Bill Klaproth: This is OMS Voices, an AAOMS podcast. I’m Bill Klaproth, and with me is Dr. Brent Ward, who is here to discuss both the surgical treatment and subsequent reconstruction necessary to restore function and appearance when we’re talking about head, neck and oral cancer. Dr. Ward, thank you so much for being here.

Dr. Brent Ward: It’s my pleasure.

Bill Klaproth: Great to see you. Can you talk first about diagnosing head, neck and oral cancer, and what goes into that?

Dr. Brent Ward: The diagnosis for this disease process is a biopsy. Those biopsies can be pretty small, but if there’s a concern about something in your mouth, somebody’s wondering what this is, getting a biopsy is the way to diagnose and understand, therefore make decisions regarding treatments you might need.

Bill Klaproth: Absolutely. When we’re talking about head, neck and oral cancer, are there often symptoms?

Dr. Brent Ward: Yes, so I would say yes, there can be symptoms, but it’s also really important to understand that it can be asymptomatic, so you can have no symptoms at all. Which is part of why for us, screening for oral cancer is really about having that routine dental care, being in a place where someone who understands and knows the oral cavity is taking a look at you, so they can pick up something that might be abnormal that you’ve never seen and don’t even know is present but they recognize that as being important and something that needs a diagnosis.

Bill Klaproth: Yeah, so that regular dental checkup if you will is always important.

Dr. Brent Ward: When you think about other diseases, oftentimes there’s tests or studies that can be done. In this area, there’s really not. It’s really about the eyes of a trained professional that need to be in your mouth every once in a while taking a look.

Bill Klaproth: Absolutely. That makes sense. So, what surgical treatments may be performed once cancer is diagnosed?

Dr. Brent Ward: Once you have a diagnosis, then there’s going to be a workup that will ensue to try and understand whether the cancer has spread to other places. The initial treatment is going to be removal of the cancer in your mouth and we do that with what we call margins, meaning just an edge of normal tissue to make sure it can be removed appropriately. The first place these cancers tend to spread is to lymph nodes in the neck or the structures that drain the oral cavity. So, if we see that there might be lymph nodes involved, then there’s also going to be surgery on the neck. And even sometimes when we don’t see that a lymph node’s involved, just because of the risk of you having that possibility, surgery on the neck will also be indicated.

Bill Klaproth: Is there a common cancer that is found when we’re talking about head, neck and oral cancer?

Dr. Brent Ward: The most common is going to be tongue, but any site in the oral cavity can be impacted by this. Any changes that you have in any location should raise some suspicion and cause people to take a look.

Bill Klaproth: Are there certain risk factors?

Dr. Brent Ward: Unquestionably. So, the risk factors we’re aware of are smoking and heavy alcohol use. But it’s key to understand that many people present without these risk factors and develop cancer. So, if you don’t have risk factors, you need to not feel safe, but boy we certainly do what we can to get people to not smoke and limit heavy alcohol consumption because those are known risk factors for oral cancer.

Bill Klaproth: After the removal of the cancerous section, what type of recovery or rehab is there?

Dr. Brent Ward: This is what I love about what I do because the functional recovery or the things that we can do to bring people back to normal are phenomenal today, even compared to when I was training years ago. So part of why I want to be here today is to let people know that we can put people back together in ways where you continue to speak, continue to eat and do all of these things, and a diagnosis I think historically was very scary, and continues obviously to be concerning, but we can put individuals back together in ways that we couldn’t do before, so people need to be willing and ready to undergo those procedures.

Bill Klaproth: How important is it to catch head, neck or oral cancer early?

Dr. Brent Ward: Early diagnosis makes a big difference in regards to survival; it also makes a difference in regards to how much tissue needs to be removed as a part of your surgical treatment. And so, it makes a difference in all of those ways. The earlier we can catch this, the better, unquestionably.

Bill Klaproth: So, I know you said a lot of times it’s asymptomatic, but if you feel a bump, lump or rough patch or something doesn’t feel right, don’t fool around, get it checked out? Is that the message?

Dr. Brent Ward: Absolutely. Nothing against primary care physicians, they do a wonderful job, but really, it’s about being in the hands of somebody that’s working in the oral cavity every day. That are going to be able to pick up those kinds of changes.

Bill Klaproth: And these types of procedures really are what OMSs specializes in, is that correct?

Dr. Brent Ward: Absolutely.

Bill Klaproth: So, you’re the expert when it comes to these kinds of head, neck and oral cancers.

Dr. Brent Ward: You want to be in a place where there’s a center of excellence. Where you have individuals who understand the oral cavity, who are operating on it every day and are performing these procedures. That’s what’s going to give you the best outcome. Because it’s not just your oral surgeon, it’s having the speech pathologist there, it’s for some patients, needing radiation and chemotherapy, you want to be in a place where there’s a team to help take care of you.

Bill Klaproth: Let’s talk about that. After the surgery, what type of long-term care takes place, you just mentioned having a speech pathologist and other people, is that what generally will take place? Or obviously, it depends on the severity of the tissue removal, et cetera?

