Terry Day, M.D., a head and neck surgeon in the Head and Neck Tumor Center at MUSC Health and Hollings Cancer Center, discusses the benefits of treating HPV-associated throat cancer with transoral robotic surgery (TORS). Removing tumors at the base of the tongue or in the tonsil robotically and by entering through the mouth allows surgeons to avoid making incisions in the skin or cutting through healthy tissue to gain access. TORS provides better functional outcomes for patients and often reduces the need for radiation and chemotherapy.
well with the epidemic in the United States going on now with HPV throat cancers, everybody's basically heard of them. It eyes most commonly in men aged 40 to 60 and it's in usually Caucasian man who are non smokers and might drink occasionally about HPV. Most people associate with cervical cancer, but now, uh, the throat cancers that air from HPV are much more common than cervical cancer. And people are seeing these. They're diagnosing these in their clinic. And so when they see uh, patient with a lump in their neck, who's an adult? The last thing physicians were trained in was This is the HPV throat cancer, but surprisingly, now people have no other symptoms. Have a lump in their neck. Most men noticed that when they're shaving, why is this side of my neck a little bit more swollen? And lo and behold, they've got a HPV throat cancer that's already spread to the neck lymph nodes, and then they'll usually see ear, nose and throat Doctor who will do a needle biopsy of the neck mass and then a scope through the nose typically finds where the HPV throat cancer started usually starts in the Tunsil and in the base of the tongue. And a lot of people think, Well, I had my tonsils out when I was a kid. I can't get this cancer. What? That's not true. You can still get an HPV throat cancer and the Tunsil or the base of tongue when you've had your tonsils out as a kid. So a lot of times they'll there referred to a radiation doctor, an oncologist, most physicians and most dentists in the United States. When they went through their training, this didn't exist, so they didn't have it in their textbooks. And oftentimes I'll see patients that air referred from a radiation doctor and on college, just just to get a second opinion. And the patient didn't even realize it could have robotic surgery for their HPV throat cancer. And that can occur in the tonsil or the base of the tongue. And the great news about robotic surgery is often times, uh, it can reduce the amount or even the need for radiation or chemotherapy. So if it's an early stage cancer and they can get that clear margins with robotically through the mouth and get the throat cancer out in the lymph nodes out that they may not ever need radiation or chemotherapy. Yeah, So when we're doing the robotic surgery, um, it's a lot of set up. It takes about 30 minutes to set up the room, uh, to get the robot what we call Doc. We bring the robot over to the patient and put all the protective gear around the eyes, the nose, the mouth. And actually, it doesn't look like there's room for a robot to have two arms and a camera and light source going through the mouth. But we have a retractor that opens up the mouth and allows the robotic arms to go through the mouth right here. And so we have a protective thing over the lips. We spread the mouth open with a retractor, and that gives direct access for the robot's arms to go in here and so we can control the arms from over in the corner. You'll see, uh, the console is over in the corner, but the robot goes through here, and then we have a retractor, and then the cutting device we use an electric artery most of the time will take out a tumor for example in the base of the tongue right here and take out this tumor and we can control the bleeding with the robot. Take out the tumor in the base of the tongue and the tonsils, and all of this is done from a console, and you can see on the three D video that this is going on. So even our assistance the nurses, uh, in the room can see what's going on and assistance as needed from the robotic console. We still take out the same amount of cancer, but we don't have to go through normal tissues to get there. We basically take out the cancer trans orally, and oftentimes people will go home the next morning after what they think is a relatively minor surgery. Whereas we're doing the same cancer surgery we did 20 years ago. But just not going through all these normal tissues and nerves and bone to get to the cancer. So it's really an awesome, uh, new procedure over the past decade that affords patients much better functional outcomes, quality of life and go on with their normal lifestyle and back toe work and doing their hobbies after a surgery like this compared to what they used tohave 20 years ago,