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State-of-the-Art Surgery Keeps Tongue Cancer Survivor at the Dinner Table

April 19, 2022

And on the eighth day, Mark Guerriero ate meatloaf, mashed potatoes and green beans. For most people, that just sounds like dinner. But for Guerriero, it was a milestone, since only a week earlier surgeons Akshay Patel, DO, FAOCO, and Clinton Kuwada, MD, Co-Directors of Hartford HealthCare Cancer Institute’s Head and Neck Cancer Program, had split Guerriero’s jaw in two in order to remove a cancerous tumor from the base of his tongue and then reconstructed his tongue by transplanting skin and blood vessels from Guerriero’s wrist. It had been a long journey from Guerriero’s initial diagnosis in January 2020 of HPV-related, p16 positive squamous cell carcinoma on the right side of the base of his tongue. He had gone through an intense regimen of radiation and chemotherapy, but by January 2021 the cancer had returned. Patel scheduled a surgery that would remove the tumor, the lymph nodes from his neck, and then reconstruct his tongue using a sophisticated microvascular surgery technique called a free flap, in which tissue from elsewhere on the patient’s body is used. “I’d never been hospitalized in my whole life,” Guerriero said. “And they said they were going to do this. But Dr. Patel explained everything to me, step by step. They were going to cut me from ear to chin to lip, and then saw my jaw in half. But he said, ‘this is going to work.’ He said I was going to be alright. And everything that they told me was going to happen, happened.” Started with a sore throat After digging into symptoms of what he thought was strep throat, Guerriero discovered that he had cancer. In October of 2019, he went to his local urgent care center in Enfield with a sore throat. The strep test was negative, but the doctor he saw asked him about a bump on his neck. “I told him I had noticed it a few weeks ago but it didn’t bother me,” he said. “It didn’t hurt, it wasn’t itchy or anything.” The bump on the right side of his neck “looked sort of like a swollen bee sting.” The urgent care provider gave Guerriero the number of a local otolaryngologist, “and he said, take the first appointment you can get. It scared the hell out of me.” A needle biopsy came back clear but a core biopsy was ordered, which came back positive for squamous cell carcinoma. Once he received his diagnosis, Guerriero was referred to Dr. Patel, but given his cancer stage, Guerriero was not a candidate for surgery and instead began seven weeks of radiation and chemotherapy. When he started, he weighed 287 pounds. By the end, he was only 214. “Cancer is a helluva weight loss program,” he said. “I never missed a day of work but by the end I just couldn’t stand food. Everything tasted like metal.” Guerriero recovered well and was essentially cancer free. He was diligent in following up for cancer surveillance, and during a routine visit with Dr. Patel in January 2021, a recurrent tongue ulcer was discovered. A biopsy was performed and confirmed the recurrence of Guerriero’s cancer. A ‘salvage’ operation Patel recommended surgery to remove the ulcerative tumor and lymph nodes from his right neck and a free flap reconstruction of the tongue. Skin, soft tissue and blood vessels were carefully taken from Guerriero’s left wrist to rebuild his tongue. After the 10-hour operation, Patel and Kuwada told Guerriero he could expect a full recovery. “Am I going to look like Mark again?” Guerriero asked his doctors. “Yes, you are,” he was assured. Guerriero spent four days in the ICU at Hartford Hospital followed by six days of recovery. On the eighth day, “they sent me for a swallow test, where they had me swallow different things, different textures and thicknesses. And then that night I had meatloaf, mashed potatoes and green beans, and I cleaned that plate. I couldn’t believe I was still able to swallow.” “It was a complete success,” Patel said. “The reconstruction was excellent, he is currently cancer free, he eats a regular diet. Our goals are always to cure the patient of cancer, maintain function and cosmesis and maximize quality of life. We accomplished all that.”

Hartford HealthCare Cancer Institute