• 1/15/2007
  • Alberta, Canada
  • Sheryl Ubelacker
  • CBC News (www.cbcnews.ca)

Doctors at the University of Alberta have pioneered a technique that gives most patients treated surgically for tongue cancer the one thing they want most besides survival – the ability to swallow and speak.

Most tongue and other oral cancers are caused by smoking and drinking alcohol – a combination that multiplies the risk dramatically over smoking alone. About 900 Canadians are diagnosed with cancer of the tongue or tonsils each year.

Standard surgery involves removing a patch of skin from the forearm to rebuild the base of the tongue after a tumour is removed. But that procedure alone doesn’t usually provide enough bulk in the reconstructed tongue because followup radiation can shrink and scar the tissue, destroying the organ’s pliability.

The result is a reduced ability to speak and to swallow, the latter often leading to the need for a lifelong gastric feeding tube to maintain sufficient nourishment.

To help protect the rebuilt tongue from the effects of radiation, Drs. Hadi Seikaly and Jeff Harris of the Edmonton university went a step farther, taking an additional paddle-shaped section of tissue from the forearm – a “jelly roll” of fat and connective tissue they have dubbed a beaver tail – to provide extra bulk.

“When you do tongue cancer surgery and you take enough of the tongue, you have to rebuild it somehow so people can talk and swallow,” said Seikaly, a head and neck surgeon who credits a team of specialists from surgeons to oncologists to speech therapists with helping patients recover.

“What we found is the bulk allows the remaining muscles of the throat and the tongue to push the food down, so they have something to act up against as opposed to just putting a piece of skin there without bulk.”

“With our modification, we can get more than 90 per cent of them back to normal eating and talking,” he said, citing an in-house study that measured oral function in 20 patients a year after surgery. “So it makes a big difference.”

It has made a huge difference to 59-year-old Michael Roach of Calgary, who had the surgery in 2002 after being diagnosed with a tumour in the base of his tongue.

“I was prepared to wake up and not be able to function, and not be able to eat but just drink fluids for the rest of my life. Now I eat everything,” said Roach, who owned a mortgage brokerage company that he recently passed on to his children.

“Without Dr. Seikaly, I wouldn’t be here. Without him, I wouldn’t have the function I have,” Roach said from Arizona, where he is vacationing in his RV and sightseeing on his 1989 Harley-Davidson. “Without this operation, in terms of being able to function and eat, I would probably be a hermit. I probably wouldn’t be out talking to people.”

The surgery even allows the skin-grafted tongue to maintain much of its unique sensory abilities because nerves are also reconnected, said Seikaly.

“Believe it or not, within six months they feel that skin on the back of their tongue as their own tongue because the nerve grows into it,” he added. “They would feel the cold, hot. If they prick it with a fork, they’d feel it. If there was any food left around, they would feel it.”

The only thing the surgeons can’t do is rebuild the taste buds at the back of the tongue.

And while the sound of the voice may differ somewhat because of changes to the back of the tongue and throat from the surgery, “the speech for these patients is between 90 and 100 per cent intelligible after surgery,” Seikaly said. “So they actually do go back to normal living and normal functioning.”

“When you think of head and neck surgery, that’s really the second most important thing for patients after living. They need to go back to work and function.”

Roach said that although his left arm has been left with a large patch of scar tissue, he is able to golf, ride his motorcycle and lift weights with no trouble.

Still, he doesn’t downplay the horrifying aspects of the more than 12-hour surgery – which involves multiple incisions and sawing through the lower jaw – and the many months of “slow and painful” recovery, including six weeks of almost daily radiation.

Roach said he had never been a heavy smoker or drinker and had, in fact, virtually quit both about four years before his diagnosis. “So I guess it caught up to me from before.”

“It’s stupid,” he said of smoking and drinking. “Somebody should have hit me in the head a long time ago.”

Dr. Dan O’Connell, a surgical resident in otolaryngology who was lead author of the post-operative study to measure speech and swallowing function after the beaver tail surgery, said doctors are seeing a disturbing trend when it comes to tongue and tonsil cancer: the fastest-rising group of new cases involves people who don’t smoke and drink – and many of them are young people.

“It’s not an epidemic, but it is scary when you realize you can do everything right and still be saddled with this condition,” said O’Connell, whose paper was given the Best Resident Clinical Research award at last year’s annual American Head and Neck Society meeting in Chicago.