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TRANSORAL ROBOTIC SURGERY

Surgical treatment of cancers of the oropharynx (tonsil and tongue base) and also the larynx and hypopharynx are complicated, and traditionally was in the form of morbid and destructive open procedures or via minimalist endoscopic approaches that had poor access and visualization. Although advanced tumours may still necessitate open ablative procedures to be properly managed, modern cancer management focuses not only on cancer cure but also in minimizing side effects of that management, and optimizing long term function.

The other option for treatment is chemoradiotherapy, which has a well-described excellent outcome particularly in HPV positive cancers. Patients can be left with long-term side effects of the radiation however, and use of radiation in younger patients is often avoided if possible.

At the RBWH, Dr Emily Perry and Dr Ryan Sommerville are able to offer Transoral Robotic Surgery (TORS) for appropriate head and neck tumours. This uses endoscopic 3-D visualization, and robotic assisted instruments completely under the surgeons control which increase the surgeons’ dexterity and provide access to difficult areas.  There are many benefits to TORS including:

  • Reduced hospital stay

  • Reduction in the need for adjuvant therapy such as radiation and chemotherapy

  • Reduced need for tracheostomy and feeding tubes

  • No need for invasive access with no visible scarring or disfigurement

  • Less blood loss than standard approaches

  • Cancer control with less side effects

 

CANCER IMMUNOTHERAPY

Immunotherapy is a type of cancer treatment that assists the body's immune system to fight cancer. Although the body's immune system commonly prevents cancers from happening due to its' ability to detect abnormal cells, some cancer cells are not detected. Immunotherapy can augment the body's immune response, or remove barriers to the immune system to fighting cancers

Whether immunotherapy is an option for you will depend on:

  • the type of cancer you have

  • how advanced your cancer is

  • what other medical conditions you may have

  • what treatment you have received already

Along with all other options, immunotherapy will be discussed in the Head and Neck Cancer Clinic. If it is an option for your cancer a medical oncologist will assist you in deciding if it is right for you

 

HUMAN PAPILLOMA VIRUS IN HEAD AND NECK CANCER - LATEST UPDATES

Latest Information from the CDC

"Human papillomavirus (HPV) can cause serious health problems, including warts and cancer.

What Is HPV?

HPV is the most common sexually transmitted infection in the United States. Of the more than 100 types of HPV, about 40 types can spread through direct sexual contact to genital areas, as well as the mouth and throat. Oral HPV is transmitted to the mouth by oral sex, or possibly in other ways. Many people are exposed to oral HPV in their life. About 10% of men and 3.6% of women have oral HPV, and oral HPV infection is more common with older age. Most people clear HPV within one to two years, but HPV infection persists in some people.

HPV can infect the mouth and throat and cause cancers of the oropharynx (back of the throat, including the base of the tongue and tonsils). This is called oropharyngeal cancer. HPV is thought to cause 70% of oropharyngeal cancers in the United States.

It usually takes years after being infected with HPV for cancer to develop. It is unclear if having HPV alone is enough to cause oropharyngeal cancers, or if other factors (such as smoking or chewing tobacco) interact with HPV to cause these cancers. HPV is not known to cause other head and neck cancers, including those in the mouth, larynx, lip, nose, or salivary glands.

What Are the Symptoms of Oropharyngeal Cancer?

Symptoms of oropharyngeal cancer may include a long-lasting sore throat, earaches, hoarseness, swollen lymph nodes, pain when swallowing, and unexplained weight loss. Some people have no symptoms. If you have any symptoms that worry you, be sure to see your doctor right away.

Can the HPV Vaccine Prevent Oropharyngeal Cancers?

The HPV vaccine was developed to prevent cervical and other cancers of the reproductive system. The vaccine protects against the types of HPV that can cause oropharyngeal cancers, so it may also prevent oropharyngeal cancers. But studies have not been done to show this.

CDC recommends that 11- to 12-year-old boys and girls get two doses of HPV vaccine. The second dose should be given 6 to 12 months after the first dose.

CDC also recommends that girls and women through age 26 years and boys and men through age 21 years get the vaccine if they were not vaccinated when they were younger. Men who are 22 through 26 years old also may be vaccinated. The number of recommended doses depends on the age at vaccination. If the series is started at age 15 or later, three doses are needed.

What Are Other Ways to Lower My Risk of Getting HPV or Oropharyngeal Cancer?

Condoms and Dental Dams

When used consistently and correctly, condoms and dental dams can lower the chance that HPV is passed from one person to another.

Alcohol and Tobacco

Alcohol and tobacco products may contribute to oropharyngeal cancers. Don’t smoke or use smokeless tobacco products, and avoid smoke from other people’s cigarettes. Limit the amount of alcohol you drink."

 

RADIOTHERAPY THAT TARGETS THE CANCER MORE ACCURATELY - TOMOTHERAPY

TomoTherapy combines an advanced form of intensity modulated radiation therapy (IMRT) with the accuracy of computed tomography (CT) scanning technology in one machine.
This advanced technology can create powerful and precise radiation plans that treat hard to reach and complex tumours. It uses a built in CT scanner to confirm the shape and position of the tumour prior to each treatment. It also expertly reduces radiation exposure to healthy and critical tissues and organs.