How a Second Opinion Gave One Neck Cancer Patient a Second Chance

Prior to his diagnosis, Steve L. was a man who lived life to the fullest. He loved his family, as well as his successful career as an IT specialist; he also enjoyed a healthy, active lifestyle. That all changed, however, on March 7, 2014, when he noticed a lump in his neck. Understandably concerned, he began to seek out medical advice.

Three days after he discovered the lump, he went to see his internal medicine doctor. He was scheduled for a CT scan the following day and was sent to a specialist for a fine-needle biopsy.

Then the doctor that performed the fine-needle biopsy delivered the bad news: Steve had neck cancer – not only that, it was the worst possible type, in his opinion. And when Steve asked if he should retire to enjoy what remained of his life, his doctor said yes.

It Was Time to Seek a Second Opinion

After his initial diagnosis, Steve was referred to an ear, nose and throat specialist who was a frontrunner for conducting the necessary surgical procedure. Despite the fact that Steve was disappointed by the doctor's bedside manner, he booked the surgery, not wanting to waste time.

In retrospect, Steve advises, "Definitely bring a family member to go with you to some of those appointments. You're pretty much preoccupied with the worst thing about it, so you've got to keep your head about you when you're in with these doctors."

Steve’s sister, who had accompanied him to the appointment, felt he should seek a second opinion. So she connected with a doctor who immediately contacted MedStar Georgetown University Hospital. Not long after, Steve had an appointment set with Bruce Davidson, MD, chairman of the Department of Otolaryngology-Head and Neck Surgery at MedStar Georgetown University Hospital.

Renewed Hope for Recovery with Dr. Davidson

Dr. Davidson biopsied the tonsil lump, but at the time of surgery, pathology did not find any cancer, so he proceeded with a neck dissection to remove the known cancer in the lymph node.

“These cancers that present in lymph nodes in the neck are called Cancer of Unknown Primary,” says Dr. Davidson. We try hard to identify the original cancer and usually it is in the tonsil or the base of tongue. In this case, we could not identify the cancer on biopsy. In fact even when we pursued tonsillectomy, the cancer was too small to be seen on pathology at the time of surgery. It was only found after further careful study by the pathologist.”

During the neck surgery, Dr. Davidson removed approximately 40 lymph nodes from Steve's neck and discovered cancer in only one of them.

The team then removed Steve's tonsils. There was no obvious tumor in the tissue removed. However, when the tonsil tissues was comprehensively evaluated by pathology, they did indeed find cancer in the left tonsil.

So with a small cancer in the primary and a single lymph node, surgery alone can be curative. However, a wider resection around the tonsil area would be required in order to avoid the need for radiation therapy. Steve went back to Dr. Davidson, who proposed a radical tonsillectomy on the left. After his surgical treatment, Steve has done well. He has undergone PET-CTs for two years. Each time, the results have been negative.

Reflecting on His Treatment and Looking Forward

Today, Steve is in good health once more. "So far, I've been very happy with what they've done. I've lost no mobility.”

As a survivor of throat cancer, Steve has learned a thing or two. "Definitely take your pain meds," he advises, "I learned that one the hard way very early on. If you're in pain, you're going to heal slower."

Most of all, Steve stresses the importance of cancer patients finding a doctor they like and trust. "Don't be afraid to fire your doctor," he says. "Don't be afraid to research your doctor.”

While Steve eventually found his way to Dr. Davidson, the beginning of his diagnosis was rocky, and he credits Dr. Davidson with being a thorough, meticulous professional. "He's a very brilliant man.”

“Cancers of the throat are increasing,” Dr. Davidson notes. “Many of these are in individuals like Steve, who are in the prime of life. While some of these tumors are treated with surgery and radiation and others are treated with chemotherapy and radiation, his case demonstrates a successful treatment using surgery alone.”

Thanks to Dr. Davidson, Steve is looking forward to the many years of good health and great times that lie ahead.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

Planning to Preserve Function and Appearance After Surgery for Head or Neck Cancer

Head and neck cancers include a range of conditions such as sinus cancer or cancers of the throat or voice box. What can make these tumors a unique challenge is that they are invariably located near areas where senses and critical functions take place.

That means treatment of a tumor, whether through surgery or radiology, can impact a patient's ability to hear, see, smell or taste. More than that, it can impair a patient’s ability to swallow or speak. Working with a medical team that keeps all of these potential impacts in mind – and plans to avoid loss of functionality whenever possible – is important.

But functionality isn't the only concern many head and neck cancer patients have. When treatments occur near the face, patients can be concerned about how they will look following surgeries.

Some head and neck cancers do require aggressive treatment; surgery to treat severe sinus cancer, for example, could necessitate removal of an eye. When aggressive surgical treatment is unavoidable, it's important to work with a team that includes an experienced reconstructive surgeon to help maintain appearance. That experience, combined with modern treatment methods, can achieve remarkable results.

