Neck Dissection

jtl said:

Dissection
I think there is less surgery today and more use of radiation therapy with chemo. I agree that Tomo is something to look into. I had it and was pleased with results but then I don't have anyhting to compare it to.
Regards,
John

Hal61 said:

What's left of my two cents
Everybody has already covered everything well. As rat/rick says, the tendency today is to do the dissection, if warranted, after the chemo and radiation. Some see it as always warranted. My medical onc did, advised it as a matter of course. My radiation onc said that with todays IMRT and good chemo, dissection was not necessarily needed, by that she meant it served no purpose. How to know if it will serve a purpose? Just as a precaution, when no other scans or signs show anything, was not good enough for me. I had a three month scan that showed dubious radiance levels attributed to scarring, cooking, etc. Somebody help me hear, I couldn't find anything on the radiance levels I was given as an indicator of activity in the nodes after chemo and rads. I think my initial read was like 3.4 and risk level started at 3.5, I'm not sure of the numbers, but it was a borderline ration along those lines. After 6th month scan, still the same nagging borderline radiance. Now my ENT chimed in--he'd been on the fence--and said lets do it, my Rad onc was mum, indicating she'd still wait a bit.

I decided to do it. 15 removed, and two showed cancer. So, in this case the mopping up surely saved me future treatment.

I went back to my medical onc after I'd healed a bit from the dissection. I belive I'd had a clean PET/CT by then. He advised a round of chemo, this time Carboplatin, just to be sure, nows the time he said, cause even if one cell remains--he put his thumb and index finger very close to illustrate one cell--then now is the time to strike. He said there was no clinical documentation that supported the efficacy of this course.

I said no thanks. My ears were already ringing from the cisplatin, and my hearing was much affected. Carboplatin could leave my extremities numb, he said. To me, sometimes you don't throw the whole kitchen sink at it.

I'm getting close to two years clear, and went for a hike in the Sierras this morning, and I'm hoping Vickie is heading in the same direction.

best, Hal

longtermsurvivor said:

Hal
It didn't just save you future treatment, it probably saved your life. Lymphatic spread is a mystical thing. Especially after the lymphatics are altered, either by surgery or by radiation. Retrograde, or skip lymphatic spread could easily have put you into the distant mets arena. Then you would have been just treading water. You did well. Hope you enjoyed the hike. I was prepared for a 200 mile sojourn in the Ozarks this winter when I got my bad news. All packed, conditioned and ready to go. Maybe next year.

Hal61 said:

Next year it will be
I didn't figure to be able to hike a year and half ago LT, it seemed to me then I was destined to spend my time over the sink, holding up my end of the mucous beam that extended into the drain. Good point about spread. I'm not familiar with retrograde, but I do know skip. No argument with you. Where I differ with some people whose opions I always respect is the idea of throwing another round of variably disabling treatment at something that can't be seen or documented, and the advantage of the treatment can't be shown. I am not for continued, unwarranted (as above) treatments as they stand--Tomo therapy looks like a nice step in the direction of where they might better stand--ust because they can be done. (I appreciate you don't believe doctors do this, and I believe that mostly they doo't, but sometimes do) I can't defend that very well, because someone will say, but what if you don't and you get cancer. But at some point you have to weigh the almost certain effects of repeated chemo/rad/surgery against the possibilies or recurrance that can be measured, quantified, or otherwise detected.

That wasn't my case--though, as said, I did decide against furter chemo for the reasons I've listed; and it isn't yours or Vicie's.

Well, forgive the tangent, I just meant to say thanks and wish you well. Ha, if 200 miles with a pack is a sojourn for you, I expect you to be back on the trail in no tine.

I'll be thinking my best thoughts for your recovery, Hal

MarineE5 said:

before or after?
I guess this is one of those issues that falls on the Doctor and Patient as to what to do.

Many good points in this thread. I lean toward the disection before hand, verses after only because, as it was explained to me by my Surgeon. He said that he would rather operate on my neck before the Radiation because in his words, the DNA changes in our bodies after being exposed to all the Radiation. He said that the tissue would be more like wet tissue paper when he is operating and would take much longer to heal along the incisions and inside.

I have read on here and another site the problems with healing after surgery when the person was radiated first. There is no right and wrong way as long as the results are the same, survival. The side effects may vary.

As my Dad would have said many times, why do you think they call it a "Practice". He wasn't one much for Doctors and said they are still practicing on us. My wife says I have a DNA problem, you Don't No Anything. : )

My Best to Everyone Here