Standard treatments for head and neck cancers can sometimes cause disabling side effects. However, Washington University surgeons are pioneering a minimally invasive transoral laser microsurgery that reduces side effects and improves long-term survival.
Head and neck cancers, which include cancers of the mouth and throat, strike about 40,000 Americans each year. It’s often a devastating diagnosis because traditional treatments of chemotherapy, radiation therapy and surgery can dramatically change facial appearance and threaten the ability to swallow, talk, eat, smell, taste, hear and even breathe normally.
But that grim outlook is starting to brighten thanks to a pioneering surgical treatment developed by Bruce Haughey, MD, Washington University otolaryngologist, and his colleagues at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University. Their work is significantly lessening the impact of an oral or throat cancer diagnosis.
Haughey is now treating many patients with mouth, laryngeal, pharyngeal and neck tumors with minimally invasive transoral laser micro-surgery (TLM). This surgical technique in which surgeons approach tumors through the mouth doesn’t require cutting through the skin and muscles of the neck so it reduces the risk of damaging delicate surrounding structures. The result? Patients are able to leave the hospital sooner, the cancer is better controlled, and mouth and throat function is better preserved.
While this TLM procedure is typically performed for early-stage cancers in the mouth and upper throat, Haughey and his colleagues are pioneering transoral surgery for more advanced cancers in the throat or neck as a first line of treatment.
The neck is packed with delicate and crucial structures – the larynx, trachea, esophagus, tongue, lymph nodes, carotid artery, spine and many more. Not only does reaching a throat tumor by opening the neck threaten these structures and potentially affect speaking, eating, drinking, smelling, tasting and breathing, but it creates a wound that even when healed can interfere with movement and function.
The transoral technique uses an endoscope or microscope and laser to view and cut out cancer without opening the neck. It allows surgeons to more precisely remove all traces of the tumor with less disturbance of nearby tissue. “This technique offers high levels of precision in removing the whole primary tumor,” Haughey says. “It contributes to the good cancer outcomes we see with this procedure.”
Transoral surgery also lessens the need for a tracheostomy, in which an opening is cut in the windpipe and a tube is inserted for breathing. Tracheostomy markedly affects breathing, speech and swallowing. These changes can be temporary after a tracheostomy, but are sometimes permanent. In open-neck procedures, about 80 percent of patients need a tracheostomy; with transoral surgery, the percentage is in the single digits.
Based on a recent study Haughey and his colleagues completed, transoral surgery improves survival and return of normal function after an oral or throat cancer diagnosis. Two years after transoral surgery combined with radiation therapy when necessary, none of the patients in the study has had a primary tumor recurrence. Often if cancer is going to return, it will do so within two years.
For some types of head and neck cancers, nonsurgical combination treatments of chemotherapy and radiation therapy may be used more frequently at other cancer centers. Unfortunately, this approach can lead to greater tissue damage than even open surgery and can destroy swallowing or speech function permanently or require major reconstructive surgery. With transoral laser microsurgery, however, reduced doses of chemotherapy and radiotherapy may be used when necessary so less damage occurs.
“With head and neck cancer, we’re dealing with some of the most visible parts of the body as well as some of the most used functions,” Haughey says. “We’ve developed these minimally invasive procedures because we take both the treatment and the functional outcome very seriously.”
Haughey tells of a patient from Washington, D.C. who recently contacted him because her doctor had offered her lengthy and expensive chemotherapy and radiation treatment for vocal cord cancer. “She had heard about the minimally invasive surgery we were performing for laryngeal cancer,” he says. “It wasn’t something available at any of her local hospitals. She wanted to get rid of her cancer but was hoping to avoid the long treatment and recovery and high expense of chemotherapy and radiation.”
Haughey performed transoral surgery, and the patient was able to leave the hospital in one day. No other treatment was needed because the surgery removed all detectable traces of cancer. “The patient was tickled pink,” Haughey says.