Treating tongue cancer with minimally invasive procedure

“When in doubt, check it out.” Bill Musgrove may have heard that motto in the process of working as a postman for decades, or maybe it was just his intuition. So, when he was diagnosed with tongue cancer and faced with extensive surgery, he and his family would check out all options and find a less radical treatment with Henry Ford experts.

Retired from his job as a postal carrier in Milwaukee, Bill and his wife Linda moved into their dream farmhouse near Holland, Michigan. A few years later, his peaceful days of feeding birds and critters were interrupted by persistent soreness on the back of his tongue.

Taking action

Inclined to follow health recommendations, Bill had a routine dental visit and learned that tongue cancer was suspected. An oral surgeon in Grand Rapids recommended extensive surgery to remove the cancer on his tongue and about 25 lymph nodes in his neck and face. Known as a neck dissection, the procedure would lower the risk of cancer recurrence, but it would increase the risk of facial and neck disfigurement, nerve damage and a host of other serious complications.

“I sensed there was a problem – there had to be another way of treating the cancer,” says Bill, then 71. So, his wife and daughter searched for more information and found otolaryngologist Steven S. Chang, M.D., the internationally known director of the Head and Neck Cancer Program at Henry Ford Health.

“We learned the radical approach is not the only way tongue cancer can be treated,” says Bill.

Another approach is called a sentinel lymph node biopsy, a minimally invasive procedure to determine if cancer cells have moved from the mouth to the lymph nodes in the neck, and it helps to determine which patients should undergo a neck dissection. About 10-20% of oral cancer patients have metastasis to the lymph nodes, says Dr. Chang. “Because of that 10-20% chance, neck dissections are done. But that means, over 80% of patients will not have metastasis and did not need a neck dissection.”

What is Sentinel Node Biopsy?
Learn more about this minimally invasive approach to get the most complete staging of cancer, rather than pursuing an unnecessary large surgery called a neck dissection.
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Expertise and innovation

However, only about 5% of oral cancer patients receive a sentinel lymph node biopsy because the procedure requires a certain amount of expertise, says Dr. Chang. “At Henry Ford, we have been innovating this technique for years, and we were one of the early adopters of a new and more accurate imaging method to locate cancer in the sentinel node.”

The ideal candidates for a sentinel lymph node biopsy are patients with an early oral cavity cancer who do not show evidence of cancer spread to the lymph nodes as determined by imaging or a clinical exam, says Dr. Chang.

“I was anxious about how much of my tongue would be removed and how my speech would be affected,” says Bill. “But I relied on God to work things out for my good, and that helped with the anxiety.”

Before the surgery, Bill and his wife Linda traveled to Detroit and registered at the fully furnished guest housing near Henry Ford. Then they had a face-to-face meeting with Dr. Chang.

“On the scale of 1-10, we couldn’t have asked for a better doctor. He’s the most regular guy. Even though he’s very busy, he was relaxed and gave us his cell phone number,” says Bill.

During the surgery, a weak radioactive tracer was injected into the area near the cancer site, and it mapped the possible path of cancer cells to nearby lymph nodes. The first three nodes were removed and rushed to the frozen tissue lab where a pathologist analyzed the tissue for cancer cells. The preliminary report indicated that the lymph tissue showed no signs of cancer. Then the cancerous tissue on Bill’s tongue was removed.

Recovery lessons

After the surgery, Bill and Linda spent the night in the apartment then drove home the next day. Although he received detailed instructions for taking pain medication, he didn’t follow them. He waited until he absolutely needed the medication.

"It was a rough two weeks, and the most pain I’ve ever experienced,” says Bill. “I learned you have to nip the pain in the bud, so you don’t experience pain before your next dose.”

During his recovery, Bill relied on his wife to cook and care for him, and his faith to strengthen him. “This experience is another area in which God helped me. It’s part of my history of faith in God,” he says.

Because the cancer was on the side of Bill’s tongue, the surgery had only a minimal effect on his speech. To strengthen his tongue muscles, he met with a speech-language pathologist, watched speech therapy videos and practiced saying certain letters.

Two years after surgery, Dr. Chang suggested that Bill could continue his follow-up care with a specialist at Henry Ford Jackson Hospital, closer to Bill’s home.

“I’d highly recommend Dr. Chang and Henry Ford,” says Bill. “It’s a place that really helps people, and it’s dedicated to people who are financially needy.”

This summer, Bill and several family members were packed into three canoes for six days, exploring the Boundary Waters between Canada and Minnesota. He says none of this would have been possible had it not been for Dr. Chang’s care and the sentinel lymph node biopsy.

Bill has some quick advice so others can enjoy a good life. Get your regular check-ups and follow up on the little things you sense aren’t right.

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