Australia's most experienced microlaryngeal and laser surgeon
Professor Havas is Australia’s most experienced laryngeal micro and laser surgeon.
For over 25 years, he has been pioneering techniques of minimally invasive endoscopic laryngeal surgery for benign and early malignant conditions of the larynx in both adults and children. Remember that if you have any symptoms related to voice, difficulty swallowing or a lump in the neck, early presentation is critical. We encourage you to get an opinion from our team to understand what the possibilities are. Early presentation leads to minimal intervention, a better outcome, and longer and better quality of life.
From thyroid cancer at 25 to motherhood
From the outside, 34-year-old Katrina Mae is an accomplished young woman who has managed to strike a perfect balance between work and family. She is a Special Counsel at a top commercial Australian law firm and has a healthy 6-month-old daughter, Amelia. Katrina is also a survivor of papillary thyroid carcinoma, the most common form of thyroid cancer and one that primarily affects younger people. We interviewed Katrina about her head and neck cancer survival journey and how it is has changed her.
Can you tell me about the circumstances surrounding your initial diagnosis?
I received my diagnosis in 2012 when I was 25. I had just gotten engaged, was planning my wedding and my fiancé was away overseas so you can imagine that it was rather dramatic timing. My symptoms began as a sore throat with a little lump. I told my mum and sister who said it’s probably nothing serious but that I should still get it checked out. So I went to the local doctor who said it’s probably just a nodule on the thyroid. They did a biopsy which came as a surprise to me; I thought it would be a swab or something less invasive, but they were sticking needles into my neck while I was awake. If it came back benign, I would have just needed some thyroid medication. My father had had some thyroid issues previously so I assumed it just ran in the family. My doctor then told to see the specialist ENT surgeon Professor Jonathon Clark. When I arrived, he told me that I had papillary thyroid carcinoma (thyroid cancer) and that it may be in my lymph nodes and neck as well. He said he would need to do more biopsies to work out the scope but that I would definitely need surgery.
As a young woman, any type of cancer is not something that one necessarily has on their radar. How did this diagnosis impact you on a personal level?
It was a terrible shock. I went to my appointment with Professor Clark thinking that I’d only be getting some medication. My parents had actually offered to come with me to the appointment because my fiancé was away, and I had said there was no need and that I could go by myself. When I got out, I was overwhelmed and distraught. I immediately rang my parents and told them what had happened. I had actually planned to go out for dinner with some friends afterward as I was so confident I would be fine. I went to that dinner and told my friends that while I have cancer and I’m worried about whether I’m going to live, everything is fine. It was a bit of a denial for a while. It wasn’t until I actually spoke to my fiancé later that night when he rang me from East Timor that it hit home. His reaction prompted my reaction, and I finally recognised that it was very serious and poor timing with my other half out of the country. I’m lucky that I have a good family around who looked after me. I think the medical team that subsequently took me through my surgery and treatment was also phenomenal so I can’t complain.
What did your treatment involve?
I had a radical neck dissection where they removed my thyroid and 159 of my lymph nodes, and I was then treated with radioactive iodine. They also had to remove a small part of my thyroarytenoid muscles which is the muscle that sits next to the voice box, as the cancer was growing into that. I had all my surgery out of St George Private Hospital but then about 8 weeks after I’d had the surgery, I went into St George Public Hospital to their oncology unit for the radioactive iodine which involved swallowing a pill that kills cancerous cells while leaving other body cells relatively unharmed. Part of the thyroid's job in the body is to absorb iodine so it essentially tricks any cancerous thyroid tissue that is left in the body after surgery into sucking up the radiation. They had already removed most of the cancer but if there was anything else floating around my body, they were then able to kill that off with the radioactive iodine treatment. At the end of the treatment, they scanned me to check how much radiation I was emitting which was still only a low frequency. The fact that there was nothing or not much showing up was indicative of the fact that there hadn’t been much left behind by the surgery which gave me quite a bit of reassurance.
Did your treatment affect your voice production?
I saw a speech therapist at St George Public Hospital for a handful of sessions. With the nature of my work as a lawyer, I do a lot of speaking and my voice was getting tired very quickly which affected my projection. I actually didn’t realise it would be a possible side effect before the surgery. The doctors came in while I was in ICU afterwards, asked if I could talk, and then inspected my voice box and throat. I was very lucky that it didn’t affect me severely. After a couple of speech pathology sessions, all I needed to do was put into action the things that they taught me in those sessions.
Did you have access to any peer support services during your recovery?
I haven’t connected with anyone else who’s had head and neck cancer at all. On a few occasions, I’ve been interested to meet either colleagues, clients, and friends down the track who had other types of cancer when they were quite young. We bonded over those experiences to a degree. I actually haven’t even met anybody else who’s had head and neck cancer at all, let alone in my age group. I feel like it’s something that is rarely talked about.
Did you want more patient support during your treatment and subsequent recovery?
I had the support I needed but I was very lucky in that my surgery and treatment were effective the first time around. It was a fairly rough three months, but it was only a three to four-month period that I was having surgery, recovering, and undergoing treatment. This is a relatively short period as compared to people who might have another form of head and neck cancer and need multiple surgeries or multiple rounds of treatment. That said, I can imagine it would be very helpful to speak to other people who have already recovered. That way, you can gauge what are you in for and see a light at the end of the tunnel. I always think that makes you feel better knowing that people feel better with time
Did having thyroid cancer mean certain milestones were delayed for you?
