Researching, Developing & Teaching Minimally Invasive Head & Neck
Oral Cancer & Sentinel Node Biopsy (SNB)
SNB is an accurate and useful
diagnostic technique, but it's use in head and neck surgery is
only now being introduced to the UK by Prof McGurk. It is a very
accurate way of establishing when otherwise invisible microscopic
clumps of cancer cells start to leave the main cancer and migrate.
It involves injecting a radio
active tracer around the tumour. This is swept away by the
lymphatic fluid to a few sentinel nodes in exactly the same way as
the cancer cells move to the same sentinel nodes.
Prof McGurk speaking on hopes for the future and Sentinel Node
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Currently, without SNB, all
patients with mouth cancer undergo a complex 3-hour neck
dissection operation, in order to protect the 30% of patients
in whom the disease has spread. This means that 70% of
patients have a major and unnecessary operation.
Making SNB available
Unfortunately the SNB test is
till only available (June 2017) in one centre in London (UCLH). However
advocated its introduction into clinical
Professor McGurk has set up a national
training program at University College
London for clinicians and surgical practitioners.
The goal is to introduce SNB
to all the cancer centres in the UK.
This introduction of SNB will
revolutionise the management of mouth cancer in the UK and
will set the pace for Europe and America.
When cancer cells first start to spread from
a malignant tumour
in the mouth or face, the first place they settle is the lymph nodes of the neck. At
present about half
people diagnosed with an early malignant
tumour (less than 4cm in diameter)
will have normally appearing necks when
they present to hospital. Yet we know from
experience that 25% of them will have small
undetectable deposits of a few cancer cells
in their lymph nodes that carry a risk of
developing into tumours. These are undetectable
by current imaging techniques
such as CT, MRI or PET scan.
this 25% of patients, current standard
practice is for all patients to be given a neck
dissection, even though 75% do not need this
quite big operation.
So by using a
much smaller operation it is possible to
separate the patients with tumour spread
(and who therefore need further surgery)
from the patients where the cancer has not
started to spread. These patients therefore
only need minimal surgery and are saved from
an unnecessary neck dissection.
McGurk's test saves 75% of people with early
malignant cancer from a neck dissection.
Guiding Surgery with
Fluorescence - Using 3D tracking and fluorescent markers
Prof McGurk is also
undertaking research to help locate the sentinel nodes more
easily by using fluorescence as well as radiation. He is now
able to add a fluorescent "rag" to the radioactive tracer so
that the sentinel nodes can be found by a combination of gamma
radiation and fluorescence.
(In a separate project,
work is being undertaken with fluorescent particles that can
be injected into the blood and bind to the tumour. The edge
of the tumour therefore becomes clearly visible and makes
surgical excision a more reliable process. This work is only
in its very early stages)
High Court ruling emphasises
consultants' duty to fully inform
profession is conservative and slow to change. In
many ways this is a good trait. More often than not
it protects the patient, but it can also mean that
there is a reluctance to accept worthwhile
are not always discussed or offered. It is important
therefore that patients
are aware of new developments that they can raise
with their surgeon.
This situation has
recently resulted in a significant Supreme Court ruling to the general
advantage of patients
The Montgomery Ruling: Montgomery v
Lanarkshire Health Board
This ruling emphasises that your surgeon
should discuss the full range of available treatment options, even if
the surgeon cannot provide them or does not agree with them.
patient should be informed about the treatment options open and be
supported to make their choice regarding which treatment best meets
Informing the patient is the focus
of the website.
Professor McGurk has pioneered a new way to treat odontogenic
tumours (ameloblastoma). These are tumours
of the jaw arising from teeth. Instead of
resecting part of the jaw, these tumours can
be removed by a minimally invasive technique
which preserves the mandible
and maintains normal facial appearance.
Usually these tumours are treated by quite radical
jaw resection. Evidence is emerging that
this is not necessary.
inferior dental nerve proximity to the wisdom tooth.
Wisdom teeth lie at the back of the mouth and the roots of the
lower ones frequently lie close to a nerve
In very few cases this nerve
lies dangerously close to the root and can be damaged during
extraction. We have developed a technique (Coronectomy) where
the crown of the tooth is carefully removed and the root is left
in position so the nerve is not threatened.
The injury rate to the nerve in
these "at risk" cases is reduced to less than 1% in
comparison to complete extractions. There are very few
complications. In 4% of cases the retained root starts to move
after the operation
and comes to the surface were it can be removed safely since it
no longer threatens the nerve.
Computer Augmented Reality
3D computer augmented reality
allows tumour images to be
projected onto the patient in real time.