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Bruce Campbell, MD
BruceCampbellMD (Physician (Verified) )| Communities: Oral Cavity and Pharynx Cancer | Answers: 8 |
| Member Since: Jul. 2012 |
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Dr. Campbell is a Head and Neck Cancer Surgeon. Since completing his fellowship at M.D. Anderson Cancer Center, he has been a leader of the Medical College of Wisconsin Multidisciplinary Head and Neck Cancer Program of the MCW/Froedtert Clinical Cancer Center.
He evaluates patients with tumors of the oral cavity, throat, salivary glands, sinuses, voice box, thyroid, and neck. He coordinates cancer care and performs any necessary surgery. His practice also includes other benign abnormalities of the head and neck.
He has been recognized in both the National and Midwest editions of The Best Doctors in America, as well as being listed as one of the top physicians in Milwaukee Magazine.
Dr. Campbell writes about his experiences in his blog, Reflections in a Head Mirror, on the Froedtert Hospital web page: http://froedtert.com/reflections
He evaluates patients with tumors of the oral cavity, throat, salivary glands, sinuses, voice box, thyroid, and neck. He coordinates cancer care and performs any necessary surgery. His practice also includes other benign abnormalities of the head and neck.
He has been recognized in both the National and Midwest editions of The Best Doctors in America, as well as being listed as one of the top physicians in Milwaukee Magazine.
Dr. Campbell writes about his experiences in his blog, Reflections in a Head Mirror, on the Froedtert Hospital web page: http://froedtert.com/reflections
Professional Info
Credential: MD
Medical school: Rush Medical College
Residency: Medical College of Wisconsin
Fellowship: M.D. Anderson Cancer Center
Areas of expertise:
Head and Neck Cancer
Head and Neck Surgery
Head and Neck Surgical Oncology
Symptom Management in Advanced Head and Neck Cancer
Thyroid Tumors
Voice Restoration after Laryngectomy
Research interests: Quality of Life After Head and Neck Cancer
Hospital affiliation: Medical College of Wisconsin
Practice name: Froedtert Cancer Center
Practice address:
9200 W. Wisconsin Avenue
Milwaukee, WI
53226
Practice phone number: 414.805.3666
BruceCampbellMD Activities
This varies greatly from surgical case to surgical case. In the “good old days,” (before 1970), almost all neck dissections were “radical neck dissections.” This meant that all of the lymph nodes, major muscles, shoulder movement nerves, and jugular veins were removed from the level of the jaw to the level of the collar bone. Today, “selective” neck dissections tend to focus more tightly on removing only the nodes that are at risk for spread.
Neck dissections are done for three reasons: To remove known cancerous lymph nodes. To remove lymph nodes at highest risk of having cancer. To allow surgical access to other anatomy.
The neck dissection is done to gain the most information possible on the cancer’s ability to spread and to allow for informed decision making. For example, if a patient has a small cancer completely removed and all of the nodes are free of cancer, there might not be any need for further treatment such as radiation therapy. If, however, the same patient has a small cancer and has a couple of lymph nodes with cancer in them or cancer that has grown into the surrounding tissues, radiation is almost always recommended.
So, to answer your question, it is common to removed 15 to 30 lymph nodes during a neck dissection for laryngeal cancer. Removing fewer or more does not seem to have any effect on the outcome. Anatomists tell us that there are 100 to 200 lymph nodes in the neck, so even with the more comprehensive neck dissection, we are removing only a percentage of the total number.
Neck dissections are done for three reasons: To remove known cancerous lymph nodes. To remove lymph nodes at highest risk of having cancer. To allow surgical access to other anatomy.
The neck dissection is done to gain the most information possible on the cancer’s ability to spread and to allow for informed decision making. For example, if a patient has a small cancer completely removed and all of the nodes are free of cancer, there might not be any need for further treatment such as radiation therapy. If, however, the same patient has a small cancer and has a couple of lymph nodes with cancer in them or cancer that has grown into the surrounding tissues, radiation is almost always recommended.
