Head and Neck Cancer [1 of 3] - Penn State Hershey Cancer Institute

Uploaded by PennStateHershey on 17.04.2012

>> Tonight -
It started with a sore throat that persisted for weeks. I knew it was something abnormal
growing in there -
>> An ABC 27 special presentation -
I was told that I would need to get my tonsil out -
I think she just looked at me, and she says it's a tumor, isn't it, and I said, yeah.
That's what they found.
I definitely thought that it was cancer this time. That they thought it was, my life was
going to be done.
>> Penn State Hershey Cancer institute presents "Head and Neck Cancer: A Matter of Facts",
brought to you by Penn State Milton S. Hershey Medical Center.
Good evening. I'm Chuck Rhodes. Head and neck cancers account for three to five percent
of all cancers in the United States. They're diagnosed more often among people over age
50. More than 52,000 men and women in the U.S. are expected to be diagnosed just this
year with head and neck cancers. Tonight, specialists from Penn State Hershey Cancer
Institute are in the ABC 27 call center to answer your questions. So just call the number
on the bottom of the screen, or you can e-mail. Just send it in to abc 27 dot com for those
questions. Head and neck surgeon Dr. Genevieve Andrews will answer your e-mails throughout
the night's show, and, of course, all calls, all e-mails are confidential. We begin tonight,
Debra Pinkerton sharing one patient’s story. Debra.
Thanks, Chuck. A York County woman thought she had a toothache. She was shocked to find
out what was growing inside her mouth.
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[ Background Talk ]
This is a perfect afternoon for Barb Marchio. Her granddaughters, eight-year-old Leanna
and five-year-old Lily, right by her side.
>> Yeah. It goes in the wing. See, I'm right.
Yeah, you were right.
Barb treasures moments like this.
I'd say my life is better due to my grandchildren, and I do like to spend a lot of time with
But for months, Barb had to devote her time to something far more important - her own
life. It started with a toothache.
In December, I started having some problems with my teeth, and a dentist just wanted to
do a whole lot of things to correct the teeth, and I didn't feel like it was quite necessary
because the teeth was in the back, further in the side of my mouth. So I just asked to
have the teeth pulled.
So a dentist pulled her teeth, but Barb says the healing process took longer than expected.
So I just sort of watched it and watched it, and it started getting, you know, I knew it
was something abnormal growing in there. So -
I think you better go to the dentist, find out what's going on there -
She showed it to me, and I immediately thought that doesn't look good, like a mouth cancer,
and it looked exactly like what was in her mouth. So, you know, I remember calling her
saying you need to go get that looked at right away. You know, not to wait.
Barb and her husband saw an ear, nose, and throat specialist.
He took a piece of it out, did a biopsy. Biopsy came back negative. So he said I'm going to
set you up for outpatient surgery and remove more of the growth and do another biopsy of
it. Remove it and do skin graft. He told my husband before that surgery was done that
he could not do the skin graft because he knew the growth was into the vein.
I was shocked. I just couldn't believe it.
I definitely thought that it was cancer this time. That they thought it was, my life was
going to be done. That it was probably my time.
Barb was right. Biopsy results confirmed it was cancer.
My dad told me. So I immediately came home, and it just feels, felt like someone just
punched you in the gut. You know, and just why my mom -
I knew she had cancer before, but she kept on saying I don't think I'm going to make
it. I don't think, I think this is my, my time's up. I said you don't talk like that.
Just see what happens -
Barb survived cervical cancer when she was 29. Now, 29 years later, she had another battle
to fight.
My mom is my best friend, not just my mom. So I'm very close to her. So I wasn't ready
to lose my mom. You don't want to think the worst, but it does, it comes to your mind
when you hear cancer, and knowing that she had it before, and now she had it somewhere
else, it was just very scary.
I cried for weeks, and then finally I told myself that, now, I don’t think it is my
time. I can pray, and I can have people pray for me, and we can have a miracle, you know.
We can have a second, I can still have a second chance. So I convinced myself that through
the power of prayer that there was going to be another miracle -
Barb's prayers were answered when she met with surgeon Dr. Genevieve Andrews.
So she had been biopsied, proven to have squimicell carcinoma of the right lower gum. This is
actually where the tumor was sitting, and it had eroded downward into her jaw bone,
and she didn't have any other signs of tumor elsewhere.
Good news. The cancer could be treated with surgery, but it would be a tough surgery.
My job was to remove the tumor, and the plastic surgeon and I did a team approach where after
I removed the tumor, he reconstructed her. I recommended to her that we do what we call
a composite resection where you remove a whole segment of the mandible, the jawbone. In addition,
do an elective neck dissection where you remove the nodes most at risk on that side of the
neck -
Then plastic surgeon Dr. Shane Johnson would reconstruct her jaw with a technique called
free tissue transfer, or microsurgery.
Our surgery involves removing the fibula bone, which is the more narrow bone on the outer
side between here and here. We take that bone with some overlying skin and some of the surrounding
muscle. We dissect it out of the leg on a single artery that feeds blood to that tissue
and one or two veins that drain the blood back out of it. We reshape that bone like
her jaw, and then we connect those blood vessels up under the microscope to blood vessels in
her neck.
After we met with the doctors at Hershey, and hearing the process of what she had to
go through to get rid of the cancer, it was horrific. It was horrific.
I was devastated. I can't imagine, and I wasn't ready to give up. I prayed long and hard every
day to get me through it, and to have my family be able to deal with what they would go through.
So surgery was scheduled, a day Barb and her family remember vividly.
She cried. She cried But when she went in there, she didn't even cry at all. Had a very
good attitude. It was hard. I was scared. I said I was scared I was going to lose my
wife. You know, I was really scared.
