Dharamshila Cancer Hospital in India pioneers in performing challenging Head and Neck Cancer Surgeries in North India

India: Department of Surgical Oncology at Dharamshila Cancer Hospital in India has achieved another pioneering step by performing challenging Head and Neck Cancer Surgeries. These are not being performed by any other cancer center in North India with such high success rate. The main objective of these surgeries is to restore normal facial appearance, chewing, swallowing and speech, ensuring a cancer free good quality of life.

WHY HEAD AND NECK CANCER SURGERIES ARE CHALLENGING?

Head and neck Cancer Surgeries require complex infrastructure with a dedicated team of highly skilled and experienced Anaesthesiologists, Critical Care Specialists, Head and Neck Surgical Oncologists, Plastic and Reconstructive Surgeons, Dental and Faciomaxillary Surgeons, Skilled Oncology Nurses, Physiotherapists, Speech Therapists and Counselors. Till recent past most of these patients were considered inoperable. Even now most of these procedures are not being performed anywhere in North India, due to lack of desired infrastructure.

Quality of Cancer Surgery

The trained and skilled Head and Neck Surgical Oncologist has the major role of carefully selecting the operable cases, performing a complete surgery by removing the cancerous body part which has clear margins and removing all the lymph nodes. During surgery dissected specimen is sent for a frozen section to the Oncopathologist for immediate report on the margins. If the margins of the dissected body part are not free from cancer, further dissection is carried out to achieve clear margins to prevent recurrences. The quality of the surgery determines the postoperative quality of the life of the patient.

Reconstructive Surgery

After the removal of the cancerous tissues, a large gap appears, which has to be filled/reconstructed by the Plastic Surgeon so that patient has near normal appearance and other oral cavity functions are restored.

Recovery and Rehabilitation

Post operative recovery with normal/close to normal appearance of the patient, restoration of eating, swallowing and voice require a dedicated team of Critical Care Specialists, Skilled Oncology Nurses, Dieticians, Physiotherapists, Prosthodontics And Speech Therapists, who work together to ensure that patient leads a normal life.

RADIATION AND CHEMOTHERAPY

Depending on the histopathology report of the dissected cancer and the lymph nodes, the need for postoperative Radiation and chemotherapy is evaluated. If required, the same is started to ensure complete treatment and prevention of recurrences.

TYPES OF HEAD AND NECK SURGERIES BEING PERFORMED AT DHARAMSHILA HOSPITAL AND RESEARCH CENTRE.

Conservative Resections for oral cavity (mouth) Cancer

Conservative resections are done for early cancers of the oral cavity. Main objective is to preserve organs and attain good quality of life for the patient For early tongue cancers only wide excision with reconstruction can be done. For lesions of buccal mucosa (Inner lining of cheek) only resection and preservation of part of mandible (marginal mandibulectomy) can be done. This can be achieved with good results using CO2 laser for surgical Resection. For cancers of upper gum only removal of part of maxillary bone can be done with prosthodontic rehabilitation.

Composite Resections

These extensive surgeries are done for locally advanced tumours of oral cavity (mouth) which are caused by tobacco chewing and are very common in south Asia (India). This involve removal of part of jaw / whole jaw with adjoining buccal mucosa (Inner lining of cheek) with or without removal of skin of cheek. Removal depends on adequate margin of resection.

For cancer of tongue, removal of tongue is done with or without removal of jaw and along with this neck dissection (removal of lymph glands in neck) is done. The gap appearing after the resection is repaired by plastic surgery (local / regional / free flaps). After that patient is rehabilitated by physiotherapist, prosthodontic surgeon, speech and swallowing therapist.

Maxillectomy

For cancers of cheek bone (maxilla), radical maxillectomy is done, which involves removal of cheek bone (maxilla) with or without preservation of eye depending on involvement of eye or not. If, cheek skin is involved, that is also removed. These tumours may extend to skull base i.e. near the brain, Resection involves removal of the tumour with preservation of vital nerves, which is technically demanding and involves team of experienced Head And Neck Cancer Surgeons. Neuro Surgeons, Plastic and Reconstructive Surgeons to achieve good cancer control and good functional and cosmetic outcome.

