In-house TrialsFroedtert & The Medical College of Wisconsin also conduct clinical research trials initiated by Medical College of Wisconsin faculty. Our General Clinical Research Center (GCRC) provides a setting for faculty members to conduct patient-oriented research. It is one of 78 GCRCs in the United States supported by a grant from the National Institutes of Health. Once the principal investigator submits a research protocol to the GCRC for consideration, it is reviewed by the multidisciplinary GCRC Review Committee. It is then also reviewed by the hospital’s Institutional Review Board (IRB).
Pharmaceutical TrialsTrials sponsored by pharmaceutical companies offer another way for patients to have access to new drug therapies. Froedtert & The Medical College of Wisconsin frequently participate in pharmaceutical studies, and that can mean a new chance for a cure for some patients.
National Head and Neck Cancer Registry (LORHAN)Called the Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN), this national registry helps monitor patterns of care. Medical College of Wisconsin medical oncologist Stuart J. Wong, MD, serves on the advisory board overseeing the development of this new national registry. LORHAN will extend current cancer registries by providing detailed data on treatments delivered to head and neck cancer patients across the country. Through LORHAN, we hope to document outcomes by treatment regimen and further the understanding of the care of head and neck cancer patients.
Leading-Edge Surgical Approaches Both traditional and minimally invasive surgical approaches can be effective in treating head and neck cancers, and Froedtert & The Medical College of Wisconsin offers every surgical option available.
Minimally Invasive ProceduresMinimally invasive procedures use smaller incisions and sometimes video-assisted techniques to remove head and neck tumors. Minimally invasive procedures can lead to shorter recovery times, less pain, fewer complications and better outcomes for many patients.
Our surgeons also have the skills and experience to make these smaller incisions difficult to detect. In some cases of parotid tumors, for example, the surgeon can hide an incision behind the hair line.
Another advanced approach involves benign tumors in the submandibular gland, one of the major salivary glands. In cases where a benign tumor in the submandibular gland is small enough, it can be surgically removed through the patient’s mouth rather than from the outside.
Transoral Laser Microsurgery (TLM)Surgery to treat certain larynx tumors can also be done through the mouth, using a microscope and a laser. Called transoral laser microsurgery or TLM, this important new procedure can sometimes take the place of chemotherapy and radiation in treating early stage larynx cancer. TLM, sometimes called endoscopic partial laryngectomy, means surgeons don’t have to work from the outside, and the larynx doesn’t have to be taken apart and put back together, which can cause swelling and other side effects. TLM can be performed as an alternative to radiotherapy or, in some cases, it can be an option for patients who fail radiation. It’s a minimally invasive procedure aimed at preserving the larynx, helping patients retain their swallowing and speech functions, and help patients avoid the need for a feeding tube and other possible side effects.
Continuous Facial Nerve MonitoringAnother measure of our patient-centered approach is the use of continuous facial nerve monitoring during certain procedures on the parotid gland, ear, or skull base. Continuous facial nerve monitoring uses electrodes to monitor the nerve that moves the muscles in the face. The surgeon is alerted if there is any stretch or stimulation on that facial nerve, providing another safety measure to avoid facial nerve paralysis as a result of surgery.
Microvascular Reconstruction Surgery Surgeons at Froedtert & The Medical College of Wisconsin are uniquely qualified to offer an innovative team approach to certain head and neck cancer surgeries. Microvascular reconstruction surgery is a complex approach to reconstructing certain structures after surgery to remove various head and neck tumors. Bruce Campbell, MD, and Becky Massey, MD, Medical College of Wisconsin head and neck cancer surgeons, work together on these advanced procedures. Dr. Campbell performs the surgery to remove the tumor while Dr. Massey removes tissue from another area of the body to repair the site where the tumor was removed. It’s all done at the same time to decrease the time the patient is under general anesthesia and make it easier on the patient. For example, if part of a patient’s jaw bone is removed by Dr. Campbell, Dr. Massey might remove part of the patient’s fibula to construct a new mandible or jaw bone. In other cases, part of the patient’s forearm or thigh might be removed to rebuild the part of the patient’s tongue, larynx or pharynx that was removed.
Once the tumor has been removed and the replacement tissue has been removed, Dr. Massey performs the reconstruction surgery, using a microscope to attach the transplanted tissue to blood vessels in the neck so blood is going directly into reconstructed area. Sometimes called a “free flap” technique, this is the same microvascular reconstruction technique used in some breast cancer reconstruction surgeries.
This new technique is cosmetically and functionally superior to previous procedures. Froedtert & The Medical College of Wisconsin are proud to be one of the only facilities in the state offering this simultaneous procedure.
Reconstruction after Head and Neck Skin CancersIn some cases, skin cancers of the head and neck require reconstruction to replace cancerous tissue that was removed. Aggressive melanomas and squamous cell carcinomas as well as other rare types of skin cancers most often require surgical removal paired with reconstruction.
Typically, surgical removal of the skin cancer and the reconstructive surgery are done during the same procedure. The head and neck surgeon and the plastic surgeon work together to achieve the best outcome for the patient.
In many cases, the surgeon removes the skin cancer and a margin of normal tissue around it. Once a pathologist in the operating room confirms that the margin of normal tissue is sufficient, the reconstruction can begin. The surgeon can use the healthy skin adjacent to the affected area to close the defect made when the skin cancer was removed. Our highly skilled surgeons work to hide the incisions and use a variety of instruments, sutures and techniques to optimize the patient’s appearance. The principles of cosmetic surgery can be applied to reconstructive surgery, especially when treating head and neck skin cancers.
At Froedtert & The Medical College of Wisconsin, our collaborative team approach helps us tailor the many treatment options for each patient. Our goal is not just to remove the cancer and repair the defect but to restore function and preserve the patient’s appearance for the best possible outcome. Head and neck surgeons, plastic surgeons, oncologist, radiation oncologists and other team members work together to ensure the removal of the skin cancer and the reconstruction are both successful. We understand the subtleties of how different approaches affect each other — for example, how radiation might affect reconstruction and vice versa. Specialists collaborate to develop an integrated, cohesive treatment plan that works for each patient.
Free Tissue Transfer In cases where a larger area is affected or where adjacent tissue is not available or not healthy, a free tissue transfer might be used to reconstruct the defect. This technique involves taking tissue from one part of the body — the leg or arm, for example — and reattaching it to the blood supply in the area where the defect was created. This approach is less common for reconstructive surgery after head and neck skin cancers, but it’s an important option for patients who need it.
Sentinel Lymph Node BiopsyIn certain cases, we may perform a sentinel lymph node biopsy to determine if the cancer has spread to the lymph nodes. During a sentinel lymph node biopsy, radioactive dye is injected and used to identify the sentinel lymph node, the first lymph node to which cancer is likely to spread from that tumor. In some cases, there can be more than one sentinel lymph node. The sentinel lymph node or nodes are removed and tested to determine if the cancer has spread.
Support Tools, Screenings and ResourcesAs part of our patient-focused approach, Froedtert & The Medical College of Wisconsin offer support programs, including the Head and Neck Cancer Survivor Wellness Forum. We also offer a full slate of screenings and health resources unlike any other in the state. From classes and workshops to online tools and more, we want our patients to be active in their own health care, recovery and healing.
Author: Joan Cotter Pike
Date: Nov. 15, 2007
|Medical Reviewer: ||John Rhee MD|
|Becky Massey, MD|
Last Review Date: Oct. 20, 2010
Online Editor(s): Richard Petre