A new way of looking at CT scans might help some cancer patients avoid unnecessary surgery.
Herbert Heider is a cancer survivor. It's been 40-years since a surgeon removed a tumor on his vocal cords.
Herbert says, "My recovery was complete and I’ve had excellent voice considering what I’ve been through."
Now he's fighting an unrelated, new tumor in the back of his mouth. This time the battle is waged with radiation and chemotherapy.
He says, "It’s completely different for me than 40 years ago was. I had a hemilaryngectomy. No discussion of radiation or chemo ever entered into the picture."
After radiation treatment for advanced head and neck cancer, surgeons often remove and test lymph nodes in the neck to make sure all the cancer is gone.
Dr. Stanley Liauw says, "A lot of times it’s negative, meaning there’s no, no viable cancer and the radiation therapy cured it. But we have no good way of knowing whether or not before the surgery it made sense for them to have it."
Now a non-invasive CT scan can show doctors if the cancer is knocked out, without surgery. University of Florida researchers identified what to look for on the lymph node images.
Dr. Liauw says, "There’s certain criteria that if they’re not there on the CT scan, there’s very little likelihood that there’s going to be disease in the neck."
Herbert remembers his long-ago cancer surgery as a rocky road. He hopes today's radiation and chemo will be all he needs.
"I was told there’s a 50-50 chance of this taking care of it," he says. And naturally, I would rather be on the correct side of the 50-50."
Then, with a little luck, a simple scan may show he's cancer-free.
In one part of the study, UF researchers followed patients who met the criteria instead of doing surgery. The patients remained 100-percent neck cancer-free in three to four years of follow-up.
Fast Facts:More than 55,000 Americans will develop head and neck cancer this year. About 13,000 will die from it.
Traditionally, doctors may perform radiation and aggressive surgery to ensure all the cancer is gone. The surgery can be disfiguring and lead to significant disability.
Now, with CT scans, patients with no signs of cancer in their lymph nodes may be able to avoid surgery.
Head and Neck Cancer
Head and neck cancer is the broad term used to describe cancer that occurs in the mouth, nose or throat. It can be divided into several specific types of cancer, based on the location of the disease. Cancer of the oral cavity includes abnormalities in the area of the lips, front section of the tongue, gums, soft tissue lining the cheeks, the bottom of the mouth and the hard palate. Salivary gland cancer affects the fluid-producing (saliva) glands found in the mouth. Cancer of the nasal cavity occurs in the area inside the nose. Paranasal sinus cancer is in the hollow spaces in the bones around the nose. Pharyngeal cancer affects the pharynx, or hollow tube that opens behind the nose and connects to the esophagus. Laryngeal cancer is in the voice box, or the area containing the vocal cords.
According to the American Academy of Otolaryngology - Head and Neck Surgery, more than 55,000 Americans will develop head and neck cancer this year and about 13,000 will die from it. It is more common in men and in people over 50.
The most important risk factor for head and neck cancer is tobacco use (including cigarettes and smokeless tobacco). The National Cancer Institute says 85 percent of the cancers can be linked to tobacco use. Alcohol is also an important contributor to the cancer. People who use tobacco and drink are at even higher risk for developing head and neck cancer. Some other possible risk factors can include: sun exposure, prior radiation to the head and neck and exposure to certain hazardous substances.
Symptoms of head and neck cancer depend upon the location of the disease. Patients may experience a lump in the neck, persistent changes in their voice or voice quality (like hoarseness), abnormal lump or non-healing sore inside the mouth, coughing up blood, swallowing problems or persistent earache.
Treating Head and Neck Cancer
There are several different treatment options for patients with head and neck cancer. The type of therapy depends upon the location as well as the extent and spread of the disease. Sometimes a combination of therapies is the best approach.
Radiation therapy is the use of high doses of energy to kill cancer cells. The treatment works best when the cancer is confined to a specific area or has not spread very far. Chemotherapy is the use of medications to kill the cancer cells. The treatment can kill cancer cells throughout the body and may be useful when cancer has spread. Surgery is the removal of the tumor and a small margin of healthy tissue. Doctors may also remove some or all of the nearby lymph nodes.
Using CT Scans
Surgery is an important treatment tool for cancer. However, in patients with head and neck cancer, depending upon the location of the disease, surgery can be disfiguring or cause significant changes (like a loss of the voice, scarring, thickening of the neck, loss of motion and problems swallowing). Traditionally, doctors start with radiation therapy. Until now, there was no good way for doctors to determine if radiation was sufficient to eliminate the cancer, so patients often undergo surgery.
Doctors at the University of Florida Shands Cancer Center are studying imaging techniques to try to determine which patients may not need surgery for head and neck cancer. First, patients receive a course of radiation therapy. About four weeks later, doctors perform a CT scan. The images from the CT scan are analyzed, taking into account factors like size of the lymph nodes, number of lymph nodes involved or abnormality within a lymph node. From their studies, the researchers estimated that patients who were free of lymph node abnormalities and had small size lymph nodes had a 94 percent chance of being cancer free and did not need surgery. To test the hypothesis, investigators followed the patients for three to four years. At the end of the study period, all those who were determined to not need surgery were still 100 percent cancer free after the three- to four-year period.
Doctors say using CT scans after giving radiation therapy appears to be a very useful guide in determining which patients may be able to avoid surgery and potential complications. Better treatment techniques, like combining radiation with chemotherapy, may further reduce the need for surgery for head and neck cancer patients.
Web ResourcesAmerican Academy of Otolaryngology - Head and Neck Surgery Web site.
For information on head and neck cancer:
American Cancer Society Web site.
National Cancer Institute Web site.