide to watch and wait. A large number never have more issues, some have recurrence in the same area, again treated with surgery only. Because of heightened following, new issues are caught early, before they get out of hand. This will require not just visual monitoring, but routine scans for a while. The risk here is that right now, micro spread, isn’t detectable in scans. There could be cells outside if the current surgery in close proximity, that have become dysplastic. Not malignant not normal. But in an area where cancer has already occurred, certainly leaning towards continuing their journey to the dark side. There are some ideas the surgeons will not be excited by, but are worth mentioning.

The first is looking at that area with a tissue auto fluorescence light. It is an FDA approved light for examining surgical margins, and doing oral cancer screening. It does not find cancer, but it does reveal abnormal cells that no longer have functioning florophors, indicating the cell is damaged in some way. It is not specific, so it doesn’t reveal how. But you will know they are not normal. A decision to surgically remove those areas would be minimally invasive.

This is all a tough decision. It’s important to be your own advocates here. The RO will certainly vote for radiation. The surgeon will lean to doing the neck dissection. We tend to trust them to know what’s best. In this case your opinion as to how much he is willing to deal with, his health, age, should all get equal weight. We wish you the best, and hope that you will post back your decisions and progress
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