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Oncology (General Cancer)/about parotid low grade mucoepidermoid

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QUESTION: Dear Donald
I had low grade mucoepidermoid carcinona in my right parotid with perineural invasion(nerve not damaged). I had surgery followed by radiation therapy(60gy) with preservation of facial nerve.
It had been three and half years ago and doing well.I am 30 now.

1) What is the chance of cure and how far I have to follow up?

2) For two and half years I have been experiencing occasional left shoulder,chest and back and arm pain that comes and goes(no elevated symptoms for last 2 and 1/2 years).
Can a lung cancer be symptomsless for 2 and 1/2 years?
After how many years lungs cancer must shows symptoms?

3) I took radiation of 64gy(32 fractions) in parotid and neck area.Recently I have done complete blood count and every thing was normal and esr was 6.
Could it be a cause for for secondary cancer(leukemia).How is the risk in my case? I have never smoke in my life.

I am worrying a lot. Please read it patiently and reply.
Thanks.

ANSWER: 1.  You are almost certainly cured of the mucoepidermoid carcinoma.  
2.  I would not expect a lung cancer to be "dormant" for 2.5 years.  It's much more likely that you have some bursitis in the shoulder, especially if it comes and goes.  Pay attention to whether there is a correlation with exercise, or with changes in the weather, or whether the pain comes after a lot of salt intake.  But I doubt it has anything to do with cancer.  
3.  There is a risk of cancer from radiation.  However, that much radiation destroys all of the cells in the field that turn over rapidly (lymph tissue, etc) so we don't see very much cancer from this kind of treatment.  We don't know how to prevent new cancers, but oddly enough, there is a little data showing that regular exercise (improves oxygenation) and a diet high in antioxidants (vegetables, especially from the cabbage family) may reduce the risk.  

Try not to obsess over this.  Some people rightly seek the help of a councilor to get through this kind of anxiety.  

All in all, I would say that any risk you have  would probably kick in in ten years or so (radiation related cancer usually doesn't appear for ten to twenty years).  By then, we'll probably know how to cure it.  Hope this helps.  

---------- FOLLOW-UP ----------

QUESTION: Dear Donald
1) Can still I have distance metastases from low grade mucoepidermoid carcinoma after 3 and 1/2 years? If yes then upto how many years these risk lies?

2) During follow-up I was only being checked locally with the help of fingers being pressed against my operated parotid gland for last three years to check the tumour grow locally and there is CBC(complete blood count).
Is it sufficient or what else tests should I be performed during the follow-up.
Thanks.

Answer
These kind of cancers almost never metastasize, even when the primary returns.  Palpation (feeling with fingers) is a reasonable way to follow up because most of the time the recurrence is local, not metastatic.  And at 3 and one half years, you will probably never have to worry about this cancer again.  I've never heard of a recurrence this far out. Hope this helps.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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