Hello, my name is Joan and this is the first time I have posted on a forum. Not sure how this all works but here goes and hoping someone can help.

Briefly, I have a very dear friend. A year ago almost to the date, he had a swelling in the right side of his neck which he consulted his GP about. Following an intramuscular antibiotic injection and AB tablets, the lump went down but never completely. Despite returning to GP with concerns he was told not to worry and it could take months to go down. 1 Year on lump started to come up again and he was referred urgently to local hospital by his dentist under the two week urgent referral rule. Following tests, biopses etc, he was diagnosed with squamous cell cancer, secondary in neck, primary in epiglottic fold. Last Tuesday had neck dissection, both tumours removed and is now recovering well. At the consultation when diagnosis was confirmed, we went armed with a list of questions, one of which was - if he needed radiotherapy could he have IMRT. We were told that he couldn't have it at local hospital but if he was a suitable candidate he could be referred to Barts Hospital and have it there and it would mean he would keep the use of his salivary glands - so obviously a preferable option for the long term. However since then and a lot more research I have come across(VMAT)which appears to be the next level to IMRT and also PDT.

I am going to be present at the oncology meeting next Friday and would like to be prepared with questions as it would seem that depending on where and what treatment is given has a huge bearing on quality and quantity of life.

The questions that I have are these: Does anyone know if it is possible to have radiotherapy/chemotherapy at a hospital of choice - e.g. If my friend requested a referral to the Royal Marsden, is that possible.

Does anyone know if PDT is a preferable treatment to IMRT or VMAT. Assuming he is a suitable candidate for all three, how does one go about finding out which is best. This is all very confusing to the average person but feel knowledge how ever small may be our best defence. Dear (Dr Vinod K Joshi)can you help sort out the confusion.

Thank you

Joan

Hi Joan

Congratulations on being such a wonderful friend. I hope he really appreciates you.

Even if you can't think of anything to ask before you go to the appointments with him, it would probably be a good idea to take along a spiral bound notebook to jot down meds, doses, restrictions, et c.

I hope everything goes well for you and for your friend.

This group is really helpful and supportive.

Julia

Hi Julia

Thank you for your advice and kind message. He and his wife have been our friends for 20 years and are such lovely people. I work for the referring dentist so have been involved since the beginning, just would like to oversee a happy ending.

Joan

Hello Joan

I am not the expert for deciding appropriate treatment. That is the role of your friend's oncologist. Facilities and expertise with treatment modalities will vary but you will get honest answers to your questions from the experts. Yes, you can ask for a referral to another centre if your treatment centre doesn't provide it. It has happened before when there was a need for this.

Best wishes
Vinod

Hi Dr Joshi,

Thank you for your reply. I suppose I wondered if alternative treatments would be discussed unless you specifically asked about them and ideally, would be preferable to have that information from a centre that can offer choices - depending on patient suitability of course. Our local hospital has a very good oncology department but uses what was described to us as "white-wash" radiotherapy which leaves the patients with more long term problems.

I will let you know what happens next week.

Joan