Chemo, radiation after surgery

My husband was diagnosed for stage II tongue cancer recently.  The cancer was large 2cmx4cm but did not spread.  He had a surgery a month ago and it was successful.  The biopsy of the removed lymph nodes was negative.  They said they had a clean edge of the removal site.  A biopsy performed during surgery suggested presence of carsinoma in stu.  The surgeon said these may not become malignant and he would just observe it instead of using radiation therapy.  He said he wants to reserve radiation for when cancer returns.  At his post op visit, I asked about the carcinoma in stu, the doctor said at the final section, the pathologist did not even mention carcinoma in stu.  We were thrilled and felt all is well.  Now, not even a month later, my husband discovered a small bump on his tongue.  He will get this checked out in a few days.  My question is,  first, can cancer return this soon after an apparently successful surgery?   Second, why reserve radiation therapy as a last resort?  Can it not be used again if cancer returns in the future?  Third, how effective is chemo in oral cancer?  Thank you for any info.

[Monica M, MD]

Hi,

From your description it appears that your husband had surgery for a 2x4 cm tumor on the tongue. The frozen section from the resected specimen done during the surgery showed positivity for a carcinoma in situ but the final histopathological evaluation of the resected specimen showed no evidence of cancer. The lymph nodes were negetive for cancer. Tongue cancers are known to be aggressive and may recur in some cases despite adequate surgery. Post-operative radiation therapy has been shown to reduce recurrence rates in patients with tumors more that 4 cm in size and in cases with tumor at resected margins. Radiation therapy is more effective in microscopic disease than in full grown tumors. Since your husband had a 4 cm tumor with a suspicious margin status, he may benefit from a course of radiation therapy.  
He needs to get the lump checked by his doctor. Sometimes the healing tissues can become thickened or hardened after surgey and these may appear as lumps. However the possibility of a recurrence cannot be ruled out without an examination and a biopsy. A small recurrence can be reexcised and followed by radiation therapy. Chemotherapy may be beneficial when combined with radiation therapy if there is a recurrence.

All the best!