Saturday, March 1, 2014

Head and Neck Cancer

My husband had surgery to remove a stage 4 cancerous growth last Monday. On our return appointment the Dr recommended radiation for 7 weeks followed by chemotherapy. They found cancer in the left tonsil and 4 lymph nodes. 

Should my husband seek a second opinion for this follow up therapy? Which Dr would you suggest he see?

Thank you.

Joseph Califano, MD, F.A.C.S. replies...

Without the specific details of your husbands history and operative pathology, it is difficult to give a precise answer your question. However, there are a few general guidelines that can be helpful. For squamous cell carcinoma of the tonsil with multiple (two or greater) metastases to the neck on the same side of the tumor treated with surgical excision and neck dissection, it is generally accepted that postoperative radiation therapy is given after surgery. Chemotherapy is recommended as an addition to postoperative radiation therapy if the margins on the tonsil resection are close or positive, meaning that the tumor is close to or at the edge of the tonsil tissue that was removed by your surgeon. In addition, chemotherapy is recommended in addition to radiation after surgery if the lymph nodes removed show something called "extra capsular spread" or that the tumor has invaded outside the capsule of one or more lymph nodes. Finally, some physicians recommend the addition of chemotherapy to postoperative radiation therapy if patients have many lymph nodes (four would qualify as many) or if the lymph nodes are a large size. These guidelines for radiation with or without chemotherapy after surgery are based on two large trials, one in Europe and one in the United States, that were well run and have high quality data.

Joseph Califano, MD, F.A.C.S.
Head & Neck Surgeon
Johns Hopkins Head & Neck Surgery located at GBMC

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