Sandy and I met with the Radiation Oncologist on Friday, 8/21.

The good news is that the PET  scan apparently revealed my hidden primary tumor.  It's on the right base of my tongue.  The location is consistent with the cancer found in the two lymph nodes in the left side of my neck.  On that basis it is recommended that I undergo both radiation and chemo therapies simultaneously.

The bad news is that the therapies are a rough road and that I probably will feel really bad for a couple of months.

What follows, if you really want to know, is a bit more of the gory detail.  If that sounds like more than you want to know, feel free to skip it.  I promise not to quiz you the next time I see you.

I'm still upbeat and I feel I'm in good hands in all ways.  My doctors seem to be competent and we have excellent medical facilities here in Lancaster.  Sandy feels a bit helpless right now but I know she will be the main strength that helps me through this.  And, sure helps that I feel you pulling for me through your e-mails, phone calls, cards and prayers.

Thank you, all!

Love,

Bill Stine

We met with my Radiation Oncologist, Dr. Eshelman, this morning.  (A Lancaster area native, Dr. Eshelman is fresh from a couple of years of practice at The Mayo Clinic.)  He said the MRI I had on Monday showed nothing but Tuesday's PET scan indicated an uptake at the base of my tongue.  Reexamination of the CT scan I had prior to surgery confirmed the probable existence of a small mass in that area.

Dr. Eshelman's Recommendations:

• Radiation of the affected area in my neck using an advanced technique called IMRT (Intensity Modulated Radiation Therapy).  Radiation is almost always recommended for this type of cancer in this area.  The IMRT will take longer to set up but has a much better chance of sparing my salivary glands, thus preventing lifelong dry mouth.

• Simultaneously, I will undergo chemotherapy.  I have yet to meet with my Medical Oncologist (Dr. Gottleib) and have done little reading in the area.  Dr. Eshleman says the chemo usually is with a platinum containing drug that improves the effectiveness of the radiation.

• While surgery is an option in my case, it would probably impair my speech and would still require radiation follow-up.

• I still have to get a confirmatory direct visual scope examination and a biopsy of the hot spot.  However, the therapy recommendation will probably be only slightly modified even if the tumor is not confirmed.

• I'll soon visit the dentist to double check the health of my teeth and to get set up for self administered daily fluoride treatments.  (The radiation will, at least temporarily, cause dry mouth.  The lack of protective saliva causes teeth to decay very rapidly.)

• I'll have a temporary feeding tube installed into my stomach.  This is a preventative measure.  The radiation will cause my throat to become very sore making it very difficult to eat and drink.  The feeding tube will allow me to pump water for hydration and Ensure for nutrition directly into my stomach if I become unable to eat or drink.  Installing the tube after treatment has begun is risky as my resistance to infection will be reduced.

• The course of these therapies usually lasts for seven weeks.  I'll probably feel OK for the first couple of weeks.  Then my skin will redden in the radiated areas and, likely, blister.  My throat will become sore ... probably very sore.  I'll likely feel pretty bad during the remainder of therapy and continue to feel bad for 3-4 weeks after therapy ends.

• Afterwards I'll have intensive medical follow-up to monitor my situation.

• Certainly, I'm not looking forward to this process.  However, it beats the hell out of the alternative!