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Metastatic Squamous Cell Carcinoma

Tanveer
Posts: 8
Joined: Oct 2011

Respected Sir/Madam.
My father is 61 yrs old. He had cancer in right lateral border of tongue (T1 lesion) and doctor has done wide glossectomy(T size: 1*1*0.9cm) on 15 March'11. Then in August right level 1 lymph node appeared, then doctor did right MND.
The report is as follows:
Clinical history: Wide glossectomy on [15.03.2011]
Now right level I lymph node.

specimen: Right MND.

Gross: Recieved Right MND specimen measuring 9*7*4 cms.
Level I: Salivary Gland is grossly unremarkable.
Eight lymph nodes are dissected, largest measures 1.5*1.4*1 cms. Cut surfaces is firm, whitish.

Level II to V: Eight lymph nodes are dissected, largest measuring 1.9*2*0.9 cms. Cut surface is firm.

Microscopy: Right MND:-(K/c/i wide glossectomy)
Level I: Salivary gland is unremarkable.
One out of 8 lymph nodes shows metastasis of squamous carcinoma with perinodal extension.

Level II to V: Eight negative nodes.

Impression: Right MND:-
Single metastatic node with perinodal extension.
After above surgery, he got 1 cycle of adjuvant chemo from 18th Sept to 21st Sept (5 Flurouracil 1200mg and cisplatin 120mg over 24 hrs infusion for 4 days). Doctor has recommended 2 cycles but he was not mentally and physically prepared for second cycle. Now here in lucknow (our hometown) doctor recommended radiations and they have now started on 19th Oct using Co-60 teletherapy for 30 days. He has much pain and hardness in submantle region in neck and difficulty in swallowing now he is also taking painkiller. He also has bad breath.
Today, when ultrasound(HRSG) report came, it says that “A lobulated hypoechoic mass lesion with breakdown areas measuring 30*25mm is seen in submantle region. Both submandibular glens,carotid arteries, internal jugular veins are seen normally.”
Does it mean that cancer is spreading, or post surgery effect? Please help me out. Is this proper treatment for him?

Waiting for your reply.

Skiffin16's picture
Skiffin16
Posts: 8103
Joined: Sep 2009

Welcome to the forum....

As for treatment, it doesn's sound out of line with what a lot have had on here for similar diagnosis.

As for the report, what do the MD's say, or is what you posted your take on it....?

I don't think anyone can really tell you what is right, or how successful the treatment will be. Unfortunately we are all different, and there are no guarantees for any of us.

Hopefully your MD's will communicate just what the report means to them. If they don't communicate in a way you can understand, let them know that...have them explain it to you in terms you do understand.

Best,
John

Hondo's picture
Hondo
Posts: 5927
Joined: Apr 2009

Sorry I agree with John as we are all different we will all respond differently to the treatment. Your Dad treatment must be in the UK or England somewhere by how the report reads. Question the doctors and don’t be afraid to ask them to please explain what they mean so you can understand it in layman terms.

I wish you the best and would like to Welcome to CSN.
Hondo

Tanveer
Posts: 8
Joined: Oct 2011

My dad's treatment is going on in India. We are asking questions and they are answering to that but they actually don't think themselves, whatever we ask they just answer it, even all the files are not in our hand, we don't know how much radiation they are giving etc, that is why a thought to consult here also.

Hondo's picture
Hondo
Posts: 5927
Joined: Apr 2009

Sorry to hear this about your Dad but don't give up hope. On my first treatment for NPC Cancer I was giving 180rads a day for 35 days no Chemo. My NPC Cancer came back a year later and I had to do treatment all over again. The second times I was giving 120rad twice a day in the morning and evening for a total of 240rads a day for 35 treatments. I was also giving Chemo. I don’t know much about India except for a Captain on one of our Ships who is from India and I get to see pictures of his home and family. Just remember when dealing with cancer you want the best doctors you can get.

Wishing you well
Hondo

Tanveer
Posts: 8
Joined: Oct 2011

I appreciate your effort for fighting with it second time it recurred. When NPC cancer happened to you and how are you now?

Hondo's picture
Hondo
Posts: 5927
Joined: Apr 2009

I am doing well and looking to my 6 years with no other recurring NPC. Life is a little difficult at times but still just glad to be here and watch the grandchildren grow-up

Wishing you well
╠╣ONDO

longtermsurvivor's picture
longtermsurvivor
Posts: 1836
Joined: Mar 2010

but it disappeared from the board. I wonder what happened to it?

The treatment is pretty standard. He had a formal node disection. The pathology report showed one positive node, with some extension of malignancy beyond the wall of the node. The radiation is standard dose.

The hypoechoic mass under the mandible is indeterminant. It is probably post-surgical effect, either resolving clot or abscess, given that he is within 60 days of surgery. Especially in view of his favorable pathology report and ongoing radiation, it is not likely this is malignancy.

It must be very difficult to try to follow this at a distance. Nothing about what you've posted is a red flag that anything extraordinary is going on.

Keep the faith.

Tanveer
Posts: 8
Joined: Oct 2011

Thanks a lot for your concern. Yea you are right, it maybe a post surgical effect.
but we cannot say for sure this time coz doctors are also saying that they will observe the effects of radiation on it and then will be able to decide either they'll refer electron beam treatment or surgery.

longtermsurvivor's picture
longtermsurvivor
Posts: 1836
Joined: Mar 2010

The comments you are receiving sound logical and proper. Best of luck to all.

longtermsurvivor's picture
longtermsurvivor
Posts: 1836
Joined: Mar 2010

ask them why they don't just put a needle in it. That is often diagnostic. Pus or blood is obvious with just simple aspiration. You wouldn't be out of line to inquire about this.

Tanveer
Posts: 8
Joined: Oct 2011

Doctors are saying that now we have only one option to give radiation either it is post surgery effect or lymph node. After 30 days of radiation if it persists or increases then they will operate or give another focussed radiation as per requirement. May be it will get dissolve by these radiations.

longtermsurvivor's picture
longtermsurvivor
Posts: 1836
Joined: Mar 2010

That's a pretty reasonable way to approach the situation, don't you think? It never hurts to ask.

Tanveer
Posts: 8
Joined: Oct 2011

yea it seems but we can't say for sure. Since there is a risk of spreading because radiation has slow effect.

Hondo's picture
Hondo
Posts: 5927
Joined: Apr 2009

Sometimes the only thing you can do is to pray for guidance then start moving forward.

Wishing you and your Dad well
Hondo

Tanveer
Posts: 8
Joined: Oct 2011

Yea you are absolutely right. thanks for the support. In these situations we can't do anything, we should have to choose a path which we think is the best.

Tanveer
Posts: 8
Joined: Oct 2011

Guys plz help me.

New CT scan of Head and Neck has following report:

An ill defined heterogeneously enhancing soft tissue attenuation lesion [measuring approx 3.2*2.2*2.0cm in size] is seen involving inferior aspect of anterior and mid part of left lateral border of tongue. The lesion is infiltrating adjacent gingivo glossal sulcus and floor of mouth. No obvious bony infiltration is noted. No obvious extension into gingivo buccal sulcus is seen.
Few rounded to oval soft tissue attenuation lesion S/O lymph nodes with short axis diameter upto 1cm are seen in left Ib and II.
Nasal septum is deviated towards left side.

What will be the next step and how it should be taken care of? Is another tongue operation required or it will be cured by radiation itself?

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