Proper diagnosis and precise treatment were demonstrated in treating two cases of tongue and mouth cancer, respectively. Collaboration of specialists during treatment helps us in implementing better procedural protocols, says Dr Vishal Rao.
I would cite a classic example of a tongue cancer patient of mine. Inspite of completing chemotherapy, his tumor recurred in a span of four months. In conventional surgery, when you remove the base tongue, you may also have to remove the entire tongue and even the voice box, which massively impacts the patient’s quality of life. I was determined to help him escape this unpleasant eventuality.
Interventional radiology helped me to block the posterior branch of the lingual artery (principal artery supplying blood to the oral floor and tongue), thereby blocking the base tongue. This way, we could achieve tongue resurrection in a manner akin to removing the entire ground floor without removing the first floor, which was unthinkable without interventional radiology and robotic surgery.
This potent combination helps the surgeon to breathe easy in every respect, given the submillimetre precision in mapping, analysing and holding on to the tumor at the exact point in the given surgical step, allowing the surgeon to take a break midway (without losing precision) along with eliminating the torrential bleeding that otherwise accompanies organ resurrection in these types of surgeries.
In 2015, a 67-year-old female came to me for a consult with an aggressive form of mouth cancer, a sarcomatous carcinoma of the maxilla. Post an eight-hour successful surgery, when she returned in a month’s time for radiation and chemotherapy, the tumor had recurred in the lungs as well as the local area. She was now in a wheelchair, unable to walk on her own.
Notwithstanding the seeming futility of further treatment given the poor prognosis, I briefed her about metronomic chemotherapy – a low-dose chemo variant developed on the simple premise that if you cannot demolish a building at one go, try to remove one block at a time, akin to the brick removal scene in the film ‘Shawshank Redemption.’
I gave her the needful medication and requested her to keep me updated through regular follow-ups. One and a half years later, she was fine and was back to normal life. A positron emission tomography (PET) scan showed no tumor this time around. I was overjoyed to see our prediction going wrong; we had given her not more than a month after she first came for radiation and chemotherapy, and here she was, urging me for a cosmetic correction with the vigour and vitality of a young woman.
—As told to Kumaran P
Dr Vishal Rao is country director, head & neck surgical oncology and robotic surgery, HCG Cancer Centre, Bengaluru.