Make way for robots

/

Though I can’t swear to it, I’m pretty sure that any physician tasked with telling a patient that they have cancer is trained, early on, to avoid opening with, “Dude, you are so screwed.” So it wasn’t too surprising that after the first doctor to scope my throat told me that he found what he suspected was a tumor on the back of my tongue, he quickly followed up with “No one wants to hear that, but this is really treatable and curable, and I think you’re a good candidate for surgery.”

“And that’s a good thing?”

“It is. Not everyone can have surgery for this—it all depends on the size and location of the primary tumor and the number of affected lymph nodes. If it can be surgically removed, you may be able to avoid chemo and, if you’re really lucky, radiation as well. You could be one of the rare ‘one and done’ cases.”

And so, unlike a lot of patients who receive this kind of diagnosis, I tripped out of his office feeling pretty positive about the whole thing. A friend of mine was diagnosed with the same cancer a year before, wasn’t a surgery candidate, and had a rough time with chemo and radiation. If I could dodge that bullet, a happier Chris I would be.

I wouldn’t have said this 15 years ago. At that time, there were the same three treatment options we have today—surgery, chemotherapy, and radiation. As a surgeon friend of mine told me, if you’re lucky, you can get away with one. More likely you’ll have two of them. And if you’re not so lucky, you’ll get all three.

Chemo and radiation treatment hasn’t changed much in the last several decades. It’s a debilitating slog, played out over weeks, but it works. When you come out the other side, there’s every reason to believe you’ll be cancer-free. Surgery has advanced, however.

There’s no way to describe past surgical solutions to oral cancer as anything but barbaric. Cancer is one tough sucker and sometimes you need methods just as tough to deal with it and save a life. If you want to look it up, be my guest, but I still shiver thinking about it. So instead, let’s talk about today.

The challenge of surgically treating oral cancers waaaay back in the throat is that it’s damnably difficult to get to the stuff with our big humanoid hands. The surgeon can’t see what they’re doing, plus how do you design handheld instruments for such a thing?

But what if you could do it with little tiny hands? Labor laws prevent using babies for this work (plus, by the time they’ve been through medical school and years of additional specialized training, they’ve got big and very awkward teenager hands). But what if you could build a robot baby?

Like any thoughtful person, I fear waking up one morning to discover that robots have taken control of the world. While I’m certain that day will come, I’m more likely to lend my fealty to our shiny overlords if they’ve saved my life.

The modern surgical option for oral cancer is termed TORS—TransOral Robotic Surgery, which, of course, invites the redundancy of saying “I’m going to have TORS surgery.” (I’m sure the robots will address this by demanding it be called a “TORS procedure.”) Rather than attempting to jam a golf-bag’s worth of instruments down your throat, a physician now sits before a console and remotely operates a machine festooned with tiny lights, grabbers, cutters,  scoopers, and burners. The doctor guides (Trans) these tools (Robotic), through your mouth (Oral), and cuts away the cancer (Surgery). The advantage of this method is that it avoids accessing the cancer via other avenues and deals with the malignancy in a way that elicits fewer side effects than the chemo/radiation route (though a lower-dose radiation therapy often follows a TORS procedure, which isn’t without side effects). Recovery is also faster.

While TORS has only been around for a little over 10 years, it’s no longer considered exotic. A good insurance plan will cover TORS because it’s often more cost effective than chemo/radiation. But getting such an operation may require you to travel. You won’t find TORS equipment or teams in your local small hospital, but major cancer centers around the globe have them. As this kind of cancer is regrettably a growth business, you’re going to see TORS more widely available over time.

Given the number of words I’ve devoted to TORS, it won’t surprise you that this is the treatment I chose after considering all options and in consultation with the entire Stanford medical team. I was fortunate to satisfy the criteria for having the procedure—my tumor was in a “good” location (accessible and not entangled in my voice machinery), I had just a single affected lymph node, and I am a healthy man in my mid-60s (which, I know, sounds frickin’ old even to me, but for this kind of thing, I’m positively adolescent). 

After weeks of research, physician visits, scans, and even dental work, I was ready for the robot.