My husband, at age 52, was diagnosed with bi-lateral throat cancer in 2013 related to HPV virus. Cancerous tonsils on both sides were removed and six weeks of radiation and targeted Chemo (cetuximab) were used as treatment. Less than two years later (May 2015) a small lump appeared at top of throat in soft pallet area. Long story short, it wasn't until Sep 2015 that drs decided to biopsy. Results - Cancer. Surgery conducted in Nov 2015 removing soft and vast majority of hard pallet and 2 lymph nodes on both sides of neck. Only hard pallet remaining holds 10 frontal upper teeth. Reconstructive surgery conducted two weeks after surgery. G-tube currently only means of eating and drinking. Swallow will be reassessed in 6 weeks. Received Pathological report last week with results from Nov surgery. Intraoperative/Urgent consult diagnosis section indicate: AFS1 "left Eustachian tube margin" biopsy for F/S: highly suspicious for invasive squamous cell; CFS1 "Left oropharyngeal margin" biopsy for F/S: positive for squamous cell carcinoma.
Surgeon appointment to further discuss this diagnosis is scheduled tomorrow (15 January 2016) as well as appointment with radiation oncologist, and medical oncologist (all scheduled for same date - 15 Jan).
We have lots of questions running through our minds such as "if" radiation is going be once again be administered. We are not even sure what is relevant or what we need to look at for positive outcome. Also, cetuximab was already administered....reason for not going full blown chemo (5 days/week) is due to compromised hearing condition already present in my husband. This has been a long road and we want to know if there are any other routes that could be potentially more effective. Would appreciate any recommendations of appropriate questions we should be asked to provide us with informed information to determine what could potentially lie ahead with this additional treatment, if it is offered.
Reply # - January 14, 2016, 01:24 PM
I'm so sorry about your husband's difficulties. I hope he's feeling better soon. I'll ask a doctor to respond.
Reply # - January 15, 2016, 06:49 AM
I am very sorry that your husband had cancer and that it has recurred. Positive margins raise the concern that there is cancer left behind. For surgery to cure, it needs to remove every last cell. That said, pathology reports can never stand alone--they require some interpretation and discussion with the surgeon before they are finalized. In my tumor board, I sometimes here the pathologist call a positive margin, but the surgeon then clarifies that actually more tissue was taken and the new margin was clean. In doc talk, this is a superseded margin; in plainer English, it means that the labeling of what goes from surgeon to pathologist is so complicated that it sometimes requires a tumor board or other conversation to be sure that it's right.
That said, a positive margin, once confirmed, is important. There are two dominant ways to treat this. One is to do more surgery until the margins are clear. The other, if possible, is radiation. Radiation may not be possible because of the prior radiation--the radiation oncologist and surgeon will typically discuss the anatomy to see if it is.
Finally, there are multiple chemotherapy regimens that can be used with radiation, if that path is chosen. As you accurately note, cisplatin is the best proven regimen, but can cause hearing loss, amongst other problems and cetuximab is the 2nd best validated. However, there are multiple other regimens used in practice that can be considered.