Baptist Health Miami Cancer Institute offers the only FDA-approved single-port robotic system for transoral robotic surgery.  Accessing the surgical site through the mouth without having to make an incision, physicians are now able to use the new technology for patients with oropharyngeal cancers — cancers of the tonsils, the back of the tongue and back of the throat, and the soft palate.

“We are able to get small tools into a hard-to-reach area and provide better visualization,” says Geoffrey Young, M.D., Ph.D., chief of head and neck surgery at the Institute. “The new technologies really allow individualized approaches to treatment.”

The single-port technology is often a better option than traditional, open surgery because it has fewer risks and may allow some patients to avoid chemotherapy and radiation therapy, which can be very effective but also carry toxicity risks. The minimally invasive procedure is just one of many sophisticated solutions physicians at the Institute have for patients with oral and head and neck cancers.

Dr. Young recently sat down with Alessandro Villa, DDS, MPH, Ph.D., chief of oral medicine, oral oncology and dentistry at the Institute and Baptist Health, for a Baptist Health Talk podcast for April’s Oral, Head & Neck Cancer Awareness Month. Approximately 71,100 cases of head and neck cancer are diagnosed in the U.S. each year, according to the National Cancer Institute. Unfortunately, over the past decade the incidence has increased significantly, particularly among younger adults.

Foremost on their minds is the prevention of head and neck cancers. The human papillomavirus (HPV), the most common sexually transmitted infection in the U.S., is at the root of the rise in cases. “We have a cancer prevention vaccine,” Dr. Villa says. “It’s safe, it’s effective. It not only prevents HPV-associated oropharyngeal cancer, it prevents many others caused by HPV persistent infections.” The HPV vaccine is recommended for children beginning at age 9 through 26. Adults up to age 45 may also benefit from the vaccine, especially if at risk of HPV exposure.

Physicians should discuss the vaccine with their patients and also speak with them about other known risk factors, such as tobacco use, excessive alcohol use and chemical exposure, the doctors agree. “But if you look at Australia, where they have a 95 percent vaccination rate, there are HPV-related diseases that they have not seen in five years,” Dr. Young says. “If you eliminate the cancer, we have a win for the world.”

Primary care physicians, pediatricians, dermatologists, dentists, dental hygienists and urgent care and emergency physicians should pay particular attention to patients complaining of:

• A lesion or sore in the mouth that won’t heal.
• Pain in the mouth or at the back of the throat.
• A lump, often not painful, in the neck.
• Difficulty swallowing or chewing.
• A change in the voice, typically hoarseness.
• A change in hearing or pain behind the ears.

Also be aware that leukoplakia, a disorder present in up to 4 percent of the population, places people at higher risk for oral cancers for which they may need to be under active surveillance or have their plaque biopsied. “Leukoplakia is defined as a wide plaque that doesn’t go away. Several lesions can be white, but typically leukoplakia has certain clinical characteristics that include demarcation of the margins. The tongue is the most commonly affected site,” Dr. Villa says.

It’s important for patients with oral and head or neck cancer to be treated at an experienced, comprehensive center like Miami Cancer Institute, the doctors say. “There are many different treatment options in the head and neck landscape,” Dr. Young says. “That’s one of the reasons why a multidisciplinary team is very important. You’re talking about critical areas of anatomy that involve speaking, communication, eating, taste, breathing. We want to preserve as much of that as we possibly can when treating these diseases.”

Treatment may involve surgery, chemotherapy, radiation or a combination of approaches. Dr. Villa is the only cancer center-based, board-certified oral medicine specialist in South Florida. The team also includes a variety of physicians, speech-language pathologists, nutritionists, nurse navigators and other specialists to help patients with specific challenges.

The Institute offers proton therapy for certain patients, which provides very targeted radiation, sparing nearby healthy tissues. Additionally, immunotherapy, which uses medications to boost the body’s own immune system to help kill cancer cells, is being studied for its ability to treat head and neck cancers.

Good oral health is essential for all cancer patients. The Institute follows American Society of Clinical Oncology guidelines that all patients who are scheduled to have radiation therapy see their dentist for evaluation. “The goal is to minimize any sources of dental infection,” Dr. Villa says. The Institute also offers treatments and recommendations for maintaining optimal oral health during treatment and can assist patients who develop common side effects, including xerostomia, hyposalivation and dysgeusia.

Drs. Young and Villa are excited about promising technologies and treatments, for example using AI to help detect a cancerous lesion. “There’s a lot of research right now on this,” Dr. Young says. “The mouth is easily accessible. So now there are tools in which you can take a photograph and the machine algorithm gives a differential diagnosis. We aren’t using this in clinical practice, but I think this is a tool that will become fundamental as a screening tool in the community.” The Institute is participating in an AI diagnostic research study.  

“As research progresses, combination therapies and novel drug development offer hope for better survival and quality of life. We are getting closer to more effective and less toxic solutions,” Dr. Young says.