Improving head & neck cancer diagnoses, new treatment for advanced ovarian cancer and preoperative recommendations for ACL injuries

More Vigilance Will Hasten Head & Neck Cancer Diagnoses

Despite the release of?clinical guidelines?from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) in 2017 on the evaluation of a neck mass in adults, diagnostic delays in identifying head and neck cancers remain common and are a detriment to patients.?

According to?Brian Burkey, MD, MEd, Chair of the Department of Otolaryngology-Head and Neck Surgery at Cleveland Clinic Indian River Hospital and Institute Chair of Surgical Specialties for Cleveland Clinic in Florida, “There is a disturbing lack of suspicion when it comes to evaluating patients with neck masses, and as a result, patients are often diagnosed months after initial presentation. This delay can limit treatment options and worsen outcomes.”?

An asymptomatic neck mass is often the first and sometimes only clinical evidence of head and neck squamous cell carcinomas (HNSCC). The AAO-HNSF clinical guidelines on neck mass evaluation assert that adults presenting with an asymptomatic neck mass should be considered malignant until proven otherwise in patients with risk factors for developing head and neck cancer.?

Dr. Burkey echoes the importance of this essential first step to a timely diagnosis, recommending a referral to a specialist for all adult age groups, especially those 40 and older, when a neck mass persists for more than a month.?

Read more about head and neck cancer causes and treatments.??

Subscribe to The Rounding Report with Cleveland Clinic in Florida.

Innovative Treatment for Advanced Ovarian Cancer

According to the American Cancer Society, ovarian cancer diagnoses and deaths have been declining for the past two decades, but the overall five-year survival of epithelial ovarian cancer (EOC) -- the most common type -- remains around 50% and drops to 30% for metastasized disease.? A new treatment approach provides hope.?

Surgeons at Cleveland Clinic Weston Hospital combined robotic-assisted cytoreductive surgery with laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) for the first time to treat a patient with advanced ovarian cancer. Board-certified gynecologic oncologist?Joel Cardenas Goicoechea, MD, MBA, collaborated with?Conrad H. Simpfendorfer, MD, FACS, Director of Hepatobiliary & Pancreas Surgery, on the novel case, demonstrating the latest approaches to treating the most lethal gynecologic cancer.?

“Right now most patients with ovarian cancer have open surgery to achieve maximal debulking, but in very select cases we can use a minimally invasive approach,” says Dr. Cardenas.?

While laparotomy is the current standard of care for advanced stage ovarian cancer, a number of small studies have demonstrated that minimally invasive interval cytoreduction may be able to achieve a high rate of complete cytoreduction along with better perioperative outcomes. Combining this minimally invasive surgical approach with HIPEC, which cites positive findings from multiple prospective studies and a trial published in 2018 to lengthen recurrence-free survival, made sense.?

“The goal of HIPEC is to target residual disease following cytoreductive surgery by perfusing the peritoneal space with a heated solution of chemotherapy agent for 60 to 90 minutes,” explains Dr. Simpfendorfer, an early adopter who helped launch Cleveland Clinic’s?HIPEC program in Florida in 2015.??

Time will tell if the unique treatment combination extends the patient’s progression free survival, but Dr. Cardenas is optimistic. “She is doing very well today under the care of a medical oncologist as she completes 3 additional cycles of chemotherapy,” he says, noting the patient will also receive treatment with PARP inhibitors for up to three years.?

Learn more about this treatment for advanced ovarian cancer.?

Aspiration and Corticosteroid Injections Safe for Young Patients After ACL Injury

Cleveland Clinic orthopaedic surgeon Kurt P. Spindler, MD, is on a mission to document that aspiration and corticosteroid injection in the knee is safe and beneficial for young, healthy patients following anterior cruciate ligament (ACL) rupture and before reconstructive surgery.??

Many surgeons remain reluctant to perform the procedures due to fear of infection, despite growing evidence that knee aspiration and corticosteroid injection reduce the risk for post-traumatic osteoarthritis (PTOA) following ACL rupture.??

Dr. Spindler and his colleagues recently published a retrospective?study?in?The American Journal of Sports Medicine, showing that over a 10-year period there were zero infections in 693 consecutive patients who underwent ACL reconstruction, including 273 who received aspiration and injection after the ACL rupture but before the surgery. Importantly, individuals evaluated in the study were between ages 10 and 65, with a median age of 26 for those who received the aspiration/injection.?

“That’s what research is about, trying to document what exists and what doesn’t exist. In my population, infection due to aspiration and injection did not occur,” says Dr. Spindler, who served as the 2021-2022 President of the American Orthopaedic Society for Sports Medicine.?

Learn more about this ACL injury treatment.?

Learn more about referring your patients to Cleveland Clinic in Florida.?