just curious what this means in my case ...

i am a five-year SCC survivor (of the tongue/neck), formerly known here as AzTarHeel (couldn't find my password so I re-registered this week) ... went two rounds with the disease in 2003 and 2004 - surgery, radiation, chemo, the works (the elephant gun, as my doctor at the time said) ... Since my last treatment in September 2004, I've gotten the all clear time and again. PETs are clean. Liver function tests are clean. Chest X-Rays are clean. Manual exams reveal nothing.

So, I go back to the ENT this week and he's ready to "graduate" me to the land of the officially cured. But there was a place of "granulated tissue" in the corner of my mouth that I asked him to check out, where my back tooth on my left side meets my gums. That tooth has given me problems for awhile now and the dentist has wrestled with putting fillings there a few times. It's probably due to come out.

So, just to be safe, my ENT takes a biopsy of that tissue area. It comes back "atypical." Not cancerous. But not clean enough that pathology folks can completely rule cancer out. Just curious if this is an ominous sign or if its just my doctor being overly protective considering my history (which I have no problem with)... Wondering if anyone has had anything similiar. Thanks for listening!

I lived on these boards for about nine months in 2003 and 2004 (I was AzTarHeel then, but I couldn't find my old password and so I re-registered). I remember finding a lot of peace, hope, encouragement and love here - much more than I ever deserved...

Eric

Eric

First remember that a finding of atypical cells is NOT cancer. Cells become damaged for many reasons, and the progression of that damage from normal to malignant is a cascade of cellular events, each one making the cell more "atypical" for the type it is (as in a squamous cell). So a woman who gets an abnormal PAP smear, (a brush collection of surface squamous cells) has cells in it that are somewhere on a line from normal to malignant, or you could say from totally normal to the height of abnormal. The midway point between the two is dysplasia.

There are lots of degrees of the stages between the beginning the middle and the end transformation. Some of the early atypical characteristics NEVER move to dysplastic cells, and even when they do, only 25% of all dysplastic cells untreated ever continue on the path to malignancy. (This is the difference between high grade and low grade dysplasia.)

Now the important part. A biopsy that is not full of malignant, fully transformed cells, is a picture of cells variously atypical, at THAT MOMENT IN TIME, somewhere on the line between normal and malignant. A woman goes back to the GYN after an atypical PAP smear in about 3-6 months to do it again. The important questions are; has it resolved on its own? (very common), has the progression continued but still not become high grade dysplasia? or is it now a dangerous high grade dysplasia which needs to be removed before it can progress to full malignancy? Even at the malignancy point, something found extremely early, (a carcinoma in situ) can often be completely removed without leaving malignant cells behind because it is so small and early.

This is the beauty of early detection. There are multiple points on a path, that you can discover (the time in the sequence of transformation, or earliest staging of full blown disease, is the most important part of the whole process, and has the greatest impact on long-term end results) and multiple decision making points in whether to watch it or remove it can be made, or perhaps even see your own body's immune mechanisms make it disappear over several months of monitoring. The trick is regular intervals of monitoring/biopsy and comparison to previous biopsies to see a trend, and then act accordingly.

It is never one day I'm a healthy normal cell, and the next day I am a malignant gone to the dark side cell.

Thanks Brian, glad this site is still going strong ... You are well-appreciated...

Eric

Hi AZ,

Welcome back and hopefully this is turns out to be nothing. You should be able to send an email to the oralcancerfoundation to get your old password back.

Take care,
Eileen

As I've read and re-read your response, Brian, I have one over-arching question: how much does dental care/hygiene play a role in oral cancer "coming back"? I mean, if I've got a bad tooth and things are out of sorts in that back area of my mouth as they have been, am I leaving myself open to having cells break down, leading to full-blown malignancy at some point? Or is it a lot more complicated than that? Does my question make sense? Thanks again...

for now, the waiting and wondering is the hardest part ...

Eric

Good oral hygiene won't prevent HPV + SCC.

Viruses in all this are not impacted by oral hygiene. I don't mean you can let you mouth go to hell in a basket, because there will be tons of other issues develop that will make your life miserable. But viruses are not impacted by anything that you can do hygiene-wise. ALSO getting back to your original post, be sure that if radiation was part of your original treatment, that anyone thinking of extracting a tooth in your mouth knows about it, and is up to speed on things. Even this many years out, you will still have healing issues, and if it can be saved by crowning that is a way better solution. Look into 02 treatments if it has to go.

thanks brian for the latest response -- i know all about radiation issues and potential teeth extraction ... my ENT said it was a good sign that the biopsy area bled pretty well when he snipped it ... but i will thoroughly grill anyone who wants to extract any teeth before that ever happens...