Look for Experience and a Multidisciplinary Approach

Patients who are facing decisions about treating head or neck cancer should look for providers that offer an unbiased approach to treatment. Each specialty provider  – such as a surgeon or a radiation oncologist – is trained in specific approaches and treatment methods. Without a balanced perspective, even medical providers can be somewhat biased in their approach.

For example, our MedStar Georgetown Cancer Institute team has met every week for over 20 years. Providers from a range of disciplines – for example, oncologists, surgeons and speech therapists – meet to discuss each active case, where treatment decisions are approached from a variety of perspectives. That's important not only for helping each patient make the best possible decision, but also for ensuring recovery is well planned.

Experience is also important when choosing a medical team. Our head and neck cancer surgery team alone brings over 50 collective years to the table. That experience helps us understand the long-term impact of any decision made to treat cancer today.

Talk to Your Providers About the Future

The landscape of head and neck cancer is changing. There has been a significant increase in the incidence of throat cancers that are the result of a prior infection with the human papilloma virus (HPV). These are often found in patients of middle age who do not have the classic throat cancer risk factors of chronic tobacco and alcohol use. The increased incidence of these tumors in otherwise healthy middle-aged patients is a major change in the field of head and neck cancer, but fortunately this new version of head and neck cancer has a high cure rate.

Not only are the cure rates for these types of cancer high, these younger patients often are healthier and do not present other illnesses or conditions that would further complicate their diagnosis and treatment. When determining the best course of treatment, medical teams and patients must balance the expectation of high survival rates with the possible long-term consequences of treatment on swallowing, on dental status and on other quality of life issues years after successful cancer treatment.

If both radiology and surgery are equally viable solutions, patients might choose radiation because they are afraid of surgery or there are more short-term disadvantages. However, radiation could lead to swallowing issues in 15 years, which might make surgery the better option in the long-term, for individual patients.

Though there are others, these are a few of the variables requiring consideration that make an experienced, multidisciplinary team approach essential to successful treatment and preservation of function for head and neck cancer patients.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

Head and Neck Cancer: What to Expect from Transoral Robotic Surgery (TORS)

Head and neck cancer can be difficult to manage, but thanks to recent developments in medical technology, surgeons now have more effective ways to treat it. In the past, certain tumors in the head and neck could only be removed by either cutting through the neck or opening the jaw.

These rather morbid procedures resulted in poorer functional outcomes and carried a higher risk of complications than their modern-day counterpart, transoral robotic surgery - commonly referred to as TORS.

What Is Transoral Robotic Surgery (TORS)?

TORS is a minimally invasive procedure in which a series of robotic arms are passed through the mouth in order to reach a tumor and resect it. It's most commonly used for tumors in the throat, particularly tonsil and tongue tumors. TORS is a good option for treating head and neck cancers not only because it's minimally invasive, but also because it can reduce the need for additional therapy. Patients who elect to undergo TORS often find that they require a lower dose of radiation --and some can even avoid radiation and chemotherapy altogether.

However, effective as the procedure is, it's important for you to understand what to expect before, during and after TORS, so that you can prepare yourself for the best outcome possible.

Before Surgery

Before undergoing TORS, your surgeon will need to conduct some tests to understand exactly how to approach the tumor. A PET/CT scan is usually necessary to visualize the tumor, and a biopsy to confirm the diagnosis and determine the extent of its development. Preparation for surgery will also include common preparations such as blood testing so that your surgeon may have a thorough understanding of your health.

You may be asked to avoid certain medications during the week prior to the operation, such as aspirin or other anti-inflammatories, as these can cause complications. Your surgeon will advise you on the steps to take prior to your surgery to make sure you are in the best condition possible.

The Day of Surgery

As is common for many surgeries, you will be advised not to eat any food after midnight the night before your TORS. It's important that you arrive two hours before the scheduled surgery so that the nurses, anesthesiologists and surgeons have time to admit you and get everything in place.

Immediately after the operation, you may find that your tongue feels somewhat swollen. This is a common side effect that should subside after a few weeks, and it is unlikely to seriously impair your speech. Either the day of the TORS or the day after, you will have a bedside swallow evaluation to ensure that your throat is functioning well. If necessary, a speech pathologist will be involved to help you along the way.

After Surgery

It's common for patients who undergo TORS to be concerned about whether they will be able to speak or eat. The fact is that TORS results in great functional outcomes, and within just one or two days of the operation, most patients are speaking and eating comfortably. Once you demonstrate that your pain is under control and you are capable of eating and moving around comfortably, you will be able to return home. Hospital stays rarely exceed two or three days.

Although very uncommon, some bleeding may occur around the site of surgery. A sudden case of bleeding in the throat can be dangerous, so be vigilant for the first week or two after your TORS. In the interest of safety, surgeons recommend having someone nearby for that short period after the operation.

Final Thought

TORS is an exciting development for head and neck cancer patients, as it has revolutionized how those diagnoses are treated. Because it is minimally invasive and can reduce the need for further treatment, patients like you are experiencing faster, more complete recoveries. Use this overview of what to expect from the procedure to be more informed when you speak with your doctor.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.