I just had a positive attitude because I wanted to be strong for everybody else. But I was
strong. I was. I didn't, I just went in with a positive attitude knowing that, you know,
that God was going to take care of me.
Once they took her in, you know, it was, like, OK, now we have to go to the waiting area,
and you just, you wait.
It was rough. I knew it was rough for me. To have a thing in the back tells you when
they're in surgery and when they're done. I bet I went down there a good every minute
I kept looking over that chart.
My mom's sister, Dori, was there for my dad and I, and she was a blessing to have because
we would have never made it that day without her there.
It was a long day. Nineteen hours of waiting. Then they received some good news.
Everything went just as they planned. The flap seemed to do well. So it was relief,
and then it was when can we see her.
I remember waking up and throwing my arms up in the air. The part I remember just going,
throwing my arms up in the air and looking up. And then I, first thing I remember wasseeing
was my husband, my daughter, and my sister by my side.
After spending a week in the hospital, Barb came home.
It was a rough recovery. When I came home, I came home with a trach and my feeding tube.
I couldn't, my mouth was wired shut -
Part of our reconstruction is we want to keep her teeth aligned like they were before the
surgery. So we want to keep her dental occlusion as it was, and to do that, and to protect
our reconstruction as we put, we term as arch bars, but they're almost like braces on the
teeth, and then we connect them together with rubber bands.
For weeks, this is how Barb communicated. Two months later, the rubber bands came off.
I just burst into tears because I knew I could have my first drink. I knew I could finally
drink something.
Pathology reports came back with a thumbs up.
I know with the power of prayer that my prayers were answered because she said they removed
51 lymph nodes and all kinds of tissues, and every one came back negative that there was
no signs of any other cancer cells.
The best news of all.
She's a very brave, brave woman, I'll tell you right now. Very brave.
It ultimately saved her life, and, you know, it's given her more time here with us, which
I honor her for that, and she's my hero. She is my hero.
It's all overwhelming. It's so much. It's sometimes hard to take. Very overwhelming.
You know you have a second chance at life.
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As you can see, Barb is very thankful the surgery went well. She did receive 30 treatments
of radiation to make sure the cancer is gone for good. Back to you, Chuck.
Thank you, Debra. I just talked to Barb and her family out in the lobby. She's doing fine,
and the attitude's great. It's just wonderful, and joining us now is Dr. David Goldenberg.
I apologize. We were standing here talking for 15 minutes to get your name messed up.
Is the director of head and neck surgical oncology. Now, let's begin with the basic,
doctor. When we talk about head and neck cancers, what are they? What are we talking about?
Well, head and neck cancers are a group of cancers that originate in the moist lining
of the mouth, the pharynx, which is the swallowing passage, the voice box, the nose, and the
paranasal sinuses. There are also some head and neck cancers that originate on the skin
or in the bones of the head and neck.
So right now, do we know right off the bat, in layman's terms, what causes this type of
cancers? Something we can understand better.
Well, the vast majority of head and neck cancers are caused by smoking, with or without alcohol.
Patients who smoke are at a much higher risk for getting head and neck cancer. Patients
who smoke and consume alcohol have an even greater risk of developing a head and neck
cancer. There is an increasing group of younger patients who do not smoke or drink who have
a subset of head and neck cancers that are caused by the human papilloma virus, the same
virus that causes cervical cancer in women.
Oh, so there's something new to deal with there. What are, we talk about signs in Barb's
package there. What are some of the signs and symptoms of someone with head and neck
Well, oftentimes head and neck cancers mimic something as benign as a cold or a sore throat
or laryngitis depending on where exactly they originate, whether it's in the swallowing
passage, the mouth, or the throat. Anything that persists, whether it be a sore throat
that just doesn't go away or hoarseness that persists or a sore in the mouth, these are
signs that tell us that maybe something more ominous than just a benign cold or upper respiratory
infection is happening.
And what do you do to diagnose this type of cancer? How are they diagnosed?
Well, head and neck cancer is diagnosed typically, the doctor will take a thorough history, asking
the patient questions about his or her habits, specifically smoking, chewing tobacco, alcohol
use. Then he will ask about symptoms. How long you've had them? How long have you been
hoarse? How long have you had problems swallowing? How long has it felt like something stuck
in the throat? After that, the doctor will move on to a physical exam where he will check
your entire head and neck region. He will feel inside your mouth, on the back of your
tongue, in your neck to feel if there's any swollen glands. Typically, then we'll use
a small camera that goes in through the nose to take the, to check the back of the throat
and the voice box. Once a diagnosis is suspected, we take a biopsy for a definitive diagnosis.
Chuck: Thorough procedure.
Oh, absolutely.
And we're going to take a break out here at the desk, and we're going to check in with
Debra Pinkerton at the ABC 27 call center. Debra.
Thanks, Chuck. The phone lines have been very busy. We've been getting a wide range of questions
from thyroid cancer to HPV infection to a lump in the neck to voice changes. The number
to call is 717-346-3333 or e-mail your questions to questions at abc 27 dot com. And here to
answer our viewer questions is Dr. Genevieve Andrews, head and neck surgeon at the Med
Center. Thanks for being with us.
This is the first question. I'm in my late 40's, and over the past three months, I've
had frequent sore throats. My mother did have thyroid cancer. Should I see a specialist?
What are the chances of me getting this type of cancer?
Sore throat is not typically associated with thyroid cancer, however, it can be associated
with other types of cancers if it persists for a long period time. For instance, throat
cancer -
And what are the chances of this patient getting thyroid cancer?
She is at increased risk for getting thyroid cancer given that her mother had thyroid cancer.
I would recommend that she see her primary care doctor on an annual basis to have her
neck examined for this.
OK. Thanks so much, Dr. Andrews, and we will be right back.
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