HPV+ Tonsil cancer- Histopathology report

AnotherSurvivor

ADlaVega

ADlaVega

I'm interested in more details.  Especially if you recall what Stage they pronounced you at.  My concern with mine (T3N1M0) were the N and M numbers, and I am still under the impression that area is the boundary line.  I had a boating buddy who had his caught late, and he very much died of his.  But I think he was very late, possibly Stage IV or V, and I know his had spread, so his M was greater than 0, and his N much more than 1.   Had my T3 been smaller than 4.5cm I would have had surgery with some, probably reduced, rad, and no chemo.   I have other family members do things like Brest cancer treatment contemporary with mine, they got minor surgery and some rechecks.   I'd like to believe that this stuff is getting more nuanced, but it sure seems here like I read a lot of 35/3 or 35/7 treatment stories.

 

Andrea39

AnotherSurvivor said:

ADlaVega

ADlaVega

I'm interested in more details.  Especially if you recall what Stage they pronounced you at.  My concern with mine (T3N1M0) were the N and M numbers, and I am still under the impression that area is the boundary line.  I had a boating buddy who had his caught late, and he very much died of his.  But I think he was very late, possibly Stage IV or V, and I know his had spread, so his M was greater than 0, and his N much more than 1.   Had my T3 been smaller than 4.5cm I would have had surgery with some, probably reduced, rad, and no chemo.   I have other family members do things like Brest cancer treatment contemporary with mine, they got minor surgery and some rechecks.   I'd like to believe that this stuff is getting more nuanced, but it sure seems here like I read a lot of 35/3 or 35/7 treatment stories.

 

In my case the report about

In my case the report about the primary tumor in tonsil catagrize the tumor as pT2, 3.5 cm (larger than 2 cm but not larger than 4 cm). The problem with lymph nodes is however greater. They call it N2. Thus what i understand it is T2N2M0. 

Given these numbers, and with hpv+ status, the new staging in hpv related oropharyngeal cancer rate it at stage II. However, the old staging would rate it IVA. 

Please refer the following for latest details about staging.

https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/staging.html

johnsonbl

AnotherSurvivor said:

ADlaVega

ADlaVega

I'm interested in more details.  Especially if you recall what Stage they pronounced you at.  My concern with mine (T3N1M0) were the N and M numbers, and I am still under the impression that area is the boundary line.  I had a boating buddy who had his caught late, and he very much died of his.  But I think he was very late, possibly Stage IV or V, and I know his had spread, so his M was greater than 0, and his N much more than 1.   Had my T3 been smaller than 4.5cm I would have had surgery with some, probably reduced, rad, and no chemo.   I have other family members do things like Brest cancer treatment contemporary with mine, they got minor surgery and some rechecks.   I'd like to believe that this stuff is getting more nuanced, but it sure seems here like I read a lot of 35/3 or 35/7 treatment stories.

 

HPV status

I was t1n2bm0...  HPV+.  Tiny primary in the base of my tongue...4mm at it's largest.  2 lymph nodes none bigger than 2cm on one side of my neck and high up (lower toward your clavicle is a high risk factor).  I was stage IV in the old staging, stage I in the new.  I had TORS surgery and a reduced dose of radiation (54 gy over 30 days) and no chemo vs. the standard treatment stories.

Your boating buddy with any m (mets to other body parts) is a stage IV even with HPV+ status.

If you were HPV+ you were possibly stage II based on t3n1m0...but there are a few other factors that could influence that.

They are getting better at treating this... 

 

rodny

HPV status

I finished full fledged treatment five years ago for an HPV  (P16) positive tonsil cancer with spread to neck as a cystic growth. The neck spread was the first manifestation, but a subsequent tonsilectomy revealed the primary tumor was in the right side tonsil. So I was T2/N1/M0. The seven weeks of radiation with concomitant chemoptherapy treatment was rough but I got through it and I alive to tell about it 5 years + later.

I am told that it is no longer appropriate to stage HVP oropharyngial cancer. The tumor histology is usually non or minimally keretinizing and often has a basaloid appearance. P16 is sufficient to determine if HPV positive. Statistics show a significant prognosis advantage to hpv tumors, and increasing consideration is being given to de-escalate radiation treatments for patients in this category. Yes, the Mao clinic is very active in this possibility and I believe are proposing it to certain patients under certain controlled conditions. I wish that this had been a option in 2013 when my treatment was started, but it was not so no regrets. I am alive and recent pet scan was clean. My saliva production is quite low which is inconvenient, but manageable. So, is HPV is a blessing if you are diagnosed with tonsilar or base of tongue cancer. 

Good luck with your treatment and do inquire about the possibility of treatment which is de-escalated by consulting doctors with a experience in this area.

