Robotic surgery to increase detection rate

Full project name: Evaluation of the role of tongue base MucOsectomy and Step sErial Sectioning in the diagnostic paradigm for unknown squamous cancers (MOSES)

Tag: Diagnosis

Dr John Hardman

Project type:
Project

Project Leader:
Professor Vinidh Paleri

Researcher:
Dr John Hardman

Commencement date:
December 2018

Length of project:
2 years

Funding provided:
£117,991

Funder:
Sir Adrian Swire

Location:
Multi-centre research project at Oxford and Newcastle upon Tyne University Hospitals and The Royal Marsden

The problem The research The future

The problem

Over the past 30 years there has been an alarming increase in the incidence of oropharyngeal cancer, with a large majority of cases related to human papilloma virus (HPV). Some of these patients will present with a cancer from an unknown primary site (CUP).

Work undertaken prior to this study with a patient focus group emphasised the anxiety involved when the primary cancer is not found and the impact of this unknown on mental health. What’s more, for patients with CUP, radiotherapy or chemoradiation requires irradiation of the whole pharynx leading to severe immediate and long-term side effects.

The research

Dr Hardman and Prof Paleri are going to investigate the impact of a combination of two techniques, one surgical, one pathological, on diagnosis and of treatment of patients with these undetectable primary sites.

Robotic tongue base mucosectomy (TBM) is a procedure, developed in the last 3 years, to remove the entire tongue base tonsillar tissue, thus enabling assessment of the entire area where primary cancer can reside. It’s both minimally invasive and precise.

Step serial sectioning (SSS) is a pathological assessment technique that will then be used to assess the TBM and tonsil biopsies. It involves taking very thin slices of biopsied tissue to find tiny cancer within. Traditionally, only random biopsies of this area are carried out, and it is purely chance that a malignancy is identified.

The future

Our researchers hope that the primary cancer will be detected in a larger number of patients thus enabling targeted treatment to the cancer and the potential for complete removal of primary cancer in some.

Additionally, even where no primary cancer is found, the robust pathological assessment of the mucosa on the opposite side to the neck node (tonsil and tongue base) will assure clinicians and patients of the lack of a cancerous focus, allowing treatment to be limited to one side alone.