After having problems with mucus in his throat, Chris Smith scheduled an appointment with his doctor. I never thought it would be cancer. Now, thanks to the work of Dr. Michael Sim and IU Health North’s robotic surgery program, he is cancer-free.
By Charlotte Stefanski, cstefanski@iuhealth.org, writer for IU Health’s Indianapolis Suburbs
Last August, Chris Smith, 59, started having problems with mucus in his throat.
He quickly scheduled an appointment with his primary care physician, but after the examination was over, he recalled the doctor’s worried expression.
Smith wondered what it could be. He has been chewing tobacco for 50 years. He also accidentally swallowed a fish bone a few months ago and wondered if it had torn something.
But the CT scan showed an inverted mass in his throat at the base of his left tongue.
We highly recommend Smith visit Dr. Michael Sim, a surgeon specializing in head and neck cancer and microvascular reconstruction at IU Health Joe & Shelly Schwarz Cancer Center in Carmel.
Smith said with a laugh: “We looked him up on the internet and he looked like a kid. “I was like, ‘He’s a boy and he’s going to operate on me? I do not think so.’ But, my wife convinced me to join.”
During Smith’s first visit, Sim performed a biopsy and discovered that the tumor was cancerous—squamous cell carcinoma caused by the human papillomavirus (HPV).
“It brought tears to my eyes,” explains Smith. “Because I have a lot of unfinished business with my children.”
It was a difficult diagnosis, but Sim was quick to reassure Smith. His cancer is treatable.
Smith added: “When he told me what kind of cancer it was, it went from ear to ear because I really didn’t understand. “He told me I had a good cancer with a high cure rate.”
Additionally, IU Health North recently received leading-edge surgical technology that makes Smith’s treatment plan easier. His surgery is scheduled for November 9, 2022, a week after his sixtieth birthday.
A new and improved way to treat oral cancer
IU Health North’s robotic surgery program has been quite busy over the past seven years, and this fall, the teams welcomed the latest in single-port robotic surgery technology. It is the first and only hospital in the state to do so.
While some types of surgery can be performed using the new technology, it is particularly game-changing for Sim’s work on head, neck and mouth cancers.
“It allows better access to tumors located deeper in the throat, the images are clearer, and the device is better,” says Sim.
Sim usually adopts a minimally invasive approach through transoral surgery, meaning he doesn’t make an incision to access the cancer, but he does surgery through his mouth instead.
He explains that some tumors are easier to remove because they are located near the entrance to the mouth and throat. But others are located deeper in the throat and larynx, in the pharynx and larynx.
“You can’t even remove those tumors without a robot,” Sim said. “It allows us to remove tumors that we couldn’t reach before.”
Before the single-port system, surgery was not an option for patients with tumors located deep inside the throat. Instead, they will need chemotherapy and radiation.
So far, the transition to the new technology has been smooth for Sim and the surgical team at IU Health North. Now, it’s creating more options for patients with deeper tumors—like Smith.
A successful operation
When Smith first heard the phrase “robot surgery,” he was a little unsure.
“The robotic surgery scared me a little bit, that a machine would do it,” explains Smith. “I had to sit and think about it for a bit, but you know Dr. Sim was very professional on the first visit.”
Smith’s son and wife attended that appointment, and he remembers Sim putting them in everything. He even let them stand on his shoulders and watch as he examined and photographed Smith’s tongue and throat, and answered any questions they had.
Personal touch is important to Smith. His wife had lost her first husband to cancer, and he knew his own diagnosis would be terrifying.
Sim assures the family that the robot is not automatic, but instead, he controls it.
“I sit on the dashboard and look through the camera and navigate the arms. I control every aspect of it,” said Sim. “It is very natural and intuitive. When I move, the robot arm moves pretty close.”
Sim adds that the robot’s camera is also binoculars, giving him a three-dimensional view of his mouth and throat. It’s like being in the working throat but not directly there.
All of this made Smith feel comfortable.
“He told me about the robotic surgery and he made me feel confident. He’s very sure of himself and he doesn’t stutter, he doesn’t hesitate,” Smith said. “I am looking for that. He knows everything and he makes me feel comfortable.”
Along with the new technology, Smith is also eligible to participate in a clinical trial that allows for a reduction in treatment intensity, meaning that patients can be treated with surgery alone or surgery followed by radiation reduction and removal. Valence. The goal was to demonstrate that patients could have similar positive outcomes with less toxicity and side effects.
Sim was able to successfully remove the tumor on his tongue, and to make sure the cancer didn’t spread, he also removed Smith’s at-risk lymph nodes, which are usually where neck and throat cancers are located. Spread.
Since Smith’s lymph nodes are cancer-free, he only needs to be monitored after surgery and doesn’t need any chemotherapy or radiation.
Now, four months after surgery, Smith says his tongue feels completely normal, but he still feels numbness or pain from the lymph node removal. That is normal and should go away within a year. He visited Sim for his first PET scan on February 17 to assess the function of organs and tissues. Smith doesn’t have cancer.
“I believe in Dr. Sim. I just did. I believe he really knows what he’s doing. I met doctors who were hesitant, but he knew his job,” Smith said. “I want to say that the nurses in the Intensive Care unit, his team, are outstanding. I feel like he gave me a second chance.”
It’s National Cancer Month
February is National Cancer Prevention Month, and when it comes to head, neck and mouth cancer, Sim says there are some signs to look out for.
These cancers often form a mass in the neck, and he strongly recommends that any mass be evaluated by a head and neck oncologist. He also notes to watch out for trouble when swallowing doesn’t improve, or any voice change or hoarseness persists. Non-healing mouth sores should also be evaluated.
“If it doesn’t come and go, but comes and stays, gets worse and doesn’t heal after a few weeks, then that needs to be evaluated,” he said, adding that smoking and heavy drinking can also increase the risk.
For IU Health North’s robotic head and neck surgery program, Sim hopes to continue to provide excellent service, provide excellent care to patients, and continue to grow in size and volume.
He also hopes that with the continuation of the research program, patients may have an alternative to chemotherapy and radiation in the future.
“We are the primary robotic denture surgery program for the entire state of Indiana and we are very proud of our program,” said Sim. “The number has been growing every year and I think it’s a great option and service that we can offer our patients.”
