Author: Henry Ford Health System
Henry Ford Cancer Institute is a leader in providing a minimally invasive procedure called a sentinel lymph node biopsy for patients with early stage oral cancer. The biopsy can be performed at the same time oral cancer is surgically removed, and it can determine if the cancer has spread to nearby lymph nodes.
For Henry Ford patient Marlene Calverley, the biopsy meant having three lymph nodes removed versus 30-60 lymph nodes, and a two-inch scar instead of a five-to-six-inch scar. It also meant no neck drains, no physical therapy, and a decreased risk of complications.
“We are one of the few – if not the first – medical center in the State of Michigan to adopt this new paradigm for treating early oral cavity squamous cell cancers,” says head and neck cancer surgeon Tamer A. Ghanem M.D., Ph.D., director of Growth, Access, and Service for the Department of Otolaryngology at Henry Ford Cancer Institute. This new paradigm is based on a standard treatment for breast cancer and melanoma skin cancer.
The early data shows that sentinel lymph node biopsy may improve patients’ survival rate. Research also demonstrates a significant decrease in recovery time, complications, and effects attributed to a treatment, says Steven Chang, M.D., director of the Head and Neck Oncology program and the Microvascular Surgery Division at the Henry Ford Cancer Institute.
Head and neck cancers are among the most common cancers in the U.S. and globally. At the time patients are first diagnosed with oral cancer, about 15-25 percent of them have hidden microscopic cancer cells in the lymph nodes of the neck.
During a routine dental exam, Calverley was told to watch a small spot on her tongue. Three years later, an oral surgeon discovered cancer. Knowing there was a significant chance of cancer spreading, the surgeon recommended a neck dissection to remove all the lymph nodes.
At Henry Ford, Dr. Chang would offer a new and more precise treatment approach.
Traditionally, when oral cancer is found, neck surgery is performed and all the lymph nodes are removed, whether they are known to be diseased or not. However, about 75-85 percent of the patients do not need this surgery. After surgery, patients may require neck drains, and some will experience shoulder and lip weakness caused by exposing and manipulating the nerves, says Dr. Chang. Also, patients will have a large scar and longer recovery time.
In the past, patients who had early oral cavity lesions and who were at risk for hidden cancer in the lymph nodes were routinely offered extensive neck surgery to find any diseased nodes. Now, we are offering a simple sentinel node biopsy to select patients to find diseased nodes, says Dr. Ghanem.
Calverley was one of those select patients. To eliminate the cancer, one-quarter of her tongue would need to be removed. When doctors at another medical center initially recommended having all of levels 1-4 removed – which could consist of 30-60 nodes in her neck – and grafting donor tissue onto her tongue, she sought a second and third opinion.
“Dr. Chang was the only one who offered to do the sentinel node biopsy and to have my tongue heal on its own,” says Calverley, a 72-year-old Rochester resident.
When Dr. Chang explained that the sentinel node biopsy is also done for women having a mastectomy, it was an easy decision for me, she said.
“I went home and prayed and spent two days talking to people about my decision,” she says. “Friends in the medical field agreed with me and asked, ‘Why would you have all the lymph nodes in your neck removed if they aren’t cancerous, and then deal with all the repercussions? It’s not necessary.’”
“I had my surgery in November, and my tongue is healing beautifully,” says Calverley.
“Only three nodes were removed, and my scar is only about two inches. It’s right in line with a wrinkle on my neck, and you can barely see it,” she says.
“Within three days, I was up and making pumpkin rolls for Thanksgiving,” says Calverley. She spent only one night in the hospital after the surgery.
The benefits of the biopsy are important. Compared to surgery that removes all the lymph nodes, sentinel lymph node biopsy lowers the risk of lymphedema, which causes a buildup of fluid and swelling in the body. Additionally, the biopsy involves mapping lymph nodes in the lower neck and opposite side of the neck – areas not typically included in the traditional approach. For cancer in the middle area of the head or neck, patients can avoid surgery on both sides of the neck.
The sentinel node biopsy procedure involves injecting into the oral cancer site a weak radioactive substance that marks white blood cells. The substance acts as a tracer and is picked up by the lymph vessels, travelling along the path most likely used by any cancer cells that might drain from the tumor to the lymph nodes. Depending on the patient, cancer cells may travel in different paths or patterns. The first lymph node that the substance goes to is called the sentinel lymph node. Imaging will find it and any other nodes containing the tracer.
The surgeon will remove the suspected lymph nodes along with the oral cancer, and a pathologist will immediately examine the tissue to determine if cancer is actually present in the nodes. If it is, the surgeon will perform a neck dissection to remove the diseased lymph nodes.
However, if the nodes are negative for cancer, then we will avoid a full neck surgery for the patient, says Dr. Ghanem. By using minimally-invasive procedures and personalized medicine, doctors at Henry Ford continue to advance their mission of improving patient outcomes.