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  #21  
Old 11 July 2015, 20:47
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Originally Posted by Chesie View Post
Lefty,
This advice comes from a surgeon familiar with the issues you are currently facing. If I understand correctly, You underwent partial glossectomy, with radical neck dissection on the affected side. If that is the case, I agree with your surgical team that adjuvant radiation therapy is not advised.
Most head and neck cancers are very sensitive to radiation and chemotherapy, so much so that for many locations surgery is only performed for failure of chemo-rad. However, most head and neck cancers are not clear cell rumors. Yours is pretty rare and less sensitive to radiation. Surgical excision remains the treatment of choice, especially at tongue base, involving submental salivary glands. If advanced, neck dissection on the involved side is also done.

There is no consensus that radiation after surgery is helpful in clear cell cancer. However, it is well established that radiation after radical neck dissection carries a whole list of long-term problems. Permanent swallowing difficulty, aspiration and dental decay are common. Less common, but causing catastrophic short-term problems, would be carotid artery rupture from radiation arteritis. I took care of one gentleman who developed this, and it was not a pretty way to go.

From what you described, I would not get radiation if I were in your shoes. It sounds like your surgeon cleaned out all the cancer. If, on the other hand, you did not undergo a neck dissection, then radiation treatment would be a reasonable follow-up treatment with a far lower risk of long-term complications. You can do a neck dissection or radiation, but doing both is entering the realm of diminishing returns.

Good luck!
I wish you an uneventful recovery. As an aside, the feeding tube likely won't stay in for long. Once you have healed from surgery, you will likely stop aspirating and be able to eat.

Regards,
Danny
You are absolutely correct about the glossectomy and radical neck dissection. However, it is my surgical team and their pathology board who are adamant about performing the radiation treatment. The contrary opinion came from a second group of oncologists who minimized the risk of recurrence and advised periodic follow-ups in lieu of radiation treatment.
You are the first to mention the cheery prospect of radiation arteritis.
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  #22  
Old 11 July 2015, 23:15
Chesie Chesie is offline
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Quote:
Originally Posted by Lefty View Post
You are absolutely correct about the glossectomy and radical neck dissection. However, it is my surgical team and their pathology board who are adamant about performing the radiation treatment. The contrary opinion came from a second group of oncologists who minimized the risk of recurrence and advised periodic follow-ups in lieu of radiation treatment.
You are the first to mention the cheery prospect of radiation arteritis.
Lefty,

Careful follow-up and periodic examination is a perfectly acceptable plan.

Good luck with your recovery!
Danny
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  #23  
Old 11 July 2015, 23:17
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Thoughts and prayers lifted your way, Lefty.
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  #24  
Old 12 July 2015, 02:20
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Wish you all the best in your recovery
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  #25  
Old 12 July 2015, 08:48
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Get well Lefty, prayers going out to your recovery!
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  #26  
Old 12 July 2015, 09:05
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Hang tough, and get well quickly
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  #27  
Old 12 July 2015, 09:26
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Prayer request sent for a healthy, no complication, recovery.
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  #28  
Old 12 July 2015, 09:39
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Quote:
Originally Posted by Chesie View Post
Lefty,

Careful follow-up and periodic examination is a perfectly acceptable plan.

Good luck with your recovery!
Danny
PM sent
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  #29  
Old 12 July 2015, 10:03
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Best of luck to you Lefty for a speedy and complete recovery, and hopes for a long and healthy life ahead of you.
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  #30  
Old 12 July 2015, 15:52
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I pray you have a good recovery and continued improving health, Lefty.

You got some sober input from the two docs. This board is a gem that way.

As you know, the continuation of the cancer course in life can be unpredictable no matter what. There are quite a few of us here to attest that the surprises can be good, as well as disappointing. We do what we have to, and keep doing it.

