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I have a disease that make me walk slowly, robs me of my balance, muddles my thought process sometimes and causes other problems.

Yesterday, we learned my wife has cancer.

Suddenly, I see everything in a different light.

In mid-January, my wife decided she had finally had enough of this sore throat and earache she's had since November. She tried everything. Even saw our family practitioner who gave her 10 days worth of antibiotics.

All the antibiotics did was make her nauseous.

She made an appointment with an Ear, Nose and Throat guy. He didn't like what he saw... a little lump on the back wall of her throat, just about where her left tonsil used to be. He ordered a CT scan, which found...

"An 18x10mm asymmetric mucosal thickening and mucosal enhancement in the left trigone region, extending into the left tongue base and left vallecula. Recommend direct visualization and, if necessary, biopsy."
So, a week ago today (Jan. 31st -- the 12th anniversary of my Parkinson's disease diagnosis) we were in the ENT guy's office and he snipped out a goodly hunk of the offending "thickening" and sent it to a lab.

Last night, about 5:30 pm, he called. It wasn't good news.

"Mildly differentiated squamous cell carcinoma of the oropharynx."

Now, here's my problem. I worked for six years as a writer/editor at the National Institutes of Health. I know what those words mean.

Now comes the staging. First, they have to determine the tumor size. The CT sized it at 18X10 mm which is about the size of the red rectangle in the black square.

size3

Now if that's all the bigger the tumor is, and it doesn't go further into the mucosa and whatnot, that would classify it as T-1, meaning "tumor 2cm or less in greatest dimension." It gets close at 18mm to being a T-2, but we'll take what we get.

Her CT scan didn't show any definite lymphadenopathy, but did remark on one in the level III area on her left side with a short axis of 6mm. I imagine if they do surgery, that will come out and be examined. Or, more likely, it will be looked at via PET scan. If there is no sign of cancer in her lymph nodes, that gets classified as N0. If that one lymph node comes back positive, then we kick it up to an N1, "metastasis in a single ipsilateral (same side of the body) lymph node, 3cm or less in greatest dimension." 6mm is pretty small.

If a PET scan shows no metastasis, that would be called M0.

So, small tumor, no lymph node, no metastasis, T1,N0,M0 would put her at Stage I.
If the tumor turns out to be a little larger? T2,N0,M0 would put her at Stage II.
If that lymph node turns out to have cancer? T1, N1, M0 would put her at Stage III.
If they find cancer in any other lymph nodes? T1, N2, M0 makes her Stage IVa.

Five year survival rate?

Stage I 50%
Stage II 47.5%
Stage III 37.9%
Stage IV 26.1%
At least, that's according to the American Joint Council on Cancer. What does the NIH say?

The National Cancer Institute agrees with the AJCC.

OK. Treatment?

Stage 1 -- Surgery or radiation is equally successful in controlling this stage of oropharyngeal cancer.

Stage 2 -- Radiation may be the preferred modality where the functional deficit will be great, such as the tongue base or tonsil, Surgery may be the preferred modality where the functional deficit will be minimal, such as tonsil pillar.

Stage 3 -- A combination of surgery with postoperative radiation therapy or postoperative chemoradiation for selected high-risk patients. Radiation therapy for patients with cancer of the tonsil. Hyperfractionated radiation therapy yields a higher control rate than standard fractionated radiation therapy for patients with stage III cancer of the oropharynx, but this has not resulted in an increase in overall survival.

Stage 4 -- A combination of surgery with postoperative radiation therapy plus chemotherapy in high-risk patients. Radiation therapy alone for patients with stage IVA cancer of the tonsil that does not deeply invade the tongue base.

So, and this is just my reasoned guess? Radiation. No surgery. But we shall see. Gotta see the guy in Baltimore first.

HE'LL know what to do!

Knowledge is power. Knowing the most you can know about your enemy helps you defeat it,

But I tell you what... I'm not going to be bitching so much about my puny Parkinson's problems for awhile.

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