MedStar Health Blog

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.

Not only is bone cancer a worrisome diagnosis for patients and their families, the prospect of treating any cancer can be frightening, as you may not know what challenges you can expect or how to overcome them.

In this article, we'll be looking specifically at bone sarcomas, which are cancers that arise in the body's bone, muscle and connective tissue. There are several other types of bone tumors, including:

• Other cancerous tumors that arise in the bone marrow;
• Benign tumors of the bone; and
• Non-bone cancer that spreads into the bone.

Each of these types of tumors brings its own unique care challenges and treatment strategies.

Alleviating Fears

When patients learn they have bone cancer, one of the most common fears is that they'll need to have a limb amputated. Historically, this kind of aggressive treatment was the first line of attack against bone cancer, and many prominent cases were treated this way.

But for many patients today, this is no longer the case. The limb is spared, and amputation is not necessary. Modern treatments for bone cancer treat the tumor(s) with a combination of medical and surgical methods. Doctors do this while preserving as much limb function as possible, maximizing the patient's ability to function and ensuring a high quality of life, both during and after treatment.

The Diagnosis Process

Providing an accurate diagnosis, with vital information about the type and stage of cancer, is critical to treatment. An accurate, thorough diagnosis helps your team of doctors create a treatment plan that's safe, effective and thorough, and minimizes unnecessary treatment.

One of the most vital aspects of the diagnosis is the biopsy, which is an examination of a tissue sample collected from the body. A good biopsy should be minimally invasive, only testing parts of the tissue suspected to be affected. CT-guided or ultrasound-guided needle biopsies, or needle biopsies performed in a major clinic, allow precise, careful testing of tissue.

An appropriately-placed biopsy takes just enough tissue to test, and no more. But at the same time, some doctors – especially those who do not commonly work with bone cancers – take too little tissue for a definite diagnosis, forcing a re-biopsy. Our doctors always work to take the proper amount for the biopsy – not too much, and not too little.

Devising a Treatment Plan

Different types of bone cancer require different treatments. The limbs affected and the stage of cancer will also affect the treatment plan. For some cancers, chemotherapy is needed prior to a limb-salvaging surgery. Other cancers don't respond as well to chemotherapy and require surgery (not necessarily an amputation) to treat. This is why obtaining an accurate diagnosis is so crucial.

Primary bone cancer is very rare, and its treatment is often highly specialized and complex. One of the best ways you can assure swift, safe and thorough treatment is to receive diagnosis and treatment at a large center that employs a team of experienced oncologists, surgeons, radiologists, pathologists and other doctors. This way, you know you'll get the care you need, and your quality of life will be assured.

Final Thought

When your doctor suspects bone cancer, one of the most important ways to ensure successful treatment and a high quality of life is to receive an accurate diagnosis at a major medical center. If you do indeed receive a bone cancer diagnosis, receiving comprehensive treatment from a team of experienced doctors at a major care facility is vital to ensuring you receive the best care possible.

While the causes were historically considered to be smoking-related, throat and mouth cancers are increasingly being attributed to the Human Papilloma Virus. Here is what you need to know about the link between HPV and oropharygneal cancer.

What Is HPV?

Human Papilloma Virus, or HPV, is the most common sexually transmitted infection in the United States. With approximately 79 million Americans currently affected by the virus and an estimated 14 million new infections occurring each year, almost all sexually active adults will be infected by at least one form of the virus at some point during their lives.

Most HPV infections resolve themselves without any intervention and have no noticeable health impacts. However, some types of the virus cause small bump-like growths (papillomas) in the genital region, often referred to as genital warts. Other types of the virus can also cause cancer, especially cervical cancers and throat cancers.

Epidemic Proportions

HPV has been widely recognized as the most common cause of cervical cancer for many years. More recently, the frequency of HPV-related oral cancers has also become apparent. HPV is now the most often diagnosed cause of oropharyngeal cancers, which includes tonsil and base of tongue cancers.

If rates of diagnosis continue to increase at their present pace, the number of HPV-related throat cancers will surpass the number of HPV-related cervical cancers within a relatively short period of time. HPV-related throat cancer is quickly becoming an epidemic.

Compared to Smoking-Associated Oral Cancers

HPV-related oral cancers are completely different from their smoking-associated cousins. While still capable of causing significant health problems, HPV-related cancers tend to strike a different population and exhibit a different cure rate when compared to throat cancers stemming from tobacco use. In most cases, patients who develop oropharyngeal cancers as the result of an HPV infection are younger and come from a higher socioeconomic background than their smoking-associated cancer counterparts.

HPV-related cancer patients also tend to experience better outcomes than smoking-related cancer patients. Whether approached surgically, or with chemotherapy or radiation, cure rates are better across the board for HPV-associated tumors.

Symptoms

In most cases, people who develop HPV-related oral cancers were exposed to the virus decades earlier. And while recent advances in vaccines are an excellent way to prevent future infections, they don't provide protection from previous encounters, meaning awareness is your first-line defense, especially if you've had exposure to HPV in the past.

The presence of unexplained masses in the neck or throat are often the first symptom of HPV-related oral cancers. If you notice a growth in these regions that doesn't go away, seek professional care as soon as possible. Other possible symptoms may include trouble swallowing, throat discomfort, or throat pain, although these are less common than with smoking-related oral cancers.

Final Thought

A successful publicity campaign has helped raise awareness regarding the link between human papilloma virus and cervical cancer. HPV's association with cancer isn't restricted to the reproductive organs, however. As the number one cause of oropharyngeal cancers, including tonsil and tongue tumors, it is important for anyone who has been sexually active to be aware of the possibility of developing throat cancers many years after the initial exposure occurred.

Although more common than smoking-related oral cancers, HPV-associated tumors are typically very treatable using conventional approaches such as surgery, chemotherapy and radiation.