Skull Base & Craniofacial Surgeries

Tumours arising from head and neck region reaching to base of the skull, require combined facial and craniotomy (opening of the skull) approach for their removal to get best surgical outcome. This technique was started at Dharamshila Hospital And Research Centre in 2000 and has been continuously refined to prevent recurrences and give good quality of life to patients.

Mandible Arch and Floor of the Mouth Resections

These challenging surgeries for advanced loco-regional tumours of the jaw, involve removing the entire tumour including jaw, neck dissection for removal of lymph nodes, removing fibula (leg bone) of the patient and reconstructing the jaw with fibula. This is done to ensure that patient's original appearance is maintained and functions of chewing, swallowing and speech are preserved. In this fibular reconstructed Jaw, teeth can be put at later date, so that patient can chew.

Free Flap Reconstructions

Free Flap Reconstruction is a novel plastic reconstruction technique. After cancer resection (removal), large gaps appear in the resected part of the body, which have to be reconstructed by using skin / muscle / bone of the patient. Before the surgery, the part of the body of the patient is chosen as a donor area, ensuring that it aptly matches the area being resected. After taking the graft from the donor area, it is harvested and used for replacing the gap caused by resection. Bone is replaced by a bone from area, where it has minimal function.

This also involves anastomoses (rejoining) of very small blood vessels to restore blood supply and joining of nerves to restore sensory and motor functions of the body. High magnification microscope and very fine sutures (thinner than hair) are used for anastomoses. This procedure is very technically demanding and takes 4 – 10 hours. Dharamshila Hospital is performing these surgeries regularly with very good results.

Carotid Body Tumour Surgeries

Carotid Body Tumours arise from the carotid artery (main artery supplying blood to the brain). These tumors may restrict blood supply to the brain. Resection of these tumours is technically demanding because if blood supply to the brain is hampered, the patient will have hemiplegia (paralysis of half body) or even death. Dharamshila Hospital is performing resection of carotid body tumors regularly with high success rate.

Peripheral Nerve Sheath Tumour Resection

Nerve sheath tumours arise from the sheath that covers the major nerve trunks of any part of the body. The major challenge lies in removing these tumours without sacrificing and damaging the nerves and preserving the functions of the body parts, supplied by the nerves.

Parapharyngeal Tumor Resection

Parapharyngeal tumours arise from and around major vessels (carotid) and nerves coming out from the brain. Major blood vessels and nerves are important for sustenance of life. So, removal of these tumours involves preservation of these vital structures and is a challenging surgery, requiring highly skilled professionals. Dharamshila Hospital is the only hospital in North India performing these surgeries.

CO2 Laser surgeries for organ and function preservation

For early vocal cord and laryngeal cancers (voice box cancer) treatment of choice is laser resection of the vocal cord with minimal thermal damage. This is achieved with endoscopic CO2 laser resection. There is no external cut, the neck surgery is done from inside the oral cavity. The advantage of this procedure is that "patient can be discharged the next day and can resume work within few days". This procedure has got minimal side effects with good voice preservation. CO2 laser surgeries at Dharamshila Hospital are a boom for patients of North India. If CO2 laser surgery is not possible, voice conserving open surgeries are performed, Preserving the voice of a person.

Total Laryngectomies with Voice Rehabilitation

There is hope for patients with advanced cancer of the Larynx (Voice box). Treatment of choice is Total Laryngectomy, a procedure by which the voice box is totally removed. To restore the speech and communication, patients are trained on voice prosthesis or Electro larynx. All patients are suitably rehabilitated and satisfied by our team at Dharamshila Hospital.

To achieve high cure rates and excellent quality of life (free from cancers) adequate infrastructure with team of highly skilled and experienced Anaesthesiologists, Critical Care Specialists, Head and Neck Surgical Oncologists, Plastic and Reconstructive Surgeons, Dental and Faciomaxillary Surgeons, Skilled Oncology Nurses, Physiotherapists, Speech Therapists and Counselors is the crying need of our country.

Dharamshila Cancer Hospital in India has treated many International patients from USA, Canada, Africa and Middle East Countries. They have dedicated wing for International Patient Services for Cancer Treatment.