So, to answer your question, it is common to removed 15 to 30 lymph nodes during a neck dissection for laryngeal cancer. Removing fewer or more does not seem to have any effect on the outcome. Anatomists tell us that there are 100 to 200 lymph nodes in the neck, so even with the more comprehensive neck dissection, we are removing only a percentage of the total number.
New answer by BruceCampbellMD (Physician - (Verified))
1
Answer |
8 months ago
A “direct laryngoscopy and biopsy” involves a trip to the operating room and a general anesthetic. While the patient is asleep, the surgeon carefully palpates the mouth and throat, then directly looks at the area where the cancer is found, often using a microscope or telescopes. This allows for precisely localizing the cancer and determining which throat structures are both involved and not involved. The biopsies are generally taken with small cutting instruments to try and preserve as much of the normal tissues as possible.
Some biopsies can be obtained through a flexible endoscope in the office. A fiber optic scope can be advanced through the nose to the area where the cancer is located. A tiny cutting forcep can be placed through a channel in these special scopes and a biopsy obtained. For some patients, this approach is better because it avoids an anesthetic. The disadvantages include a less thorough examination and the tiny size of the biopsy.
Finally, some biopsies are obtained using a needle aspiration and examination of small clumps of cells that are retrieved through the needle (Fine Needle Aspiration Cytology). This is effective for neck masses but not particularly useful for the voice box itself.
On the horizon are various tests where specific genetic changes and products (“biomarkers”) will be examined in the spit. These are still experimental and, although useful for screening, will not tell the physician exactly where the problem lies.
Some biopsies can be obtained through a flexible endoscope in the office. A fiber optic scope can be advanced through the nose to the area where the cancer is located. A tiny cutting forcep can be placed through a channel in these special scopes and a biopsy obtained. For some patients, this approach is better because it avoids an anesthetic. The disadvantages include a less thorough examination and the tiny size of the biopsy.
Finally, some biopsies are obtained using a needle aspiration and examination of small clumps of cells that are retrieved through the needle (Fine Needle Aspiration Cytology). This is effective for neck masses but not particularly useful for the voice box itself.
On the horizon are various tests where specific genetic changes and products (“biomarkers”) will be examined in the spit. These are still experimental and, although useful for screening, will not tell the physician exactly where the problem lies.
New answer by BruceCampbellMD (Physician - (Verified))
1
Answer |
8 months ago
What does it mean to be a squamous cell carcinoma and how is this relevant to head and neck cancers?
If a cell is “squamous,” that means that it looks flat under the microscope; thus, squamous cells are flat cells. Squamous cells more cube-shaped when they are first produced and then flatten out as they reach the surface. Eventually, they are sloughed off, only to be replaced by the new cells rising up from below. Thus, squamous cells replenish themselves. When they replenish at the proper rate, everything is fine.
Squamous cells are most numerous on the body’s outside surface and in regions where there is a transition from the outside to the inside. Thus, normal, healthy squamous cells are found on the skin and lining tissues in places such as the ear, nose, mouth, throat, esophagus, trachea, lung, vagina, cervix, and anus.
When cancers arise from these cells, they are called “squamous cell cancers,” or “squamous cell carcinomas.” There are a variety of triggers that can turn a healthy squamous cell into a squamous cell cancer, but the underlying change involves a series of genetic events that push a normal cell to a pre-malignant cell (often described with terms like “dysplasia,” “atypia,” or “carcinoma in situ”) to a cancer cell. Things that can trigger or promote change include UV radiation (for skin and lip cancers), tobacco, alcohol, human papilloma virus (HPV), Epstein-Barr Virus (EBV), and chronic irritation.
Squamous cells are most numerous on the body’s outside surface and in regions where there is a transition from the outside to the inside. Thus, normal, healthy squamous cells are found on the skin and lining tissues in places such as the ear, nose, mouth, throat, esophagus, trachea, lung, vagina, cervix, and anus.
