This morning that we're focusing on -- Jim Kelly is a recurrence of cancer. Our guest in studio to help us sort through all the complications. The good news the bad news. The doctor on -- seeing a doctor singles and oncologists from Roswell park cancer institute and be with us for the next hour. Doctor -- thank you thank you so much for coming in and joining us let me ask you heard of -- that. After Jim Kelly whose initial surgery. He opted against follow up book chemotherapy or radiation I'm pretty sure. We all looked is that as a good sign that his cancer had been treated effectively but we also learning of the very same time. That his type of cancer. Almost always. Recur somewhere. Thome was not a wise decision to begin with do you think. Well I can't speak to the individual case but what I can tell you. Is that in general when a patient is diagnosed with head and neck cancer and surgery is performed first. That the surgical specimen was removed at the time of surgery is looked at very closely underneath the microscope. And based on the microscopic. Features of the tumor how it looks. What it invades how close to the how close to the edge of where the surgeon removed the tumor goes. And whether or not it invade certain structures like nerves. Or lymph vessels that's where your lymph -- live. Based on those factors. One makes a decision whether or not. Additional treatment is necessary. Those factors are actually fairly well worked out and Derek guidelines nationally. In fact one of my colleagues. Doctor Wesley hicks is on the committee that makes those guidelines for the entire country and really the entire world. And they decide. Which factors. Require you to have chemotherapy and radiation afterwards and which factors require you to have radiation only. And in the absence of all of those factors you can choose to observe. So. In any case when the decision is made to observe one hopes that that is the process that was. Undertaken. To come to that decision now unfortunately. Denied. Regardless. What decision is made it's not always the right line because cancers are very serious thing. And it has a tendency sometimes to act in surprising ways. But those -- the general factors that make that decision. It will when you have a recurrence FF DA had surgery. What are the choices that to him at that point. So one of the great things that has happened in the -- had neck cancer research over the last. 220 years is the ability to treat. These types of cancers with many different treatment choices. And those treatment choices include surgery. Radiation. And chemotherapy or some combinations. That includes all three of those. In addition there are some more exotic treatments like photo dynamic therapy which we offer Roswell park. That can also be added to the treatment of these tumors. When a cancer occurs in the head neck reason or if it re Kurds in the and that grief and those are always the treatment choices. So -- rise -- we would do is we would have an expert in each of those treatment. Areas. Come together and review the case with a -- -- -- I'll be doing this Wednesday morning -- our group. And the decision would be made about each specialist. Trying to determine. What is the best. Treatment that can be offered to the patient and what will be the consequences. Of that treatment. So for instance. They had -- is very different from say the thigh. It's possible to remove a significant portion of the -- And leave the patients function largely intact. In the had -- it's much more complicated because. Function is a key element of what needs to happen in the treatment of head neck cancer. If you think about it. Many important functions occur in the head neck so speaking swallowing. Tasting. Seeing. Hearing. Many of the things that define us as people occur in the head neck and the way we relate to each other. Occurs in the head neck so we recognize each other not fire posed for our elbows but fire faces. So a treatment that will radically Alter that. Even if it leaves your function intact. Is not necessarily something that's best for the patient. So a decision needs to be made what is which approaches are going to leave the patient with the greatest chance of cure. And the best possible function. That's why you're really needs to be a multi to. Some pulmonary approach. So for instance who among my surgical colleagues. -- some whose specialize. In it just in general had neck cancer which they all do. By it and we have from world famous surgeons. Doctor carry out those who does skull base surgery. Which is a very difficult kind of surgery. Very few of those around. On one of our. Younger -- sector has -- tried it does robotics. Recession. So the head neck is obviously a very tight space. The robot can get into those tight spaces and -- surgeries that would have required much more aggressive approaches in the path. And Al ready mentioned doctor hicks. -- we also have doctor David -- and who has. Who comes to us from a private practice background and has been fellowship -- so he really focuses on what's the function. What's going to be left for the patient and he sort of keeps us honest. In addition to being great surgeons. We also have medical oncologists and myself as a radiation oncologist -- we would all make the decision together well. If you go first then what am I gonna have to do I go first and what are you gonna have to do. And then we'll come back to the patients say this is what this is what was discussed that the multi disciplinary. Clinic these are your choices this is and how would you like to proceed.