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Invasive moderately differentiated squamous cell carcinoma.
Please read all to answer questions.
Male 63 , low weight, alcoholic, chain smoker, poor hygiene.
Difficult combative individual.
Refusing surgery for now. Willing to do chemo & radiation.
Sever Oral pain, trouble swallowing & breathing.
Oral cavity, right mid tongue, biopsy: Invasive moderately differentiated squamous cell carcinoma.
Pet/ct scan findings
Large mass in the oral cavity centered in the right tongue but involving the left aspect of the tongue as well is markedly FDG avid with SUV max 21.1. Large right level 2 lymph node has SUV max 11.6. A few smaller right neck nodes are also mild to moderately FDG avid. Tiny left submandibular node has mild uptake.
Presumed odontogenic uptake in the right maxilla.
Incidental findings at low-dose noncontrast CT: Small noncalcified pulmonary nodules in the left upper lung are not definitely
FDG avid but may be below the size threshold of PET. Vascular calcifications. Mild dilation of the ascending aorta Thickening of the left adrenal gland. Diffuse bladder wall thickening.
Impression
Large mass involving much of the tongue with FDG avid lymphadenopathy in the right neck.. Tiny mildly FDG avid left submandibular node. No FDG evidence of more distant metastatic disease.
Questions -
#1 - what stage would this be classified under?
#2 - is this a curable situation?
#3 - survival rate.
#4 - if not curable, how long do they have.
#5 - as a caregiver what is your best advise.
#6 - what resources are their for caregivers in situations like these.
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I feel sad & frustrated for you and/or his care giver…it’s incredibly hard to try & help someone that is unwilling to make lifestyle changes or accept the advice of a Dr. The Dr can prescribe medication that would maybe ease the alcohol or smoking cravings. In my experience, if the patient is unwilling to change or take the meds there’s little anyone can do. I wish you the best of luck, especially if it involves dealing with family loved ones or a dear friend as those situations are the hardest.
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2 ReactionsMaybe these are discussions you should be having with his oncologist with him present? Perhaps even over the phone, if he is reluctant to visit directly with the doctor.
caregivingcaregiver, the gentleman may be well served by radiation and chemotherapy.
Your relationship with him is unclear, so it isn't possible to determine how much you can help.
Everything depends upon his permission to enter into his medical care because you'll be limited by privacy laws protecting him. It is easiest if you have Power of Attorney for healthcare. Without that, he can sign a release of information which would allow you to gather his information and speak with providers about his care.
With permission you could (or I would)
Order a biopsy. We already know that this is an SCC, but with the biopsy material it is possible to have somatic (genetic) testing of the tumor itself. This will give you the clearest information about which chemotherapeutic agents would be most effective against the tumor.
Schedule appointment with radiation specialists. This can be faster if you collect his records of the cancer. CDs of the PET/CT and written reports. I'd send to a proton radiation center as well as one that uses photon.
You may be able to schedule video appointments initially, which you could attend and record, if you would be helping with the decision.
Your efforts with your question indicate that you are genuinely interested in helping this guy. I hope you
proceed, because it sounds at though without your help, he has no one.
It is easy to dismiss a combative person with poor hygiene, but how much of that is from having cancer for it sounds like some time, and maybe not feeling cared for.
Though radiation can be painless, chemotherapy is not. Bless your struggle, bless you for struggling.
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