When cancers arise from these cells, they are called “squamous cell cancers,” or “squamous cell carcinomas.” There are a variety of triggers that can turn a healthy squamous cell into a squamous cell cancer, but the underlying change involves a series of genetic events that push a normal cell to a pre-malignant cell (often described with terms like “dysplasia,” “atypia,” or “carcinoma in situ”) to a cancer cell. Things that can trigger or promote change include UV radiation (for skin and lip cancers), tobacco, alcohol, human papilloma virus (HPV), Epstein-Barr Virus (EBV), and chronic irritation.
New answer by BruceCampbellMD (Physician - (Verified))
1
Answer |
8 months ago
The surgeon views his/her task as understanding the extent of the cancer, making certain that all of the proper tests and consultations have been arranged, arranging for any needed biopsies, and helping to explain the treatment options. If the patient and physician decide on surgery as the best treatment option, the surgeon will help explain the surgery (all of the risks, benefits, and alternatives), and also schedule the procedure.
These visits can take a lot of time. The surgeon must make certain that the patient and family understand the treatment and REALLY get a feel for the expected side effects. There are a lot of potential quality-of-life issues involved, including changes in voice, swallowing, breathing, appearance, oral moisture, sense of taste, sleep, pain, eating, weight, and energy level. Not every patient will have problems in all of these areas, but all of them need to be discussed so that the patient can make an informed decision on treatment.
There are resources available for patients to review before that first visit. I would recommend information from the National Cancer Institute (http://www.cancer.gov/cancertopics/pdq/treatment/laryngeal/Patient) the American Cancer Society (http://www.cancer.org/Cancer/LaryngealandHypopharyngealCancer/index) and the American Academy of Otolaryngology-Head and Neck Surgery (http://www.entnet.org/HealthInformation/laryngealCancer.cfm).
These visits can take a lot of time. The surgeon must make certain that the patient and family understand the treatment and REALLY get a feel for the expected side effects. There are a lot of potential quality-of-life issues involved, including changes in voice, swallowing, breathing, appearance, oral moisture, sense of taste, sleep, pain, eating, weight, and energy level. Not every patient will have problems in all of these areas, but all of them need to be discussed so that the patient can make an informed decision on treatment.
There are resources available for patients to review before that first visit. I would recommend information from the National Cancer Institute (http://www.cancer.gov/cancertopics/pdq/treatment/laryngeal/Patient) the American Cancer Society (http://www.cancer.org/Cancer/LaryngealandHypopharyngealCancer/index) and the American Academy of Otolaryngology-Head and Neck Surgery (http://www.entnet.org/HealthInformation/laryngealCancer.cfm).
New answer by BruceCampbellMD (Physician - (Verified))
1
Answer |
8 months ago
Surgeons are usually involved early in the management of voice box cancer patients because of the need to obtain tissue for a biopsy. Occasionally, a patient will present with a neck mass and the diagnosis will be made based on a needle biopsy of the mass rather than with a biopsy of the voice box.
The surgeon can be helpful even for patients who will not have surgery. The surgeon’s office will often have fiber optic equipment needed to view the cancer. This is very helpful prior to treatment to view the extent of the cancer and the movement of the vocal folds. Once treatment is complete, the fiber optic examination helps with surveillance of the cancer site and the rest of the surrounding structures.
The surgeon can be helpful even for patients who will not have surgery. The surgeon’s office will often have fiber optic equipment needed to view the cancer. This is very helpful prior to treatment to view the extent of the cancer and the movement of the vocal folds. Once treatment is complete, the fiber optic examination helps with surveillance of the cancer site and the rest of the surrounding structures.