I had radiation to the neck, mantle, and mediastinum in early '89 for Hodgkin's lymphoma, after surgery to neck and abdomen. It definitely has side effects, though things have improved since then. I got over the internal sunburn to my mouth, esophagus, and trachea. I remained with some increased GI sensitivity; but I always was a bit sensitive there. I got over the fatigue. Although the IDF wouldn't have me back (I was first noticed sick while in the field on operations with my reserve unit), I eventually got back to backpacking and climbing and SAR and everything else. The lower salivary glands are damaged, so when teaching I had to keep a drink handy. But I recovered well and got on with my life. When I came to the States later that summer, they told me that in the US they would have treated me with a combination of chemotherapy and radiation after surgery. But I did fine with the treatment I got. December 2013 I was diagnosed with a stage 4 lung cancer. The only reason I'm mentioning it, is the working theory (can't prove it one way or the other) is that the radiation laid the foundation for the eventual lung cancer so many years later. You just can't predict all the consequences. This time around there was minor disagreement between MD Anderson and my local oncologist. We went with the local guy's plan, while keeping the guys at Anderson on tap for consults. So far, so good. Very good, in fact. You never know.

As Chesie/Danny already pointed out, your head and neck are already very vulnerable to the likely side effects of radiation. I know clarity is hard when your life is on the line and there are no certainties. It sounds like the conservative approach says you may do quite well without the added risks of the radiation. Risks that are pretty well anticipated. The more aggressive approach is acting on precaution, not actual known disease. The list of 'what-ifs' are pretty long.

I see you PM'd Danny. Further talk with him may help. Have you spoken with a second team (i guess third in this case) outside the area? If not, you might consider a long-distance consult with one of the big clinics that handles more cases like yours. In my case, that was/is MD Anderson. In your case it could be Mayo, or Sloan-Kettering, or Dana Farber, or a few others. At Anderson, the patient can initiate the contact and set up the consult without their physician. I did the initial stuff online and by phone, then got my records and physician's notes sent to them. They reviewed everything, including films. I went there for a day, but that turned out unnecessary. We formulated a plan in cooperation with my treating physician here, along with a contingency or continuation plan (one has to expect eventual further challenges). I still had to make a choice in the end; but I understood my situation and options that much better.

Whatever you choose for now, keep the option of a consult at a big center in mind; just to further inform you and maybe even get you a little more peace of mind with the course you take.

I pray that you will do well, and we'll here news of good improvement from you.
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  #31  
Old 12 July 2015, 20:36
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I have nothing constructive to add but my thoughts will be with you.
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  #32  
Old 13 July 2015, 10:01
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I'd like to echo those wishing you well Lefty. I don't know shit about oral cancer, not even enough to ask an intelligent question. But I hope that you can minimize further impact with a well informed course of action. Good luck brother.
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  #33  
Old 13 July 2015, 11:15
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Good luck Sir.
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  #34  
Old 13 July 2015, 12:29
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K. Glad to see you posting. All I can do is continue to keep you in my thoughts and wishing you a speedy recovery.

JP

PS. If you need me to come open up your futon, let me know.
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  #35  
Old 13 July 2015, 12:35
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I got nothing but thoughts for your recovery.
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  #36  
Old 13 July 2015, 14:11
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Thoughts and prayers, Brother.
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  #37  
Old 13 July 2015, 14:20
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I cannot adequately express my sincere thanks to all who have responded, especially Chesie & 8654maine. It proves once again the breadth and depth of this invaluable site. Using the information and thoughts presented, HH6 and I have done more research and spoken in depth with our oncology team. After much discussion and soul searching, I have decided to go through with the radiation therapy. I will begin on Thursday and will face six weeks of daily treatment.
I have placed my faith in the Almighty that I have made a good decision.
Thank you again to everyone & God Bless You All.
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In every organization there will always be one person who knows what is going on.
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"For the mission, then. As long as he functions, I will humor him."
"If you don't humor him, you may find out how well he functions."
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  #38  
Old 13 July 2015, 14:30
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Lefty,
Good luck with your treatment. I hope everything goes great.
Regards,
Danny
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  #39  
Old 13 July 2015, 19:46
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Thoughts and prayers for your recovery, sir.
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  #40  
Old 13 July 2015, 19:54
8654maine 8654maine is offline
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Sir, good luck and speedy recovery.

I am a PM away.
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