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Form and Function:

Curing Head and Neck Cancer is Only Part of the Challenge

Not long ago, Lisa Bourdon-Krause walked into a restaurant. She ordered a hamburger and a coke. She ate the hamburger. She Sipped the coke through a straw. On the way home, she entertained her two young children with silly songs. Ordinary stuff, you say? Not to Bourdon-Krause. The simple acts of chewing, swallowing, sipping, and especially communicating With her family became extraordinarily important when, diagnosed with oral cancer and facing surgery to remove half her tongue, she thought she might lose all of those abilities.

She didn't, and her seemingly commonplace visit to the hamburger joint is a testament to her successful treatment by a University of Michigan comprehensive cancer center team that cared not only about curing the young mother's cancer, but also about returning her to something close to her pre-cancer life. Leading a quality life after cancer treatment is always a concern, but with head and neck cancers -- those that originate in the mouth, nose and throat -- patients' apprehensions are especially acute.

"So much of who we are as people involves our head and neck region," says Carol Bradford, M.d., co-director of the Cancer Center's Head and Neck Oncology Program. "Talking, tasting, interacting with other people and the world around us are all so important to our sense of identity."

Traditionally, many treatments for head and neck cancers have been devastating to self-image and dignity: surgeries that leave patients disfigured or unable to speak clearly, radiation treatments that wither salivary glands and make eating and swallowing difficult. But new approaches, many pioneered at U-M, focus on preserving appearance, function and sense of self, without compromising a patient's chances for a cure.

It's a mission that requires a coordinated, patient-centered effort from a team of specialists: surgical oncologists with expertise in head and neck and reconstructive surgery, medical oncologists, radiologists, radiation oncologists, nurses, dietitians, speech pathologists, physical therapists, schedulers, physician assistants, medical assistants, dentists, prosthodontists and social workers. And it's a mission that's becoming increasingly important.

Squamous origins

Lining the moist, inner surfaces of the mouth, nose and throat is a mosaic of flat, scale-like cells called squamous cells. It's here that most head and neck cancers originate, often spurred by tobacco use and heavy drinking, but sometimes -- recent research suggests -- by stealthy viruses. If not detected and treated early, these malignancies can quickly spread to lymph nodes in the neck and on to the lungs and other parts of the body.

At one time, the typical head and neck cancer patient was a 60-year-old man with a smoker's rasp and a liking for liquor, but nowadays doctors are seeing more and more young, clean-living patients, many with cancers that test positive for the presence of human papilloma virus (HPV, the same virus that causes cervical cancer), and some with cancers whose cause is unknown. "We're in the midst of an HPV epidemic," bradford says. "Seventy-five% or more of the patients we see with tonsil, throat and base-of-tongue cancer have hpv-related cancer." This preponderance of youthful, active, otherwise healthy patients has contributed to the push for approaches that allow for normal, productive lives after treatment.

Bourdon-Krause was only 30, married not quite six years, working full time and the mother of a toddler, when she started feeling twinges along the left side of her tongue whenever she chewed gum or drank through a straw.

"At first it was just a mild pain, and I didn't pay much attention to it," she says. But after a month or so of putting up with the discomfort, she got curious and took a look in the mirror. "There was a sunken spot that was white and pitted. I looked at it and went, "Oh, my Lord!' but I didn't freak out. I had no clue there was such a thing as tongue cancer."

She mentioned the spot during a dental exam; the dentist sent her to an oral surgeon, who took a biopsy. When the results came back positive for carcinoma of the tongue, Bourdon- Krause was referred to an ear, nose and throat specialist in her hometown of Bay City, who examined her and ordered a few more tests, then sent her to the U-M for treatment.

 

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Learn more about the Head and Neck Oncology Program.

This article first appeared in the Fall, 2009 issue of Thrive.
Print Thrive Magazine; Fall, 2009