New Care Procedures for Head and Neck Cancers and Thryoid Surgery
When actor Michael Douglas was diagnosed with oropharyngeal cancer, it raised awareness of how the sexually transmitted human papillomavirus (HPV), often associated with the cervical cancers, are beginning to manifest in the mouth and throat.
“The dangers of tobacco use have been long established as a contributing factor for mouth and throat cancers, but, we’ve begun to see a shift in the cancers associated with the HPV,” says Dr. Deepak Gurushanthaiah, an ENT-Otolaryngologist at Kaiser Permanente, “People are smoking less so the rates of oral cancer from tobacco use are way down. We’ve known about HPV for a few decades, but now we’re seeing an increase in mouth and throat cancers. Data shows virus-related oral cancers will soon surpass cervical cancers.
Tell me a little about your practice.
My practice is based around the endocrine glands in the head and neck. Endocrine surgery is a sub-specialty within the Ear, Nose, and Throat (ENT) specialty, with a focus on the thyroid, parathyroid, and adrenals glands.
Besides being an ENT, I’m also an oropharyngeal surgeon. These types of cancers attack the soft tissue of the oropharynx—the middle part of the throat, including the back of the palate of the mouth, the base of tongue, tonsils, and soft tissue of the pharynx. You might remember seeing film critic Roger Ebert after he lost the lower half of his face to a papillary thyroid cancer.
Until recently, we were mostly seeing patients with smoking-related cancers, but now the fastest-growing segment of oral cancers is occurring in young, nonsmokers infected with the virus, which can be transmitted through oral sex.
How does your practice differ from other physicians?
I recently attended a world conference of endocrine surgeons with just 1,800 participants – just to give you an example of how specific our sub-specialty is. Patients diagnosed with endocrine cancers are not going to see an ENT. My practice treats a very selective group of patients suffering from oropharyngeal cancers. It’s an interesting specialty within our own specialty.
Additionally, we run what we call a Tumor Board to review and analyze our patients among a panel of experts who can all dial in remotely, look at imagery, confirm diagnosis, and discuss a plan of treatment. We get 30 opinions all at once! And, we’re the only facility within the Northern California Kaiser system where a patient won’t have to travel.
How have procedures for head, neck cancers and thyroid surgery changed in the past decade?
The pendulum keeps swinging. One decade we’ll treat these cancers with surgery, and the next with chemo, and back again. As we learn more about the disease and reconstructive techniques, outcomes continue to improve.
We’ve also made great improvements in reconstructive surgery. When cancer starts in the lining of the mouth and grows into the jawbone, we have to remove it through the mouth and also remove cancerous tissue through an incision in the neck.
While one is removing the jaw, another physician is removing a live bone, the tibia – part of the lower leg to, use to reconstruct the jawbone. We remove the whole bone with a viable blood source even if we only need a couple of centimeters. It’s a bone you can live without – you might walk on crutches for a few weeks after the surgery. Then, we sculpt the bone to create a new jawline, and attach it to healthy tissue.
The neck is very sensitive place on the body, most likely you’ll have a scar from the incision, but it should heal nicely because of the neck’s blood supply.
What are the symptoms of oropharyngeal cancers?
Ongoing sore throat, change in voice, persistent hoarseness, lumps or bumps in the mouth. If you or someone you know is experiencing these symptoms, get them checked out. Unfortunately, it’s often diagnosed in its later stages because there might be no symptoms when the primary cancer develops.
Maybe a bump on your neck that won’t go away spreads to lymph nodes, and doesn’t respond to antibiotics. It might be months before an ENT determines it’s cancer.
Fortunately, more and more dentists are beginning to screen for these types of cancers. If diagnosed early enough, recovery rates are very good. We hope this becomes a common medical practice for preventative care.
What should a patient expect from treatment?
It’s a difficult question to answer. For a healthy patient, they might be talking, eating, and swallowing in as little as six weeks, but it really varies patient by patient. A whole host of people is responsible for their care–oncologists, radiologists, speech and physical therapists. It’s intensive, multidisciplinary treatment But, the surgeon is always the QB.
There are six to eight of us who perform these types of procedures. Because we treat high volumes, we can maximize efficiencies, and treat the whole patient – including quality of life issues. It’s intensive care, but we have much better outcomes.
Kaiser Permanente, kp.org