I had to wait at least 12 months to become pregnant after the initial treatment. About three years in, when I went back for some more radioactive iodine for scanning purposes, I again had to wait a further year to conceive. So all up I had to wait four years after the surgery. The other factor is that iodine is quite important for the development of a baby so they have to monitor your medication quite closely before you decide to have a baby, once you’ve had your thyroid removed. Given that I’ve now got my healthy little baby Amelia with me, it all seems worth it.
How do you feel changed by your experience of thyroid cancer?
I grew up being a very gentle, timid kind of person and I was always terrified by medical procedures. I really had to toughen up. It does build resilience. As my mum said to me subsequently, I think about the things that I have gotten through in life and if I can get through that, I can get through anything. The silver lining was that it showed me that I was made of a bit more than I thought in terms of my personal strength.
I am now nine years since my initial diagnosis and remain cancer-free. It was such a scary time, so I would love to do anything to help others facing the prospect of a head and neck cancer diagnosis. Beyond this, I want to support research to find targeted ways to remove all types of cancers that don’t injure the host as much as traditional chemo or radiotherapy.
A game-changer for pain relief
Dr Anders Sederis (our 2019 grant recipient) recently completed his masters thesis in a biodegradable novel mesh impregnated with nanoparticles to prevent pain and optimise healing after tonsillectomy.
This project is part of a group of research projects directed by Professor Havas in the development of novel technologies to treat and improve the quality of life not only of patients with head and neck cancers but also patients undergoing necessary common operations.
The Prince of Wales Hospital Foundation has very generously provided seeding capital for this project to go to second-stage animal studies. We are optimistic of being in a position to commence clinical trials mid to late-2022.
Professor Havas uses special safety precautions while performing laser surgery
In the Covid era, special precautions need to be taken when performing laryngeal laser micro surgery.
Professor Havas has been a leader in this field for over 30 years.
He has not only performed over 1000 Microlaryngeal laser surgeries for a variety of conditions, ranging from benign polyps to aggressive laryngeal cancers, but he has also been seminal in the design of appropriate surgical instrumentation.
If you have a problem with your voice or larynx, he is certainly the man to see.
The Head and Neck Foundation's Fordham School of Translational Medicine
Our multi-disciplinary, problem solving-focused vision: A school of translational medicine in Otolaryngology, Head and Neck Surgery
The traditional definition of translation medicine focuses on translating medical advances from the laboratory to the bedside. However, at the Head and Neck Cancer Foundation, we have a different vision that begins by identifying a clinical need.
“We’re all about looking after patients, treating clinical conditions, getting some insight into where we’re providing good treatment, and understanding where we’re not, so we can work backward to fill a need,” says Professor Thomas Havas.
Although Otolaryngology, Head and Neck Surgery is far from the glamour areas of science research, approximately every third visit to a General Practitioner is for an ENT-related issue. There is huge prevalence with massive community cost and treatments are often more profit-focused than problem-focused.
Professor Havas explains a practical application of this.
“About ten years ago, it started to become popular to wash your nose out with salt water spray. There’s no good evidence that it achieves anything and yet last year in America, Americans spent over $2000 million buying saltwater to wash their nose out with. It’s not science-based but profit-based and it’s usually the manufacturers of the saltwater spray who hire a couple of prominent Otolaryngologists with a significant financial incentive to spruik a product with little evidence backing it up,” he says.
The future School of Translational Medicine in Otolaryngology, Head and Neck Surgery will focus on science-driven solutions to clinical needs as opposed to the current framework that is too often fear and economically driven. We will create an independent school with academic credibility, staffed by senior Otolaryngologists and researchers who appreciate that the hackneyed commercially-driven approach is no longer appropriate.
“The school will provide a grassroots approach ranging from common problems to innovative treatments for Head and Neck Cancer. It will be holistic and ecumenical, focused primarily on improving patient outcomes,” explains Professor Havas.
Another unique aspect of our school will be controlling the commercialisation process. While profit from medical advances is important, it needs to be reframed to become more eco-friendly. This means that a significant amount of profit will not only go to the individuals who own the intellectual property but will be used to support universities and to a lesser extent, hospitals.
“You don’t have to make obscene profits to make medical advances profitable.”
The Head and Neck Cancer Foundation Research Group is already engaging in a multi-disciplinary approach to research. We have been collaborating with biomedical engineers and other scientists for the last three years as evidenced by our research reports.
“What strikes me is that hitherto and in many other areas, how little interaction there is between biomedical engineers and clinicians generally. We bought half a dozen of these students into the operating room and they have never been in an operating room. They are intelligent, they have enormous skill bases that we as clinicians don’t have, but there has been no integrated vision or foresight in terms of bringing the two together,” says Professor Havas.
The School of Translational Medicine will be unique worldwide in its multidisciplinary, inter-disciplinary, problem-focused, and product development-focused approach. As a clinician-led school, it will also include basic scientists, biomedical engineers, and lawyers to teach students about both intellectual property and the commercialisation process.
“The quicker we can bring to market, the quicker it is at the bedside, and the quicker patients benefit,” says Professor Havas.