Iceman is back, but not his real voice

If you are one of the millions of moviegoers who have seen "Top Gun: Maverick" since it opened in theaters in May, you might be surprised to learn that the brief dialogue you heard from Val Kilmer, who reprised his role as Tom “Iceman” Kazansky, was created via a voice synthesis prototype.

This elaborate sound technique was necessary because Kilmer, who reprised the Iceman role in the long-awaited "Top Gun" sequel, lost his ability to speak after going through throat cancer treatment in 2015. In addition to chemotherapy and radiation, Kilmer had a tracheostomy, which was indicated after he underwent surgery.

“Depending on where the tumor is located, when you're dealing with this type of cancer, it can affect your voice,” said Oncologist Edward Wyluda, DO, at Cape Cod Healthcare’s Davenport-Mugar Cancer Center in Hyannis, who noted that he has not personally looked into the particulars of Kilmer’s disease. “If the patient has laryngeal cancer, you sometimes lose the use of the larynx, either through removal or with chemotherapy and radiation, which can affect the function of the larynx. Sometimes patients need a tracheostomy, such as those who undergo a total laryngectomy (an extensive surgery).”

However, long before a patient faces these kinds of challenges, there is much they can do to prevent head and neck cancers and identify them early on, he said.

“The big things are avoiding smoking and tobacco use and limiting alcohol because both can increase the risk of developing something like this,” said Dr. Wyluda. “It is also important to make sure you have good mouth care and go to the dentist regularly. Your dentist can pick things up during cleanings when they examine your tongue and mouth. They might notice abnormal tissue growth somewhere in the oral pharynx throat area and can help fix something quickly.”

Signs to Watch For

Among the other symptoms patients should pay attention to are:

• Sore throat that won’t go away,
• Trouble swallowing,
• Excessive mouth bleeding, and
• Recurring sinus infections.

More concerning and possibly indicative of metastatic cancer are extreme fatigue, unexplained weight loss, enlarged lymph nodes, or night sweats that have no other cause.

“The symptoms of head and neck cancers are variable depending on the site of a tumor,” Dr. Wyluda said.

Primary care doctors and ear, nose, and throat (ENT) specialists can also spot anything of concern and help discover any cancer early on, when it is typically easier to treat.

“Depending on when they catch it, the first thing that would need to be done is a biopsy,” he said. “If you have some atypical infectious process, like an abscess, it’s important to sample that tissue and get a diagnosis.”

In addition to a biopsy, imaging may be needed, such as a CT scan, Pet scan, or MRI. “This can really give us a better understanding of how extensive the disease is, and then from there, you can kind of determine treatment options.”

Where the tumor is located, along with how advanced the cancer is, helps oncologists formulate a treatment plan for their patients. Overall, options for head and neck cancers include surgery, chemotherapy, and radiation, in different combinations.

“If it's involved in the vocal cords, for example, sometimes surgery could be difficult, so you have to assess it on a case-by-case basis,” Dr. Wyluda said.

In the early stages of certain cancers, it can be treated with surgery alone. At the same time, another more complex disease may require a tri-modality approach, in which the patient undergoes surgery followed by chemo and radiation, he said.

When the region under treatment gets inflamed, it can affect the patient’s swallowing ability, so some patients require a tube that is put temporarily into the abdomen to give them artificial nutritional support.

“It definitely is sometimes scary for patients, and they are a little hesitant to do it,” he said. “So, it's important to remember that the feeding tubes are a temporary treatment that provides them the nutrition they need while giving the throat and larynx area time to heal.”

Depending on the problem being treated, a tracheostomy, like Kilmer had, can be either temporary or permanent. “Some people need a trach because of the extent of the disease and the extent of surgery,” said Dr. Wyluda.

The Hope of Immunotherapy

Other therapies are offering benefits to his patients, he said.

“Immunotherapy has become an option for patients where the cancer is more advanced and has perhaps spread outside of the head and neck area,” he said.

These infusions of monoclonal antibodies or checkpoint inhibitors prime the immune system to fight cancer. “They attack the cancer in a different kind of way and can give us good responses,” said Dr. Wyluda, who indicated that immunotherapy is often palliative care for patients with metastatic cancers. “It's changing the way we approach some of these patients that do have cancer that, while not likely curable, can still get us really good results.”

The process is done right at Cape Cod Hospital and gives physicians like Dr. Wyluda more advanced treatment modalities.

“Immunotherapy is really helping my patients, especially my older ones, and offering them better outcomes and a better quality of life.”