Innovative surgery gives woman chance to be heard
Diane Miner talks with co-workers Michael Carrigan and Linda Seals at their Clarksville office. (Photo by Donna Jones Bailey).
Diane Miner has set a summertime goal for herself: to re-learn how to lick an ice cream cone.
After a cancer diagnosis last fall, nearly one third of her tongue was removed and her tongue reconstructed with a flap of skin and tissue from her arm.
The surgery at Vanderbilt University Medical Center has potentially saved her life, but because the new portion of her tongue has no muscles, Miner has had to re-learn how to talk and how to eat.
"I was worried most about whether people would be able to understand me, and without something like this, I have no doubt I'd be unemployed now," said Miner, who has returned to 50-hour work weeks in her job overseeing several Clarksville, Tenn., physician practices.
Speech therapy and her own determined spirit have resulted in a speech pattern that is very understandable only six months after her surgery. Dr. Terry A. Day, assistant professor of Otolaryngology, predicts Miner will continue to improve for about a year after surgery. He adds that most young, otherwise healthy patients whose cancer is caught early ‹ like Miner ‹ can do equally well.
The use of a free skin flap still attached to underlying tissue, blood vessels, and a nerve, to reconstruct the tongue or other areas is a significant advance in the treatment of head and neck cancer, Day said.
"Head and neck" cancer includes several forms of cancer, the most common of which are cancers of the oral cavity, the larynx (voice box), and neck. Overall, the cure rate for head and neck cancer is about 50 percent, and these forms of cancer are potentially the most disfiguring and disabling, Day said.
"Head and neck cancer is the most obvious kind of cancer to the general public," Day said. "When you go to work or go out to the grocery store, it's obvious that something has happened to you. Patients often retreat into their homes and rarely return to public life."
However, early detection and advances in treatment are offering significantly greater odds of survival and less disfigurement and disability than ever before. In Miner's case, a purplish scar on her neck, two different shades of skin on her tongue and a scar on her wrist are the only tell- tale signs.
"This kind of reconstruction is allowing us to remove larger tumors yet preserve function more than ever before," Day said.
Other advances in treatment of head and neck cancer include investigational new chemotherapies and immunotherapies, as well as new combinations of more established drugs.
Vanderbilt is also participating in the study of a new gene therapy using the tumor suppressor gene p53. The study is reserved for patients with the most advanced head and neck cancers. Preliminary results are expected to be known later this year.
Day's partners in the reconstructive surgeries are Drs. James L. Netterville, associate professor of Otolaryngology, and Brian B. Burkey, assistant professor of Otolaryngology.
In Miner's case, it took about 10 hours to remove the portion of her tongue, remove the flap of tissue from her left arm, sculpt it to replace the missing segment of tongue, microscopically reconnect the blood vessels and nerve into the neck, and perform a skin graft from Miner's thigh to cover the raw area on her arm.
Because the skin from the arm is thin and pliable, it can be contoured to reconstruct not only the tongue, but other parts of the head and neck area. Day said that sometimes bone from the back or leg can be moved along with a flap to reconstruct a jawbone, for example.
The flap from the arm is also preferable to other types of flaps and skin grafts because it can include its own blood vessels and nerve, Day said.
Most cases of head and neck cancer are directly linked to use of tobacco, alcohol or a combination. However, Miner was among a growing number of younger patients with no known risk factors who develop head and neck cancer, Day said.
Miner said she had noticed a little whitish sore under her tongue that was irritated from a nearby tooth. After about three months, it hadn't gone away and she brought it to the attention of her dentist, who recommended a biopsy.
Day said that some evidence now suggests that such cancers may result after trauma to the tissue ‹ from her tooth rubbing the spot on her tongue, for example.
The diagnosis was squamous cell carcinoma. Of her various options, Miner selected the reconstruction because it offered the best hope for a return to normalcy.
"Dr. Netterville said that his first goal was to save my life," she said. "I'm grateful for that, but I feel fortunate to have had physicians who also think beyond that because they were also concerned about the quality of life I would have after surgery."