Lympho Vascular Invasion after complete removal of tonsil with ample negative margins

My husband had intraoral laser surgery to tonsil/base of tongue. The surgery was very extensive lasting 14 hours and because of anatomy issues and extent of cancer at BOT couln't use( they tried ) the robot. Long story short margins were clear so he didn't have throat radiated. He did have  a right neck dissection at same time as above surgery and 3 weeks later had left neck dissection. The right side was positive for 3 lymph nodes and left side was completely benign. He, therefore , had radiation to right side of neck with concurrent Cisplatin x 3 doses, although, only received 2 doses due to hearing loss.

That's our individual story and one thing I have found on this site is that everyones cancer is unique and there are alot of different ways to treat it. The insitution where we were treated recommended surgery then based on operative findings and other diagnostic information followed up with radiation and chemo. But, many on here, in fact most, it seems went with the radiation/ chemo route.

I was and still do drive myself crazy asking or wondering which route is best and will my husband be ok, considering the path we chose. But, in the end all you can do is get as much information from the docs as possible, be informed and then go with your gut. When considering any decisions I also ask that particular dr, what they would do if it were them or their loved one. You have to go into it trusting the dr's with whom you have entrusted your care. I thank God everyday for all in the medical field who have helped us and spend their life doing so. When someone, such as a dr says they can help you beat this it is a priceless feeling and I will always be grateful to them and all behind the scenes, such as researchers who work to improve surivior rates and cure cancer, any cancer.

Trust and believe. What else can we do...oh, and fight. You and your wife will make the right decision and when you do will feel relieved because then you will be getting on with life and moving forward.

Joan

I'm sorry you had to look us up, but I'm way glad you found this site....the people here are wonderfully supportive.  I had nasopharengeal carcinoma, and am 4 months out of all treatment.  I had radiation and chemo as my cancer was inoperable.

I guess I get hung up on words like "prudent" since the path report showed LVI was present.....personally, I'd throw everything they had at the cancer to help ensure it's irradication....I wouldn't want the possibility of a reoccurance hanging over my head.  That's just me, of course....everyone has to decide for themselves.  Radiation is a pain for sure.....I still have trouble tasting food (good for a few bites then the taste is gone).....and I still have problems with saliva....but I'm still very new in the recovery phase of all this.  It does get better every week, tho. 

There will be many people here who will pitch in on your question....so hang tight for some more answers.....

p

Rick removed these comments because the comments were just too cynical.

rjmeyers1 said:

Lympho Vascular Invasion after complete removal of tonsil with

Hi Everyone.

My wife is leaning towards not getting the Rads as the surgeon said he was "OK' with that approach but with vigorous follow-up of course. He said that with the Rads however she would probably enjoy a 95% chance of a total cure. He could not give a success % if in fact the cancer came back and was treated at that time. Her stage II with clear lympth nodes and ample negative margins plus HPV+ makes her possibly a borderline case on the Rad/No Rad question. We have not yet spoken to the Radiologist for his opinion which of course is the next step. I'd have been back sooner but getting on this site is not easy as you all know.  Any thoughts? Thanks.

Rudy

I do have an opinion, but of course it is ONLY an opinion.  I don' tknow if you got my email,  the line of reasoning that suggests itself from our current understanding of the disease is as follows:  if your wife gets a reoccurance it will either be local or distant.  They have already said to you that they are happy with the margins of resection.  That lowers the risk of local reoccurance considerably, but does not lower it to zero.  If she gets a local reoccurance which is caught early, her chances of cure by radiation at the time of reoccurance are good. 

The perivaxcular and perilymphatic invasion increases her risk of distant metastasis.  That's the point I was raising earlier.  BUT if she gets DM, that process has already occured.  It isn't going to be affected by radiation, it is already in place.  And frankly, she won't be cured under those circumstances anyway.  So it is illogical to assume that radiation now matters in this risk. 

To further muddy the water, there is some evidence that in cases where HPV is positive, lower radiation doses may be effective.   There are trials being considered where the radiation dose of 56 gray is used rather than 70 gray.  This lower dose would decrease complication rates to radiation by a huge amount.  I hesitate to mention that,  because my bet is the radiation oncologist is gonna start squirming if you bring this up.

Rudy, my OPINION, for what it is worth, is that I would forego the radiation for now and rely on careful follow up over the first two years.  Having said that, I reiterate it is all a crap shoot.  Here's the story of my second cancer, which began in 2010.  I had my first malignancy in 1998, and was clearly cured by radiation.  I got a second cancer, located on the floor of my mouth, in 2010.  It looked to be caught early, and the ENT oncologist thought he could do an outpatient resection and primary closure with a high cure rate.  My pathology showed cancer up to the margins of resection, so we went back a couple of weeks later and I had a 14 hour radical resection and reconstruction.  The pathology was favorable, so follow up began.  Ten months later I got a reoccurance in the margin of my soft palate and in the tonsillar fossa---- not at all where you would expect to have one.   So they considered me for a complete second course orr radiation.  Lucky for me, the area radiation was enough different geographically from my first malignancy that they were able to pull it off.  That was 11 months ago, and thusfar I am NED.   My case proves you never know.   All you can do is take your best shot at this, and see how it goes.

Pat