Wednesday, December 5, 2012


Its been a long time since I set down to write a blog post and I'll confess I wish it was about a cheerier subject, but "needs must..." as they say.

The purpose of this entry is to cover the medical background of what we are going through, and I'm writing it as me and Ann are waiting for her to get called back into the OR for a partial glossectomy with a possible neck dissection and node removal.  The qualifier "possible" is important here because it relates to the official diagnosis we got yesterday afternoon, which is also the title of this post.

OSCC - Oral Squamous Cell Carcinoma  (of the mobile tongue)
The other numbers are whats called the TNM staging numbers. Tn - Tumor classification number, Nn - Number of Lymph Nodes invaded, and Mn - presence of metatasis from the original cancer site.

Common sense tells you the more of these variables are greater than 0 (zero) the worse off things are.  That being said Ann is a T1N0M0.  Her tumor was about 5 to 6 mm in diameter and less (according to the biopsy from weeks ago) less than 1mm in depth.  In the world of oral cancer any thing less than 2 cm in diameter and less than 4mm in depth is a T1.

Volumetrically Ann's T1 tumor was only 2.25% the size of the largest T1 tumor on the classification scale { d (ann) = 6mm D (ann) = 1mm V (ann) = 28.27 mm^3 vs.  d (max) = 20mm D (max) = 4mm V (max) = 1256.6 mm^3 and so V (ann) / V (max) = (28.27/1256.6 )*100 = 2.25% }.  Which is good news, its quantifiably very small and is statistically less likely to have sent out metastasis anywhere else. T2 tumors are anything between 2cm and 4cm in diameter and can be anything from 1mm to > 4mm in depth.

If you are interested there is a very good journal article about early stage OSCC that can be found here : Early Stage squamous cell of the oral tongue.   I'm going to borrow some figures from the journal article to illustrate what the prognosis is at this moment.

This figure (Fig.2 in the article) shows the percentage of patients with early OSCC with T1 and T2 tumors.  So based on what we know right now the prognosis is very good, and the overall survival rate percentage at 5 years is in the 90's.

Ready?  OK more graphs now - 

This is relapse of the tumor based on the "margin status" during the surgery.  Margins are what the  surgeons call the boundary of  tissue that surround the tumor site in the excised volume of tissue.  What this graph really says is that less people relapse if the cancer is compact enough for it to be cut away.  There is a phenomenon called POI (pattern of invasion) that they look at on a cellular level.  If the POI is diffuse (imagine scattering salt on a table) then its obviously harder to cut it all out.  If its compact (imagine gently pouring salt on a table) then its much easier to remove it all.

What we are hoping for here is that the POI of Ann's newest little problem is such that it can be removed with ease.  There is a suggestion that the earlier the tumor the more compact the POI is.  Its not definitive, but thats what we are hoping for.  I'll circle back around to this later.

last graph -

This shows the recurrence of cancer based on the DOI or Depth of Invasion.  Ann's T1 (1mm DOI) is on the upper - less than 2 mm line.

Now the part I said I would come back to:  There is a caveat with these charts.  The diagnosis of T1N0M0 is locked to a certain extent.  The CT scan Ann had the other day confirmed that there are no involved lymph nodes - but, it was not able to image her mouth clearly.  Too much metal dental work scattered the energy of the CT Scanner and made the image look like a disco ball.

So while Ann is under Dr. G will be doing a through and detailed search with some other scanning methods MDA is testing.  It is possible that the the T number or the M number could change.  Not likely but it is a possibility.  If they do then it will change the course of the planned surgery, and I'll try to explain how.

Ann is right now set to have a partial glossectomy - aka part of her tongue will be removed.  Hopefully not a lot, just the portion that is invaded and a good clean margin around it.  I think they aim for 5mm of clean tissue around the site.

If Dr. G finds anything else, or cant get good margins (because of a poor POI)  then things will be much more serious and Ann will have a Neck Dissection with removal of all the lymph nodes on the left side of her neck.  Do yourself a favor and DO NOT look up pictures of this procedure.  Its disturbing to look at but people do recover successfully.

OK so that is all we know and I hope it has answered some questions that some were having regarding the cancer diagnoses and surgery.  Right now we were scheduled to have surgery at 12:30pm, but have just been told they are running behind because of a difficult operation and we have been "asked" to wait until 2:45pm.  The "asked" part kills me - like we would want to be somewhere else right now.

I'm not proofing this, I'm going to spend time with my sweetheart.

EDIT:  Turns out I had to proof it after all


Anonymous said...

hug to both of you

lisa adams said...

love you both. will be waiting for updates and thankful for the time you took for this one.

Diana said...

Thanks so much, you explained it so well. Sending big hugs to you both and hoping that it all goes very smoothly.

Wholesale Products AKA Louisiana Wholesale said...

Gosh you two, it has been a long time. Chris, I saw you on Twitter. Ann, you will be in my thoughts and prayers. Take care.

Nancy said...

Thank you for the update. I"m sorry, about the surgery delay.

You explained everything so well Chris. You are both in my thoughts and prayers.

Too late. Yesterday, I looked up all the stuff you just said to not look up. But, Ann is strong and young, and will recover. Her prognosis seems good and it's good they caught it early. Stay positive. Sending you both hugs and love!!!!

I'll be on the lookout for your next update. love, n