Surgeon Removes Throat Tumor Using Robotic Surgery Without an Incision

Bob Foster, 63, of Oak Creek, didn’t think the lump on the right side of his neck was unusual because he first noticed it when he was sick with a cold. Eventually the cold went away, but the lump did not.

“It didn’t hurt, and it wasn’t really visible to other people,” Bob said. “It wasn’t bothering me, so I just forgot about it.”

It Wasn’t Just a Common Cold

Six months later, Bob was playing with his dog and injured his shoulder. He went to an urgent care clinic to get his shoulder checked, but the doctor was more concerned about the lump in his neck. Bob ended up seeing an otolaryngologist, or ear, nose and throat (ENT) specialist, who performed a biopsy and diagnosed him with throat cancer. He had stage IV squamous cell carcinoma in his right tonsil.

“He doesn’t know it, but my dog, Watson, helped save my life,” Bob said.

Smoking is a major risk factor for oropharyngeal cancers, but Bob is not a smoker. His cancer was caused by the human papillomavirus (HPV). HPV-associated head and neck cancer is rapidly rising in the U.S. The rate of new diagnoses has surpassed that of cervical cancer.

There is hope for the future, though. The HPV vaccine was introduced in 2006. The teens and children who receive it now will see a decrease in the rate of HPV-related head and neck cancers in the decades to come.

Seeking a Second Opinion

Bob wanted to determine the best course of treatment for his cancer and made an appointment for a second opinion with Becky Massey, MD, an otolaryngologist with our Head and Neck Cancer Program, part of the Froedtert & MCW Cancer Network.

“Dr. Massey was so refreshing and straightforward,” Bob said. “She reviewed my scans and recommended surgery. She also said I would be a good candidate for a clinical trial that would make the treatment after surgery easier for me.”

Transoral Robotic Surgery

Things moved quickly after the appointment. Bob saw Dr. Massey in August, and his surgery was scheduled for September. He and his wife canceled a prepaid trip to Italy and Greece because he wanted to get the procedure done as soon as possible.

“I didn’t want to spend time fretting,” Bob said. “I just wanted to get better.”

Dr. Massey performed transoral robotic surgery to remove the tumor. This is an advanced technique that allows the surgeon to remove the tumor through the patient’s mouth, instead of through an incision, making less of an impact on important functions during recovery, such as breathing, swallowing and speech.

“Using this technique, we gain access to the tumor without disturbing normal tissues,” Dr. Massey said. “It allows the patient to recover faster and easier, with less pain.”

A Clinical Trial and a 2,000-Calorie Shake

“Bob was approved for a clinical trial that allowed him to get the same outcome as with standard therapy, but with less intense radiation therapy,” Dr. Massey said. “This meant less of an impact on his quality of life.”

In the phase II clinical trial, after surgery, Bob received a chemotherapy drug called cisplatin for seven weeks. Due to this drug’s impact on his kidneys, his treatment team changed the drug to carboplatin, which was better tolerated. He also had daily low-dose radiation therapy at the same time.

After the surgery, Bob completed radiation therapy, and weekly chemotherapy under the guidance of Stuart Wong, MD, hematologist/oncologist. Throughout his treatment, Bob’s biggest concern was maintaining his weight.

“Eating solid food was difficult, but I was motivated because I did not want to have to get a feeding tube,” Bob said. “The clinical trial helped with that, because the radiation therapy was less intense.”

Nurses, cancer dietitians, speech pathologists and other specialized staff in the Clinical Cancer Center at Froedtert Hospital provide supportive care for patients throughout treatment, from swallowing therapy and IV fluids to nutritional supplements. Bob consulted with the dietitians once a week.

“With their help, my wife and I came up with a recipe for a 2,000 calorie shake. We used ice cream, chocolate, peanut butter … all the good stuff, in addition to certain powder supplements.”

Bob never required a feeding tube. He also kept busy during his treatment. He spent a lot of time with his dogs and worked with a friend to remodel a bathroom in his house. He says this helped him take his mind off the disease and keep a positive mindset.

“Don’t underestimate the strength of your support system,” Bob said. “My family, friends and everyone who took care of me at Froedtert Hospital helped me stay motivated to beat the cancer.”

Learn more about the Froedtert & MCW Head and Neck Cancer Program.

Head and Neck Cancer