Experimental robotic-assisted oral cancer surgery.
Rod Sinn endured a sore throat for a long time before making an appointment to see his doctor. "It was a tickle in the throat that would bug me but it was nothing painful."
The doctor thought it was an infection, maybe tonsillitis, and prescribed antibiotics. But the cough and sore throat persisted.
Eventually, Mr. Sinn, a 50-year-old businessman from Oakville, Ont., ended up at a specialist, who diagnosed oropharyngeal cancer. Commonly known as oral cancer, it can affect the throat, tonsils, tongue and soft palate.
The traditional treatment is radiation and chemotherapy, but the side effects can be unpleasant, including loss of salivary glands and taste buds. In some cases, surgery is required, which involves sawing the jaw in half and removing all the teeth to access the throat to excise the tumour.
"I didn't really like my options so I went to see Dr. Google," Mr. Sinn said. What he found, to his delight, was a group of Canadian researchers beginning a study on an alternative, minimally invasive surgery.
"It turns out I was a perfect candidate," Mr. Sinn said.
The surgery, conducted in April 2011, involved placing a tiny 3-D camera in his throat and surgeons using a robot to control miniature instruments and cut out the tumours.
"The surgical techniques we had before were very invasive," said Dr. Anthony Nichols, a head and neck surgeon and professor at the University of Western Ontario in London, Ont. "The robot makes it easy to do an operation that is not otherwise feasible."
He stressed, however, that the study will determine objectively whether outcomes are better with the new technique, known as transoral robotic surgery, than traditional radiation and chemotherapy.
Dr. David Palma, a radiation oncologist and clinical scientist at the Ontario Institute for Cancer Research, said finding better treatments for neck and throat cancers is essential.
"The weapons we have now are very effective – there's a very high cure rate – but there's a lot of collateral damage," he said.
Dr. Palma said radiation essentially burns away tumours but also burns the throat, damaging salivary glands and making swallowing difficult; chemotherapy, for its part, can damage the kidneys and hearing.
Oral cancer is one of the fastest growing cancers, and the profile of those affected is changing markedly.
Oral cancers used to be seen principally in heavy smokers. But these cancers are increasingly common in healthy, young people. The principal cause is infection with human papillomavirus, a sexually transmitted infection that almost all adults get at some point. (Only a tiny percentage of these infections lead to cancer, however.)
Last year in Canada, an estimated 4,000 Canadians were diagnosed with various oral cancers, and 1,150 died as a result. The five-year survival rate after an HPV-related throat-cancer diagnosis is 80-90 per cent.
HPV is also the cause of cervical cancer, anal cancer and penile cancer.
The researchers received a $223,000 grant from the Canadian Cancer Society to do a head-to-head trial of radiation/chemotherapy versus minimally invasive surgery. They hope to enroll 68 patients over the next three years. Patients will be randomly assigned to treatment with one method or the other and then the results compared.
André Picard