Saving a Linguist’s Tongue
The goal of the Head and Neck Cancer Program at Memorial Hermann and McGovern Medical School at UTHealth is to help patients with head and neck cancer and their families through diagnosis and treatment and into recovery and rehabilitation.
“Only 4 percent of all cancers are head and neck. Because it’s a small number, only a few centers specialize in the multidisciplinary treatment these cancers require. Memorial Hermann-Texas Medical Center is one of them,” says Ron Karni, MD, Chief of the Division of Head and Neck Surgical Oncology at the hospital and an Associate Professor who holds joint appointments in the Department of Otorhinolaryngology-Head and Neck Surgery and the Division of Medical Oncology at McGovern Medical School at UTHealth.
Corpus Christi resident David Beck is among the many patients to benefit from the skill of Dr. Karni and Kunal Jain, MD, who is fellowship trained in head and neck oncology and reconstruction and an Assistant Professor of otorhinolaryngology at McGovern Medical School at UTHealth. The two surgeons and a team of other specialists in the clinic and operating room work together to provide patient-centered care for head and neck cancer patients.
In summer of 2017, Beck had what he thought was a canker sore that was not healing. His dentist examined it and advised him to see a specialist for a biopsy if it didn’t heal in a couple of weeks. After a biopsy that fall, he learned he had stage 2 carcinoma of the tongue and was referred to Todd Weiss, MD, an otolaryngologist who practices in Corpus Christi.
“Dr. Weiss said that the cancer was too extensive for him to treat and told me I needed to go to a place where specialists do the kind of surgery I needed every week. He knew of Dr. Karni and Dr. Jain in Houston and referred me there,” says Beck, a linguist who took Russian in high school during the Cold War, joined the United States Navy and was sent to the Defense Language Institute in Monterey, Calif., for a two-and-a-half year immersive training course in Russian. He was stationed in Russia and worked as an interpreter on chemical weapons and nuclear disarmament treaties, including the Intermediate-range Nuclear Forces Treaty, signed in 1987 by President Ronald Reagan and General Secretary Mikhail Gorbachev, and the Chemical Weapons Convention, signed and ratified by most countries of the world in 1993 under the auspices of the United Nations. He returned to the U.S. in 2000, got married and graduated summa cum laude with a bachelor’s degree in mathematics from Texas A&M University Corpus Christi.
Beck traveled to Houston to see Drs. Karni and Jain on Dec. 7, and four days later, he was admitted for surgery. “They gave me a good overview of what to expect during and after surgery,” he says. “They would dissect the tumor and cut out a portion of my tongue, then take a graft from my right forearm to reconstruct the tongue so that I could talk and swallow. I remembered going to the OR and waking up with a very swollen tongue.”
“The cancer was on the right lateral tongue,” Dr. Jain says. “It’s important for everyone to be able to speak after this type of surgery, but because he’s a linguist, we knew it was especially important for Mr. Beck. We replaced the tongue tissue with forearm skin and soft tissue, which is as pliable and thin as the tongue, using microsurgical techniques to reconstruct the tongue by reattaching the very small artery and veins of the forearm flap to the vessels in the neck.”
They also removed the lymph nodes from the right side of the neck for biopsy – standard for these tumors; the lymph nodes came back negative for cancer.
“Shortly after surgery, Mr. Beck’s speech was intelligible, and he was able to start eating two weeks later,” Dr. Jain says. “He’s a healthy man with a long life ahead of him. We wanted to ensure a high quality of life by returning him as close as possible to normal.”
Beck spent 10 days at Memorial Hermann-Texas Medical Center, recovering from the complex surgery under the care of specialized nurses and physicians. “By the time I was discharged on Dec. 22, I was doing very well,” he says. “I never had pain during my stay and didn’t even need an ibuprofen.”
He returned to Corpus Christi before Christmas, and by mid-January, he was taking the majority of his food by mouth. By the end of January, he no longer needed a feeding tube.
His recovery was fast. “They did a very good job. Thanks to their skill and professionalism, I can eat and drink anything,” says Beck, who started working with a speech-language therapist in early March and expects to recover full function of his speech within the next year and a half.
“Because we do so many cases like Mr. Beck’s we have dedicated ORs and can work efficiently,” Dr. Karni says. “We have a team of 20 people, including anesthesiologists, circulating nurses and scrub techs who are focused solely on head and neck cancer cases. Otorhinolaryngologists, pulmonary intensivists and critical care nurses work hand in hand to treat patients with complex conditions in our dedicated ENT ICU, the first in Houston. We take on complex cases like his, day in and day out. We were able to give him a good operation for cancer. Fortunately his tumor was removed with clear margins, no lymph node was involved and no radiation was required.”
Beck, who is retired, hopes to be able to return to speaking Russian in the next months. “Our church has a project not too far from Moscow, and groups visit from Moscow. The Cyrillic sounds of Russian are the most difficult for me, but I’m making good progress,” says Beck. “I had a lot of support from the doctors and staff at Memorial Hermann and the community here in Corpus Christi, and especially from my wife, Katherine Kearley. I’m very grateful to Dr. Karni and Dr. Jain. They’re a great team. It was not a bad experience at all.”