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November 16, 2018

Video Gives Patient With Tonsil Cancer Perspective, Hope

By SharingMayoClinic

Linda had been diagnosed with HPV-related tonsil cancer. When she came upon a video on social media featuring two Mayo Clinic doctors discussing an innovative treatment for the disease, the Georgia woman felt she'd been thrown a lifeline.

Linda had been diagnosed with HPV-related tonsil cancer. When she came upon a video on social media featuring two Mayo Clinic doctors discussing an innovative treatment for the disease, the Georgia woman felt she'd been thrown a lifeline.


When she received a diagnosis of tonsil cancer and learned about its treatment, Linda was intimidated. A resident of Georgia, Linda was told that the standard therapy involved a potentially lengthy and difficult course of surgery, radiation and chemotherapy. She nearly decided against treatment.

"The treatment can damage salivary glands and causes dental issues. It can be painful, and patients may need a feeding tube for up to six months,” she says. “Honestly, I said at one point that I wouldn't get treatment."

Linda's cancer was related to HPV — a virus that affects 1 in 4 people in the U.S., according to the Centers for Disease Control. For Linda, it's likely she had HPV for decades before the infection turned cancerous.

A retired teacher who likes to make well-informed decisions, Linda went to her computer and researched HPV-related tonsil cancer treatment options. Her search took her to a YouTube video featuring two Mayo Clinic physicians who gave her a different perspective on her future.

The clip featured Eric Moore, M.D., a Mayo Clinic ear, nose and throat (ENT) specialist and Daniel Ma, M.D., a Mayo Clinic radiation oncologist. The two are co-directors of Mayo's Oropharyngeal Cancer Multidisciplinary Clinic. In the video, they spoke in detail about Linda's specific type of cancer, highlighting an innovative, less-invasive treatment option.

It was enough to prompt Linda to make an appointment at Mayo Clinic’s Rochester campus. And in late September, she had a successful operation that completely removed the cancer from her body.

"Seeing that video changed my life," Linda says. “I can't believe I went from thinking that I might not even have treatment because of side effects to having such an amazing outcome."

Fast-tracked treatment

It was midsummer when Linda first noticed blood as she brushed her teeth.

"Honestly, I didn't pay much attention to it,” she says. “At the same time, I felt like something was stuck in the back of my throat. Finally, one day I looked. One of my tonsils was huge."

A visit to a local ENT specialist led to a biopsy of the mass and a diagnosis of HPV squamous cell cancer. Following the diagnosis, a radiologist first suggested that surgery was not an option, and the cancer would require six weeks of daily radiation therapy.

Linda returned to the ENT specialist, who recommended another approach: a tonsillectomy and removal of lymph nodes from her neck. If the surgeon could not remove the entire cancerous lesion, however, Linda still would require radiation therapy and possibly chemotherapy.

Wanting to explore more options, Linda took matters into her own hands. It didn't take long for her search to lead to Dr. Moore and Dr. Ma's video. A few days after discovering it, and after much encouragement from her children to pursue treatment options at Mayo Clinic, Linda submitted an online appointment request. A few days later, she received a call from Mayo Clinic. A little more than a week after that, Linda and her daughter arrived in Rochester for an appointment in the Department of Otorhinolaryngology/Head and Neck Surgery.


"I knew immediately when I met [Dr. Moore] that I was in good hands."

Linda

"I was apprehensive and at the same time really excited to meet Dr. Moore," Linda says. "When I finally did, I told him: 'I've watched your videos so many times. You are like a rock star.' I knew immediately when I met him that I was in good hands."

Prior to the appointment, Dr. Moore had reviewed Linda's images. During the meeting, both a resident physician and Dr. Moore examined Linda's throat.

"Amazingly, he said I was a good candidate for surgery, which was the best news. I can't even tell you what it meant to hear that," Linda says. "I said, 'Will you do the surgery?' And he said, 'Absolutely. I'll do it Friday.'"

Like all patients seen by Dr. Moore and his team, Linda had a care plan crafted around her specific disease.

"We have a multidisciplinary clinic that we run with Radiation Oncology, and the hallmark is individualized medicine," Dr. Moore says. "We tailor the treatment to the disease. Has the tumor spread, or metastasized? What's its size, location? Is it invading? We consider the person: Who are they, what's their occupation, where do they live? And we try to come up with an individualized treatment plan that is not one size fits all, but optimizes their treatment."

Optimal outcome

For Linda, the treatment that best fit her situation was a procedure called transoral robotic surgery. Dr. Moore and his surgical team performed the surgery, which involved the use of robotic arms to precisely navigate the throat and remove Linda's cancerous tonsil. The team also removed nearly 30 lymph nodes from her neck.

During Linda's surgery, the edges, or margins, of the extracted tissue were tested in a nearby pathology lab. As a result, pathologists were able to immediately determine whether all the cancerous tissue was removed.

When Linda was out of surgery and recovery, Dr. Moore and his team paid a visit to her hospital room. "I was really nervous because I didn't know if they got the whole thing," she says.


"Before going into this, I thought Mayo Clinic was out of my reach, and it wasn't. It was so accessible."

Linda

The news was good. Linda's cancer had not spread to her lymph nodes, which would have required a course of radiation and chemotherapy, according to Dr. Moore.

"If it doesn't spread, we can often get away with surgery alone," he says. "There's a lot less time in recovery, less trouble swallowing. And fortunately, that is how she ended up: treated with just surgery."

Less than a week after surgery, Linda was back home in Georgia.

"I can't believe how fortunate I was to get it done so quickly," Linda says. "I didn't know that much about the Mayo Clinic before all of this. You just hear that Mayo is the premier in health care, so if you have something really, really bad, go to Mayo. But I had no idea it is so finely run. Before going into this, I thought Mayo Clinic was out of my reach, and it wasn't. It was so accessible."


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Tags: Cancer, Dr. Daniel Ma, Dr. Eric Moore, ENT/Audiology, HPV, Oropharyngeal Cancer Multidisciplinary Clinic, Tonsil Cancer

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