A specialist in head and neck cancer and skull base tumour at Apollo Speciality Cancer Hospital, recently shed light on the latest technological advancements in the management and treatment of the diseases amidst their growing prevalence worldwide.
Dr. C. Rayappa, Senior Consultant of the Department of ENT – Head & Neck and Skull Base Surgery, noted that the rise of more innovative technologies over the last decade has exponentially improved patient care and treatment outcomes.
“Working as a team, head and neck surgeons and reconstructive surgeons can bring out the best results in head and neck cancer operation. Improvements in surgical techniques have allowed surgeons to remove tumours, while preserving nearby uninvolved structures. New and modern treatments are now aimed at not only curing the patient but also preserving and restoring vital functions and appearance post-surgery,” said Dr. Rayappa, who is renowned for his expertise in open as well as minimally invasive surgical techniques using the endoscope device.
The head and neck take part in the complex functions of chewing, swallowing, speech, breathing, vision, and sense of smell. A wide range of cancers develops in the head and neck areas, including the throat, voice box, nose, sinuses, mouth, salivary glands, and thyroid.
Squamous cell carcinoma of head and neck (HNSCC) is one of the most common types of cancer today, with an annual incidence of more than 500,000 cases worldwide. Some of the symptoms of HNSCC, which has a five-year survival rate, include a non-healing ulcer in the mouth; change of voice; difficulty in chewing and swallowing; a lump in the neck; bleeding or pain in the nose or the mouth; and difficulty in opening the mouth.
Tobacco chewing and smoking, are the most common HNSCC causes. People, especially those from India and Southeast Asian countries, who are engaged in the practice of mixing cured tobacco leaves with betel nuts are 2.8 times likely to develop HNSCC.
According to Dr. Rayappa, surgery or radiation therapy - or a combination of both - are the primary treatments of head and neck cancer, while chemotherapy is often used as an adjuvant treatment. Reconstruction of bones and other structures is often possible immediately after the surgery to restore the shape of the face as well as its functions.
As for tumours situated deep in the base of the skull, skull base surgery, once considered nearly impossible, can now be safely performed using innovative surgical approaches. Dr. Rayappa said tumours can now be removed without damaging the nerves and blood vessels in that region thanks to the rapid technological advancements.
“Traditionally, to remove a skull base tumour, a surgeon has to open the skull and make facial incisions to expose the tumour. Today, most of the benign tumours and certain malignant tumours of the nose and sinuses, as well as some purely intracranial tumours, can be removed successfully through the nose using an endoscope. This reduces the complications and hospital stay compared to the traditional open surgery,” he said.
Other innovations, he said, include a special laser that is attached to the microscope, or the trans oral laser surgery, and the minimally invasive robot, or the trans oral robotic surgery (TORS). The former is used to remove tumours in the voice box while preserving the structures involved in speech and swallowing without compromising cancer clearance. TORS, on the other hand, can be utilized to remove tumours through the mouth.
“Apart from the endoscope, laser, and robot, we also offer at Apollo the microvascular technique to reconstruct the surgical defect and regain form and function. All these technology-driven techniques deliver improved chances for organ preservation compared to chemotherapy and radiation without the long-term side effects of chemoradiation,” Dr. Rayappa added.
Dr. Rayappa, who is formerly part of the medical team of King Faisal Specialist Hospital in Riyadh, Saudi Arabia, and his multidisciplinary team have been working together to develop treatment plans using the latest technologies and advanced surgical techniques and therapies for patients with head and neck cancer and skull base tumours.
Continued efforts of the team to improve the quality of care have made his department at Apollo Speciality Cancer Hospital.