New answer by BruceCampbellMD (Physician - (Verified))
1
Answer |
8 months ago
Once a diagnosis is established, most centers make certain that a team of physicians and care givers is available to help with treatment decisions and planning. Pretreatment evaluations are frequently scheduled with a speech/language pathologist and a dentist to help the patient and family understand the expected effects of treatment. Depending on the patient and the plan, appointments might be made with an audiologist, quality of life expert, psychologist, pain management expert, dietician, or primary physician. Most patients will also see a surgeon, radiation oncologist, and a medical oncologist prior to treatment.
One of the hallmarks of cancer centers is the Tumor Conference where the entire team can review the patient’s story, understand the findings, review the pathology, view the scans and images, discuss possible research project opportunities, and make treatment recommendations based on the best available evidence and guidelines. This approach works particularly well with patients with laryngeal cancer because there is more than one “correct” approach to many of these patients. For example, some patients with advanced voice box cancer might be eligible for radiation/chemotherapy protocols or surgery with planned postoperative radiation and chemotherapy. The tumor conference participants can discuss the advantages and disadvantages to each approach, considering the patient’s social situation, work and family requirements, other health issues, and other cancer findings. This “many heads are better than one” approach can benefit the patient.
With the best advice available, one or more of the treatment team meets with the patient to review the recommendations. Once question have been answered and resources shared, treatment can begin.
One of the hallmarks of cancer centers is the Tumor Conference where the entire team can review the patient’s story, understand the findings, review the pathology, view the scans and images, discuss possible research project opportunities, and make treatment recommendations based on the best available evidence and guidelines. This approach works particularly well with patients with laryngeal cancer because there is more than one “correct” approach to many of these patients. For example, some patients with advanced voice box cancer might be eligible for radiation/chemotherapy protocols or surgery with planned postoperative radiation and chemotherapy. The tumor conference participants can discuss the advantages and disadvantages to each approach, considering the patient’s social situation, work and family requirements, other health issues, and other cancer findings. This “many heads are better than one” approach can benefit the patient.
With the best advice available, one or more of the treatment team meets with the patient to review the recommendations. Once question have been answered and resources shared, treatment can begin.
New answer by BruceCampbellMD (Physician - (Verified))
1
Answer |
8 months ago
The mainstay of radiology imaging for the voice box is a CT scan. This gives valuable information on the extent of the cancer. The treating physicians wan to understand whether the cancer extends beyond the limits of what can be seen on the surface, whether it destroys any of the supporting cartilages of the voice box, and whether there are enlarged or necrotic (partially dead) lymph nodes nearby. Each of these findings makes the cancer more difficult to cure. The CT scan images can be integrated with the radiation therapy treatment in order to make certain that the cancer is completely covered with the treatment fields.
MRI scans provide similar information and are preferred by some surgeons and radiologists.
PET/CT scans are also useful for more advanced staged cancer because they can look for unexpected involved lymph nodes. As research emerges, it might be possible that 30% of patients have unexpected cancer spread that cannot be identified with “routine” CT scans. More data are needed, however, to make certain that PET/CTs are needed in every case. Generally, for early stage cancers of the true vocal fold (Stage I and II glottic cancers), PET/CT is not particularly helpful.
The surgeon might rely on a CT scan to determine whether the cancer would be amenable to removal with a procedure, either through the mouth (using microscopes, a laser or a robot), or through the neck skin (an “open approach”).
Imaging studies are very helpful and improve the accuracy of staging when compared to the physical exam.
MRI scans provide similar information and are preferred by some surgeons and radiologists.
PET/CT scans are also useful for more advanced staged cancer because they can look for unexpected involved lymph nodes. As research emerges, it might be possible that 30% of patients have unexpected cancer spread that cannot be identified with “routine” CT scans. More data are needed, however, to make certain that PET/CTs are needed in every case. Generally, for early stage cancers of the true vocal fold (Stage I and II glottic cancers), PET/CT is not particularly helpful.
The surgeon might rely on a CT scan to determine whether the cancer would be amenable to removal with a procedure, either through the mouth (using microscopes, a laser or a robot), or through the neck skin (an “open approach”).
Imaging studies are very helpful and improve the accuracy of staging when compared to the physical exam.
