Head and Neck Cancer: Tissue-sparing Techniques Personalize Treatment

Fall 2013

Emre Vural, M.D.

Smokers and drinkers made up the bulk of head and neck cancers seen by James Suen, M.D. … until recently.

The preeminent head and neck cancer surgeon who wrote the textbook for 30 years on treating that medical specialty says the sexually transmitted human papilloma virus (HPV) is changing that.

In the past, 80 to 90 percent of oral cancers were related to tobacco and alcohol, he said. And while tobacco still causes a high percent of cancer of the oral cavity, 50 percent to 60 percent of tonsil and base of the tongue cancers now are related to the HPV virus.

“We’re going to see an epidemic of it, a marked increase in this type of cancer in the next 10 to 15 years,” said Suen, chair of the Department of Otolaryngology — Head and Neck Surgery in the UAMS College of Medicine.

The good news is though it’s still squamous cell carcinoma, it is less aggressive and, therefore, so is the treatment. “It’s allowing us, now that we’ve got more data, to do more tissue-sparing treatment,” Suen said.

In the past, oropharyngeal cancer was treated vigorously with complicated surgery, radiation and chemotherapy. Patients had huge side effects, sometimes resulting in their inability to swallow, talk or breathe.

But surgery has evolved. What previously was done by going through the neck and face can now be done through the mouth with a robotic device by specially trained UAMS surgeon Emre Vural, M.D.

Hospital stays went from five or six days to one or two days. Patients often don’t require feeding tubes, scar tissue is minimalized and complications are reduced.

“Instead of treating everybody the same, we really personalize treatment because we have a lot of different modalities,” Suen said, including the fact that many can be treated successfully with just radiation and chemotherapy.

UAMS treats hundreds of these cases a year, allowing its physicians to develop the expertise to personalize treatment. Radiation physicians who treat only one or two cases a month tend to give higher doses of radiation, Suen said. The higher doses may not be necessary and cause greater complications.

Emre Vural, M.D.

Emre Vural, M.D., uses this robotic device for minimally invasive surgery.

Suen entered the head and neck cancer field in the early 1970s, when most physicians wouldn’t treat it because results were so bad. After focusing on the field at UAMS, he became the first head and neck cancer fellow at M.D. Anderson Cancer Center in Houston and was asked to join the faculty just seven months into the one-year fellowship.

A native of Dermott, he was recruited to return to UAMS, where he helped start the Winthrop P. Rockefeller Cancer Institute and continues to treat patients and train residents in the specialty.

He’s always been ahead of the curve. In the early days he began doing modified neck dissections to treat neck cancer when it was still commonplace to do a more radical procedure that removed muscles, nerves and blood vessels.

“I was criticized; they said ‘you can’t show that modified is better.’ I said ‘I’m not trying to show they are better. I’m trying to show they are just as good with fewer side effects.’ We started using modified neck dissections in the 70s and 80s, and now it’s accepted as the standard.”