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Chicken Or Egg?

wolfen's picture
Posts: 1313
Joined: Apr 2009

First, forgive me if I have asked this question before. I am now past addlebrained.

What seems to be the standard protocol? Rads and chemo first or surgery first?

Original onc says teeth pulled, then rads and chemo, then surgery. MDA seemed to lean toward pulling teeth during surgery(strange to me), and then rads and chemo. I know with colon cancer, rads and chemo come first to shrink tumor. Have become rather disillusioned with MDA. Still no callback regading tests to be done or treatment plan since consult ten days ago.So considering just returning to original team.

Hubby still in A-fib and experiencing CHF. Cardio still not concerned. Just said make an appt. to come in, so I did for tomorrow.

Please chime in with your experiences and opinions.



hwt's picture
Posts: 2330
Joined: Jun 2012

I had 19 hour surgery, teeth were removed during the surgery, last January. Rads and chemo followed. I finished tx mid-May. I recently had an appt. preparing to undergo HBOT and a doctor was shocked that I had surgery 1st...that came as a surprise to me.

Posts: 344
Joined: Sep 2012

It seems like on this site many have been treated in different ways depending on the Dr and medical center you chose. My husband had intraoral laser surgery to base of tongue and right selective neck dissection( the nodes were positive on right side) and then about 5 weeks after all that a left selective neck dissection. All nodes on left side were proven negative by pathology so therefore, when he had radiation they did not radiate the left side of the neck. He went on to have 30 radiation treatments and 2 Cisplatin treatments. Three were planned but couldn't have third due to hearing loss.

But, it seems like treatment for this type of cancer has alot of different strategies. Probably depends on the exact particulars of each cancer and the way that that particular doc feels is best to treat it. Different institutions have different focuses. Also, we are in a study and that is a deciding factor to, whether to participate in a study or clinical trial.


osmotar's picture
Posts: 1005
Joined: Jul 2011

I didn't have any surgery as far as neck dissection , Aug 8 , 2011 started all day chemo every 21 days for 3 months, cisplatin. , taxatore (so) and the 5fu beast from mon thru Friday , followed by a neulasta injection .. This went on till oct nov 1 started 7 1/2 weeks of rads plus one chemo treatment of carboplatin for each week of rads. I forgot to add all started with I did have the rt tonsil removed later June 2011 as it was the primary

phrannie51's picture
Posts: 4672
Joined: Mar 2012

but I had NPC, which in itself is inoperable. They did tell me when I started treatment....(Cisplatin & concurrent radiation)...that when I was done with the last chemo, that should the PET scan show anything in the lymph nodes, that surgery would be done at that time to take them out. So in a way, they did opt to hold off on the lymph nodes until after radiation and chemo.


CivilMatt's picture
Posts: 4301
Joined: May 2012

Hi Wolfen,

I had surgery to remove spot on lower tongue and Jugular Vein dissection to remove one entangled and cancerous lymph node prior to 35 rads and 8 Erbitux.

The ENT said he may or may not remove lymph node depending on how difficult it would be, instead shrinking it first with chemo and rads, but he was feeling good and his scalpel was sharp so he went for it. After surgery and the discussion about how well it had gone (clean margins) he recommended rads and chemo also (as a choice) just incase there were residual cancer cells left behind. He mentioned that sometimes the cancer comes back and you end up having rads and chemo anyway.

Hopefully, having a belt and suspenders in my case pays dividends as I really do not want to go through any of this again.



donfoo's picture
Posts: 1644
Joined: Dec 2012


From all my reading, it seems there are many avenues and treatment options utilized to treat head/neck cancers. A common pattern is both chemo and radiation. Surgery seems to be less utilized and generally after treating with chemo/radiation.

Every person has a unique set of variables and the final treatment plan is drawn up from evaluating your specific set. Some variables are: where it cancer located, how large is it, has it spread, what type of cancer cells are they, etc.

In my own case, my primary doctor thought they would do surgery first but after seeing two ENT they both stated chemo/radiation first, then decide if surgery would be required.

Skiffin16's picture
Posts: 8286
Joined: Sep 2009

There is no standard...

Like many have hit on, as best I can tell, and have gathered from my ENT.

It depends on many variables going in, general health, etc....

But all things equal, like mentioned, it depends on the facility, their philosophy, history, success rate, etc...

And even that is dynamic, one period radiation might come first, or concurrent radiation and chemo..., next year it could be like my protocul;

I had nine weeks of chemo (Cisplatin, Taxotere, and 5FU), in three week cycles. Then seven weeks of concurrent weekly Carboplatin, and 35 daily rads...with Amifostine injections in the stomach each day just before rads.


blackswampboy's picture
Posts: 341
Joined: Jul 2012

I couldn't get surgery for my tonsil cancer, due to proximity of tumor to major arteries and other important things. still got the tonsils, after all the treatments.

but I do believe any teeth that need to be pulled have to go prior to rads--can be a big mess if needing major dental work after.

Tonsil Dad's picture
Tonsil Dad
Posts: 489
Joined: Dec 2011

I actually had a choice of treatment. Back in December 2011 once
I had been told I had Tonsil C stage II. I had a choice of ...Surgery,
Rads and chemo or just rads. I asked for advice on this board and
there was lots of mixed replys of what to do. I eventualy chose rads only
(33) but I had to get my teeth fixed first (crowns, wisdom out, cavitys fixed)
and after 10 weeks after being dx I stared treatment. Now 7 months out
and as I've mentioned in many posts.... I'm feeling GREAT, so I hope
I made the right choices......( I didn't make them ...he did )
I can't see into the future but the song says
" Que sera sera, what ever will be will be, the futures not ours to see"

God bless
Tonsil dad,


wolfen's picture
Posts: 1313
Joined: Apr 2009

Thank you for all of your replies. I guess it's like a coin toss.

4 AM here and I just got home from the hospital. Hubby's breathing got so labored he could barely stand and then his kidneys appeared to be failing(couldn't urinate at all) so took him to Emg. With about thirty people ahead of us, they took one look at him and immediately went into action. He was as white as a sheet. They ran three bags of fluid into him along with various meds and still no urination. Did a CT of his head and came back and did a later one of his kidneys(I think). Put him through excrutiating pain trying to insert a catheter, which they finally gave up on, and then did a bladder scan. Bladder was empty so kidneys not working right. Finally got him into a room and are calling his cardio and a kidney specialist in for later this morning. He's resting somewhat comfortably so I came home to get a few hours sleep and will return later in the morning. Will update when I return home again.

He's just falling apart faster than he can be fixed.



Skiffin16's picture
Posts: 8286
Joined: Sep 2009

Stay positive, keep the fight going..

I'm sure they'll figure out what is going on and come up with a plan of action.

Hopefully before you get back to him.

Thoughts and prayers,

wolfen's picture
Posts: 1313
Joined: Apr 2009

Back home now....almost 10 PM. Hubby now appears to be going in and out of A-fib. Like the proverbial three year old who won't perform his cute trick in front of your friends, he was not in A-fib when the cardio showed up, so naturally everything looked good to him. Was finally told the reason for not wanting to do the heart rhythm reset. In cases like his, there is a greater possibilty of clots and that action has a great risk for stroke. So, no real soultion right now.

As for the kidney function, speculation is that during his original CT, the contrast dye damaged his kidneys. This is indicated by rising Creatine levels. They're guessing on this one.

So for now, he's still held prisoner.

As I expected, MDA finally called today to schedule CT, labs and cardio consult. We're always a day late and a dollar short. So, will get back to them when these latest issues are resolved.

Thanks for listening.



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