New answer by BruceCampbellMD (Physician - (Verified))
1
Answer |
8 months ago
The evaluation focuses on determining whether there is cancer, getting a good look at the voice box (both with radiology studies and a direct view), and understanding the extent of the cancer. The evaluation guidelines by the National Comprehensive Cancer Network (NCCN) and the American Head and Neck Society (AHNS) are similar.
First, a good history and physical are performed. What symptoms does the patient have? Are there problems with breathing, voice, throat pain, or swallowing? How long have they persisted? Is/was the patient a smoker and/or abuser of alcohol? What other health issues are present? The physical exam includes all areas of the mouth, throat, voice box, and neck. The voice box is examined, initially with a fiber optic scope or a mirror. Sometimes, a videostroboscopy (slow motion voice box digital photography) is performed at this point. The oral cavity, throat, and neck are palpated, feeling for masses or lymph nodes. If cancer is suspected, usually the physician can estimate the stage at this point, although there will be refinement as the work-up progresses.
Next, imaging (radiology) studies are performed. The voice box is routinely studies with a CT scan and/or an MRI scan, looking for the size of the mass, areas of involvement that are hidden from view, and enlarged lymph nodes. Patients with more advanced cancers (Stages III and IV) will probably have a PET/CT scan, as well. Many centers will also obtain a chest x-ray or chest CT scan, especially in patients who have been smokers. The scans allow the physicians to refine the exact stage of the cancer and help with treatment planning.
Next, some consultations might be placed depending on the treatment plans. Patients are often sent to see a dentist, a speech/language pathologist, a radiation oncologist, a medical oncologist, and/or other treatment team members.
Finally, a biopsy is obtained and the voice box is sampled in the operating room. The procedure (a “direct laryngoscopy”) allows the surgeon to look directly at the voice box and obtain samples for the pathologist. Sometimes, the procedure involves a microscope or magnifying telescopes. Occasionally, the procedure is done through a flexible scope and does not require anesthesia.
With all of the information from the history, the examination, the imaging, the consultations, and the biopsy, treatment planning can be completed and the cancer treatment started.
First, a good history and physical are performed. What symptoms does the patient have? Are there problems with breathing, voice, throat pain, or swallowing? How long have they persisted? Is/was the patient a smoker and/or abuser of alcohol? What other health issues are present? The physical exam includes all areas of the mouth, throat, voice box, and neck. The voice box is examined, initially with a fiber optic scope or a mirror. Sometimes, a videostroboscopy (slow motion voice box digital photography) is performed at this point. The oral cavity, throat, and neck are palpated, feeling for masses or lymph nodes. If cancer is suspected, usually the physician can estimate the stage at this point, although there will be refinement as the work-up progresses.
Next, imaging (radiology) studies are performed. The voice box is routinely studies with a CT scan and/or an MRI scan, looking for the size of the mass, areas of involvement that are hidden from view, and enlarged lymph nodes. Patients with more advanced cancers (Stages III and IV) will probably have a PET/CT scan, as well. Many centers will also obtain a chest x-ray or chest CT scan, especially in patients who have been smokers. The scans allow the physicians to refine the exact stage of the cancer and help with treatment planning.
Next, some consultations might be placed depending on the treatment plans. Patients are often sent to see a dentist, a speech/language pathologist, a radiation oncologist, a medical oncologist, and/or other treatment team members.
Finally, a biopsy is obtained and the voice box is sampled in the operating room. The procedure (a “direct laryngoscopy”) allows the surgeon to look directly at the voice box and obtain samples for the pathologist. Sometimes, the procedure involves a microscope or magnifying telescopes. Occasionally, the procedure is done through a flexible scope and does not require anesthesia.
With all of the information from the history, the examination, the imaging, the consultations, and the biopsy, treatment planning can be completed and the cancer treatment started.
New answer by BruceCampbellMD (Physician - (Verified))
1
Answer |
8 months ago
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