Head & Neck Cancer

Head & Neck Cancer - About

Head and neck cancer accounts for five to 10 percent of all cancers in the United States. Head and neck cancer is more common in people over age 50 and three times more common in men than in women. If detected early, head and neck cancer is often curable.

These cancers can affect the nasal passages, sinuses, mouth, throat, larynx (voice box), swallowing passages, salivary glands and thyroid gland.

Ninety percent of cases of head and neck cancer) begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat). These cancers are often referred to as Head and Neck Squamous-cell carcinoma, abbreviated as HNSCC. Head and neck cancers can also begin in the salivary glands, but salivary gland cancers are relatively uncommon. Salivary glands contain many different types of cells that can become cancerous, so there are many different types of salivary gland cancer.

Symptoms of head and neck cancer may include : A lump or sore that does not heal; a sore throat that does not go away; trouble swallowing; a change or hoarseness in the voice.
Using tobacco or alcohol increases your risk. In fact, 85 percent of head and neck cancers are linked to tobacco use, including smoking and smokeless tobacco. If found early, these cancers are often curable. Treatments may include surgery, radiation therapy, chemotherapy or a combination.

Head and Neck Cancer - Diagnosis

There are a wide range of tests used to diagnose cancer. If cancer is present doctors will also be looking to see if it has spread to another part of the body, called metastasis. For most types of cancer, a biopsy (removing a small amount of tissue or fluid for testing) is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. Some tests may also determine which treatments may be the most effective.

If a person has symptoms and signs of head and neck cancer, the doctor will take a complete medical history, noting all symptoms and risk factors. The following tests may be used to diagnose head and neck cancer:

Physical examination/blood and urine tests. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. Also, the doctor will carefully inspect the nose, mouth, throat, and tongue for abnormalities.  Blood and urine tests may be performed to help diagnose cancer.

HPV testing. Evaluation may include testing for HPV (Human Papilloma Virus) infection. HPV has been linked to a higher risk of some head and neck cancers. In some cases, whether a person has HPV can also be a factor in determining which treatments are likely to be most effective.

Endoscopy. This test allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The tube is gently inserted through the nose into the throat and down the esophagus to examine inside the head and neck. Sedation medications may be given to allow the patient to become more relaxed, calm, or sleepy. The examination has different names depending on the area of the body that is examined.  A laryngoscopy views the larynx. A pharyngoscopy views the pharynx.  A nasopharyngoscopy views the nasopharynx. When these procedures are combined, they are sometimes referred to as a panendoscopy which is typically done while the patient is under general anesthesia.

Biopsy. A biopsy is the removal of a small amount of tissue which is then sent for analysis by a pathologist.  A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. One common type of biopsy is called a fine needle aspiration. During this procedure, cells are withdrawn using a thin needle inserted directly into the tumor or lymph node. The cells are examined under a microscope for cancer cells, which is called a cytologic examination.

Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy.

X-ray/barium swallow. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A barium swallow may be required to identify abnormalities along the swallowing passage. During a barium swallow, a person swallows a liquid containing barium, and a series of x-rays are taken. Barium coats the lining of the esophagus, stomach, and intestines, so tumors or other abnormalities are easier to see on the x-ray. A special type of barium swallow called a modified barium swallow may be needed to evaluate specific swallowing difficulties. If there are signs of cancer, the doctor may recommend a computed tomography (CT) scan.

Ultrasound. An ultrasound uses sound waves to create a picture of internal organs.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor's size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient's vein or given as a liquid to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays or radiation, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue. MRI can also be used to measure the tumor's size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient's vein or given as a liquid to swallow.

Bone scan. A bone scan uses a safe radioactive tracer to look at the inside of the bones. The tracer is injected into a patient's vein. It collects in areas of the bone and is detected by a special camera. Healthy bone then appears differently than areas affected by cancer. This test may be done to see if cancer has spread to the bones.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small and safe amount of a radioactive sugar substance is injected into the patient's body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

Head & Neck Cancer - Treatment

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient's preferences and overall health. Many cancers of the head and neck can be cured, especially if they are found early. Although eliminating the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs, and tissues is also very important. When planning treatment, doctors consider how treatment might affect a person's quality of life, such as how a person feels, looks, talks, eats, and breathes.

The three main types of treatment for managing head and neck cancer are radiation therapy, surgery, and chemotherapy. The primary treatments are radiation therapy, surgery, or both combined; chemotherapy is often used as an additional, or adjuvant, treatment. The optimal combination of the three treatment modalities for a patient with a particular head and neck cancer depends on the site of the cancer and the stage (extent) of the disease.

Surgery

The goal of surgery is to remove the cancerous tumor. A small amount of surrounding healthy tissue may also be removed to ensure the tumor has been completely caught. Types of surgery for head and neck cancer include:

In general, depending on the location, stage, and type of the cancer, some people may need more than one operation. Sometimes, it is not possible to completely remove the cancer, and additional treatments may be necessary. For example, surgery may be followed by radiation therapy and/or chemotherapy to destroy cancer cells that cannot be removed during surgery.

Patients should be encouraged to talk with their doctor about side effects expected from the specific surgery and how long the side effects are likely to last. Side effects vary and depend on the type and location of the surgery.


If surgery affects the person's appearance then reconstructive surgery may be recommended to retore appearance or maintain important functions, such as chewing, swallowing, and breathing. Talking with your doctor about what to expect and how to recover can help you cope with side effects.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. In general, if the surgical removal of the primary tumor is indicated, radiation is given afterward if necessary. Sometimes, however, the cancer is extensive or it is not feasible to completely remove the cancer initially. Radiotherapy is then given first to try to shrink the tumor, and surgery will follow radiotherapy.

The most common type of radiation therapy is called external-beam radiation therapy, which is radiation given from a machine outside the body. One specific type of external-beam radiation therapy is intensity-modulated radiation therapy (IMRT). IMRT uses advanced technology to more accurately direct the beams of radiation at the tumor. This helps reduce damage to nearby healthy cells, potentially causing fewer side effects. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy.

Proton therapy is another type of external-beam radiation therapy that uses protons rather than x-rays. While it is becoming increasingly available, proton therapy is not a standard treatment option for most types of head and neck cancer.

Radiation therapy to the head and neck can cause a broad range of side effects. Many of these side effects go away soon after treatment has finished others are more long lasting. Patients should be encouraged to talk with their health care teams about what to expect from side effects of radiation therapy before treatment begins, including how these side effects can be prevented or managed.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells' ability to grow and divide.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Targeted therapy

Targeted therapy is a treatment that targets the cancer's specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them.

For head and neck cancers, treatments that target a tumor protein called epidermal growth factor receptor (EGFR) may be recommended. Researchers have found that drugs that block EGFR help stop or slow the growth of certain types of head and neck cancer.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Metastatic head and neck cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer because there can be different opinions about the best treatment plan. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes a combination of surgery, radiation therapy, chemotherapy, and targeted therapy.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having "no evidence of disease" or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it's important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope.

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