Dr. Brent Ward: Sure, so it’s clearly going to depend on the severity of tissue removal. For some of the smallest cancers, we can just do a small removal and even just close it up with sutures or stitches. Sometimes we need a skin graft, or a little piece of skin from another part of the body. Sometimes in the more complex rounds, we need to actually take one part of the body and transfer it to another. And so, when you think about a kidney transplant, where you’re getting a transplant from somebody else, in these cases you’re getting a transplant for yourself. So, your wrist tissue might be used to reconstruct your tongue or a leg bone might be used to reconstruct your jaw, and in those types of complex situations, you really want the care of a team that can help you get through that, rehabilitate and get back to normal.

Bill Klaproth: So long-term recovery then depends on the severity, but as you said earlier, you want people to know we can put you back together? Do the efficacy of these treatments and follow-up visits, people can lead a normal life after say, tongue cancer and throat cancer?

Dr. Brent Ward: Absolutely. Just a little anecdotal story that is really meaningful to me. I had a patient about a year ago come and she was going to be transferring to our survivor clinic and she said, ‘Is this the last time I’m going to see you?’ And I said, ‘Well, I kind of hope so, because that means you don’t need my services any longer.’ And she gave me a little plaque and the little plaque said ‘Hope’ on it. And she said, ‘Dr. Ward, that’s what you gave me the first time I came to see you.’ And I thought about that, and I thought, ‘I gave you a cancer diagnosis? How was that hopeful?’ But she said, ‘You told me that I’d be able to speak again, you told me I’d be able to eat again, you told me I’d be able to do all these things like I did before. You gave me hope.’ And I guess the message I want people to understand is there remains hope in a cancer diagnosis. Don’t be scared of it. Get in there, get the diagnosis as soon as you can. Because there’s great hope for that functional recovery for getting back all of the things you love to do as you treat this appropriately.

Bill Klaproth: Absolutely, and that is a great message. And thank you so much for sharing that. That is a really beautiful story and the difference that you are making in people’s lives and hope is part of it. Because they think their world is crashing down on them and oh my gosh I’m talking to someone like you that says, we’re going to take care of you.

Dr. Brent Ward: You’re going to be okay. And every situation is different. There’s very advanced disease and maybe there will be some compromises along the way, but the kinds of reconstruction we can do today is so far ahead of even if you go do an internet search and get really scared, we can do things today that we couldn’t do in the past and so go see someone who knows what they’re doing and your outcomes are going to be the best that they can possibly be given your situation.

Bill Klaproth: Absolutely. What the specialty can to do today is amazing, but let’s talk about the future. What’s coming up? Can you talk about the latest advancements in surgical techniques?

Dr. Brent Ward: We’re becoming more and more patient-specific in the treatments, and over the recent past that has primarily been in bone. And so if I’m going to take a piece of jaw and remove that, I’m probably not just making decisions in the operating room, I’ve put your CT scan or your CAT scan or your X-ray into a computer and I’ve manipulated that image on a computer so I know exactly where I want to put your bone, I know where I want to put implants, it’s all pre-planned and helps us be much more accurate. I think down the road, we’re going to see the opportunity to do that with soft tissue as well. And so, there’s currently a foundation-funded research project that I’m kind of the mentor for where they’re looking at soft-tissue defects and saying, well how do we make sure that the right amount of soft tissue is taken from that other part of the body to reconstruct exactly the form and function? And so, I think we’re going to get more and more specific in regards to how we reconstruct these defects. The more specific we get, the better the outcomes we’re going to see.

Bill Klaproth: I was just going to say, these advancements it sounds like it not only helps with the efficacy of the treatment but recovery time, as well? 

Dr. Brent Ward: There’s some amazing work being done. We’re here in San Diego, there’s some amazing work being done in San Diego, particularly with the Armed Forces, where they’re making some advances in regards to functional recovery but doing it so much quicker than the rest of us have been able to do and it’s about resources. Being able to put those resources in but I think what we’re going to see is that things that used to, a surgery where you stayed in the hospital for a week, you’re now going to be getting out in a couple of days. And getting to be able to chew, where we used to… when we started, even when we were beginning to do this, you had to wait two years to get your implants. Now people can get implants in the operating room, they can get teeth on top of those implants, you can be chewing very quickly. And so, I think you’re going to see a speed of engagement that allows us to get you back to whatever your best normal’s going to be, and it’s going to happen really quick.

Bill Klaproth: Hope is getting turned into reality. This is great, Dr. Ward, I love talking to you. So, can you share some final thoughts for someone listening who potentially is battling head, neck and/or oral cancer?

Dr. Brent Ward: My advice is hit it head on. It’s a challenge, there’s no question, but hit it head on. And go and get the treatments you need as soon as you possibly can, because the sooner we can diagnose this, we’re going to limit the amount of surgery you need to have done, and you just go, go get it done, and get in the hands of some folks who know what they’re doing.

Bill Klaproth: Thank you, Dr. Ward, for educating us on head, neck and oral cancer. It is scary to think about, but your message of hope has been well-delivered and thank you for that, we appreciate it.

Dr. Brent Ward: Absolutely, I appreciate your time.

Bill Klaproth. For sure. And once again, that is Dr. Brent Ward and for more information and the full podcast library, please visit MyOMS.org. And if you found this show to be helpful, and hopefully you did, please make sure to share this on your social channels and don’t’ forget to subscribe. Thanks for listening.