<img class="alignnone size-full wp-image-35370" src="https://mdthinks.com/wp-content/uploads/2017/12/treatment-for-throat-cancer-gives-dentist-new-point-of-view.jpg" alt=" After undergoing robotic surgery, radiation therapy and chemotherapy as part of a clinical trial on cancer, Bruce Trulson he can take better care of his own patients. "width =" 805 "height =" 453 "/>
After undergoing robotic surgery, radiation therapy and chemotherapy as part of a clinical trial to treat cancer, Bruce Trulson has gained a new understanding of how he can best take care of his own patients.
In 2015, after nearly 40 years of practicing dentistry, Bruce Trulson, DDS, learned to take care of his patients when, after a diagnosis of throat cancer he became a patient himself .
That summer, Bruce noticed that while he was shaving, a lymphatic ganglion under the right side of his jaw was swollen. When this remained for a few weeks, Bruce called his primary care provider Mayo Clinic . The call put on a trip not only to a surprising diagnosis, but to a unique approach to treating throat cancer. It also deepened Bruce's understanding of his own practice.
"That made me a better dentist," says Bruce, who lives and works in Stewartville, Minnesota. "Since coming back to work after my treatments, I've had a number of patients who have suffered cancer, they come back to see me because I've been there and you've done that, you speak the same language if you left. through this kind of thing. "
The experience has also changed the way Bruce performs his patient exams.
"I am much more aware of my patients' lymph nodes," he says. "People come to see the dentist regularly, and we are the first line to find these things."
A striking diagnosis
Bruce's path to survival began in an examination room with his primary care physician, Jay Mitchell, MD ., Who is part of the Department of Family Medicine to Mayo Clinic & The Rochester Campus . After examining Bruce, Dr. Mitchell ordered an ultrasound of the swollen lymph node. He then referred Bruce to the head and neck specialist of the Mayo Clinic Eric Moore, M.D. Otorhinolaryngology . Bruce, who had no other symptoms beyond swelling, was waiting to be diagnosed with an infection and to receive an antibiotic. Instead, Dr. Moore ordered a computed tomography and a biopsy .
Bruce had the biopsy on a Tuesday in August. Subsequently, he returned to see Dr. Moore, where he learned that he had no infection. He had cancer.
"It was like being hit on the side of my head with a two-four to hear this news," says Bruce. "But Dr. Moore had an exceptional way in the chair, he was very, very sensitive to my needs."
Blindsided by his diagnosis, Bruce called his wife and asked him to meet him in Dr. Moore's office. They learned that additional imaging with a positron emission tomography was necessary before his doctors could plan his treatment. The analysis, conducted this afternoon, revealed that the cancer had not spread beyond Bruce's neck. This meant that Bruce could have the tumor removed the same week.
"It was as if I'd hit on the side of the head with two out of four to hear this news, but Dr. Moore had an outstanding attitude to the chair and was very, very sensitive to my needs. "- Bruce Trulson
"That kind of puffed me out of my chair, how fast he was able to move the ball, and impressed me on the significance of the diagnosis and making the treatment the as soon as possible, "explains Bruce. ]
Bruce also had his own quick thought to thank for the speed with which his treatment advanced. His swift action to have the swollen lymph node checked was essential to stopping cancer before it spread beyond his neck.
"Tonsils and the base of the tongue are areas that do not have much sensation, you can develop bumps and sores that you can not feel," says Dr. Moore. "Most people with this type of cancer do not know it until they have reached advanced stage."
Bruce learned that his cancer began as a lesion at the base of his tongue and spread into his lymph nodes. But the good news was that it was very treatable.
A new approach
A multidisciplinary team, including Dr. Moore, Daniel Ma, MD in Radiation Oncology and Katharine Price, MD in Medical Oncology formed around Bruce to plan his treatment. Bruce had two options. He was able to receive traditional treatment combining surgery at six to seven weeks of radiotherapy and with chemotherapy . This option often has high success rates. But it can leave patients with life-altering side effects such as damaged salivary glands and taste buds destroyed.
An alternative that the team presented to Bruce would place him in a clinical research trial that also used surgery, radiotherapy, and chemotherapy. But the study examined whether the radiation dose reduction was half for people with cancer from the tonsils or the basal of the tongue and caused by the human papillomavirus, would maintain the same rate of cancer control as the traditional practice, while reducing side effects.
"They hope that if this study ends, and that the results are as good as they wish, it will become the standard of care for this particular type of cancer." – Bruce Trulson
"With the increase in the human papilloma virus, we are starting to see more people with these tumors, and more people are surviving," says Dr. Moore. "But they have more side effects, so we wanted to see if we could de-escalate the treatment process."
For Bruce, it was a clear choice.
"Being a dentist and knowing the side effects of radiation to the head and neck, I decided to go to study," he says. "They hope that if this study is going on, and that the results are as good as they want, this will become the standard of care for this particular type of cancer and the beauty of this treatment is the side effects." considerably diminished. "
A step forward successful
Bruce says his doctors pointed out that because the trial involved a new treatment, they could not tell him with certainty how it would work.
"I had a lot of confidence in the Mayo Clinic," Bruce says. "I did not think that they were going to do a study like this unless there is good evidence that the results would be good."
The first step in reducing the amount of radiotherapy required for these patients is to use a minimally invasive surgical procedure. Robotic surgery that uses curved instruments, a telescopic camera, and laparoscopic tools allows surgeons to see patients' tissues and cut out diseased parts without making incisions.
"If we can take it using the mouth as a natural orifice, healing is much faster," says Dr. Moore.
During Bruce's operation, the tumor was removed using this minimally invasive approach, and more than 40 lymph nodes, four of which were cancerous, were removed. Bruce is awake from his operation with several tubes coming in and out of his body. But his doctor's predictions about his recovery – as well as their predictions about the side effects of his treatment regimen – went as planned.
"I am now back in dentistry, mountain biking, fishing, reading good books and, above all, living with my grandchildren and my wife, who is the best caregiver in the world. "Dr. Moore, Dr. Ma, Dr. Mitchell, the nurses, everyone in the department was so kind and caring, I really felt like they cared about me." I was not just another number that was 39, they had to deal with. "
A result that changes the practice
In early October, Bruce began radiotherapy and chemotherapy. From Monday to Friday for two weeks, he received radiotherapy sessions in the morning and afternoon. One day a week, Bruce also received a chemotherapy infusion between his radiation therapy sessions.
"I felt like a wet rag by the time the day was over," says Bruce. "But my feeling was:" Let's finish it and do not prolong it. ""
Bruce had some side effects as a result of his treatments, including dry mouth, mouth sores and loss of taste. But he feels that the adjustments he had to make, like drinking more water and eating more slowly, are minor hurdles compared to the alternative.
"These tests have the potential to change the standard of care, we are very excited about them." – Daniel Ma, M.D.
"I really believe that my doctors at the Mayo Clinic have saved my life, and I am very, very grateful for that and the way everyone has treated me," Bruce says.
Bruce's low side effects with the other 79 participants in the clinical trial. Compared to traditional treatment of throat cancer, where 40% of patients need long-term feeding tubes due to complications due to side effects, no one needed a long term feeding tube. And two years after treatment, the cancer control rate is the same for study patients as for patients receiving traditional high-dose therapy.
Drs. Moore and Ma hope that the trial, which has now reached the third and final stage, continues to demonstrate the effectiveness of lowering the amount of radiotherapy needed to treat certain head and neck cancers. neck.
"These tests have the potential to change the standard of care," says Dr. Ma. "We are very excited about them."