Form and Function:
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.
Curing Head and Neck Cancer is Only Part of the Challenge
Lisa Bourdon-Krause and her son, share a coke.
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
"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.
Carol Bradford, M.D.,
co-director of the Cancer
Center's Head and Neck
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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