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Thursday, December 5, 2013
Head and Neck Cancer
My friend has tongue cancer and is scheduled for surgery. Only a biopsy has been done. He has not seen an oncologist, but is scheduled with an ear, nose, throat surgeon. No mention has been made of TomoTherapy nor has a CT scan been done. He would like to get another opinion before having the surgery. The surgeons credentials look good, but his specialty is surgery/plastic surgery. Shouldn`t other things be considered since any slip of the knife might affect my friend`s speech? My friend would prefer TomoTherapy since it is not as invasive. Who should he consult?
The management of tongue cancer depends on the stage upon presentation. The stage is determined by the size and depth of the tumor on the tongue and the presence or absence of neck nodes involved by tumor. It also depends on what expertise is available in your community. Unless the tumor is very large and would require removal of the entire tongue, surgery is the preferred modality of therapy. This can most often be done without significant impact on the patient ability to speak and swallow. If a large amount of tongue needs to be done the tongue can be reconstructed with tissues borrowed somewhere else in the body.
The need to remove the lymph nodes in the neck depends on the presence of palpable nodes or size of the tongue lesion….most often they need to be removed. Only with a very small thin lesion are the nodes not removed. Most surgeons trained in the treatment of these tumors in this country are ear nose and throat doctors. The surgery is best performed by someone that does this on a regular basis. It would not be unreasonable to ask your surgeon how often he treats these cancers.
Radiation therapy alone is rarely used to manage these tumors. However sometimes radiation is used with or without chemotherapy after surgery. This is determined by the results of the pathology, the adequacy of the resection and the number of nodes involved by tumor. Again make sure your surgeon is a recognized expert in the management of head and neck cancers. This person will have close relationship with radiation and medical oncologists, and is therefore surrounded by an entire team.
Pierre Lavertu, MD, FRCS(C), FACS
Professor of Otolaryngology-Head and Neck Surgery
School of Medicine
Case Western Reserve University