 

AlreadyOne

15 months post treatment

Hello All, I took part in a clinical trial in Toronto for hpv related tonsil cancer in Nov. and Dec. of 2016. I had a reduced regimine of six weeks of radiation combined with a once weekly chemo - Cisplatin - treatment. They use the chemo to further intensify the radiation treatment. I really felt no side effects from the chemo but the radiation was hard on me. There are side effects and dry mouth, loss of taste, nausea and sensitivity to anything that is not totally bland are some of them. Sores in the mouth were the worst. BUT, I kept a positive attitude and tried to keep my eye on the end date. Keep in mind that you will continue cooking for two weeks following your last radiation treatment but hopefully you will be home. You will survive. If they want to put a tube in your stomach I would recommend it. It makes it a lot easier to keep hydrated and to ingest calories. Keep swallowing. Take your pain killers and have a good support system around you. 15 months post and I have about 82 % of my orginal saliva. I am able to eat spicy food and drink red wine. My last CT scan indicated that my right lymph node had shrunk to .8cm. All of the treatments worked and I am feeling great! If you have any questions, as I did when I was first diagnosed, fire away. Oh yes, I am a 60 female.

AlejandroDeLaVega

AnotherSurvivor said:

ADlaVega

ADlaVega

I'm interested in more details.  Especially if you recall what Stage they pronounced you at.  My concern with mine (T3N1M0) were the N and M numbers, and I am still under the impression that area is the boundary line.  I had a boating buddy who had his caught late, and he very much died of his.  But I think he was very late, possibly Stage IV or V, and I know his had spread, so his M was greater than 0, and his N much more than 1.   Had my T3 been smaller than 4.5cm I would have had surgery with some, probably reduced, rad, and no chemo.   I have other family members do things like Brest cancer treatment contemporary with mine, they got minor surgery and some rechecks.   I'd like to believe that this stuff is getting more nuanced, but it sure seems here like I read a lot of 35/3 or 35/7 treatment stories.

 

My stage at time of diagnosis

First, I am so sorry for the very delayed response. I have been out of touch for the past six months. Hopefully, you are doing well. In response to your question, for your benefit or others, here was my sitatuation:

Ultrasound Guided Lymph Node Biopsy: Enlarged right level 2B lymph node. Large vascularized mass measuring 4.6 x 2.2 x 2.2cm.  No other lymph nodes are seen.

Biopsy Report: Right lymph node level 2A.  4.5cm (ultrasound guided FNA). Metastatic poorly diferentiated carcinoma fvor squamous cell carcinona.

Surgery Pathology report:

A: Neck, level 2, right, fine needle aspiration: Positive for squamous cell carcinoma.

B: Right glossotonsillar sulcus biopsy: Invasive squamous cell carcinoma arising in high-grade squamous dyspiasia. 

C: Right lateral toungue base, biopsy: Sauamous mucosa, negative for dysplasia and malignancy. 

Glossotonsillar sulcus, right excision: Sauamous mucosa, negative for dysplasia and malignancy. 

E: Right neck, dissection: One of twelve lymph nodes positive for metastatic squamous cell carcinoma (1/12).  Positive lymph node measures 5.0cm

Oral cavity carcinoma, snynoptic report:

Specimen: Glossotonsillar sulcus.

  Procedure: Resection, partial glossectomy.

    Specimen laterally: Right

      Histologic type: Squamous cell carcinoma, conventional.

        Histologic grade:  Grade 2, moderatley differentiated. 

          Tumor site: Dorsal surface of tongue (glossotonsillar sulcus).

            Tumor size: 1.0 x 0.5cm.

              Margines: Uninvolved by invasive carcinoma.  Widely free of margins greater than 1cm from all margins. 

 

Swp

AlreadyOne said:

15 months post treatment

Hello All, I took part in a clinical trial in Toronto for hpv related tonsil cancer in Nov. and Dec. of 2016. I had a reduced regimine of six weeks of radiation combined with a once weekly chemo - Cisplatin - treatment. They use the chemo to further intensify the radiation treatment. I really felt no side effects from the chemo but the radiation was hard on me. There are side effects and dry mouth, loss of taste, nausea and sensitivity to anything that is not totally bland are some of them. Sores in the mouth were the worst. BUT, I kept a positive attitude and tried to keep my eye on the end date. Keep in mind that you will continue cooking for two weeks following your last radiation treatment but hopefully you will be home. You will survive. If they want to put a tube in your stomach I would recommend it. It makes it a lot easier to keep hydrated and to ingest calories. Keep swallowing. Take your pain killers and have a good support system around you. 15 months post and I have about 82 % of my orginal saliva. I am able to eat spicy food and drink red wine. My last CT scan indicated that my right lymph node had shrunk to .8cm. All of the treatments worked and I am feeling great! If you have any questions, as I did when I was first diagnosed, fire away. Oh yes, I am a 60 female.

Your 15 month post treatment

i am new here so just read your April post. I am 4 month past radiation and cancer free they say. Challenges now are still have feeding tube since cant eat /swallow food yet , too much saliva and fatigue . It beats cancer but is messing with my head and attitude at time for sure. Hope you are doing well.