Head and Neck Cancer
At Central Coast Head and Neck Surgeons, we have a team of highly trained and experienced surgeons in oncologic surgery, to provide you with the best treatment available. We work closely with our colleagues in radiation oncology, medical oncology, speech and swallow therapists, and occupational and physical therapists to provide a multidisciplinary approach to treatment, which is personalized and tailored to the patient. We meet regularly with our hospital tumor boards to present cases and coordinate care, and use the latest minimally invasive/organ preserving approaches, and our radiation oncologists use IMRT( intensity modulated radiation therapy ) which dramatically reduces side effects while intensifying treatment of the targeted cancer. Just as important as curing cancer is providing a personal and caring approach, and remaining with you at every step of what can be a very challenging time.
Head and Neck Squamous cell carcinoma ( cancer of the mouth, throat, and larynx ) make up 3% of cancer diagnosed in the United States, with approximately 50,000 cases diagnosed every year, and affect people of all ages and backgrounds. There is a strong link to previous tobacco, alcohol, and the human papilloma virus (HPV), but patients can still develop this cancer without any risk factors. Treatment and Prognosis depend on its size, the location, and how early the cancer is detected. Often times there can be spread to nearby lymph nodes in the neck, and treatment usually includes these lymph nodes as well. Early stage tumors can have excellent prognoses with surgery or radiation, and for more advanced tumors surgery combined with radiation and sometimes chemotherapy/radiation can be very effective. After treatment the patient needs close surveillance and frequent office examination to detect recurrence.
Squamous Cell Carcinoma of the tonsil and tongue base – These tumors can often present with subtle throat symptoms early on, such as pain, the feeling that something is stuck in the throat, a noticeable mass in the neck, asymmetry of the tonsils, pain with swallowing, persistent ear pain, voice changes, or bleeding. There is a recently increasing trend for these cancers to be HPV related, in over 50% of cases, and this is an active area of research. Treatments include surgery or radiation, and often in combination depending on the stage of the tumor. Minimally invasive transoral approaches for resection can also be used with low complications and excellent preservation of speech and swallowing. Even small tumors in these locations have the propensity for lymph node metastasis, and examination and CT/MRI imaging is needed to detect this. Even when no lymph node metastasis is evident, neck dissection with removal of at risk lymph nodes is recommended to remove microscopic disease and at-risk lymph nodes.
Laryngeal cancer – Cancers of the “voice box” account for approximately 12,000 cases each year in the United States. Symptoms may be hoarseness, pain, bleeding, ear pain, difficulty swallowing, or the presence of an enlarged nearby lymph node. Smoking and alcohol are the main risk factor for this, and the risk remains elevated even many years after a person has quit. There are different subsites within the larynx, called the supraglottis ( above the vocal cords ), glottis ( vocal cords ), and subglottis ( below the cords ). Early stage cancers can be treated with high success rate and good prognosis with minimally invasive surgical excision through the mouth. Radiation is also an option. Depending on the subsite and size, a patients voice and swallowing ability can be preserved with these approaches. For advanced stage tumors chemoradiation or total or partial laryngectomy may be required.
Salivary Gland Tumors – The parotid and submandibular glands secrete saliva into the mouth, located just below the ear as well as below the jaw on each side of the neck. There are multiple types of both benign and malignant tumors which derive from salivary gland tissue. Most tumors of the salivary glands are benign, but up to 20-50% can be malignant, depending on the location of the tumor. Needle biopsy can be used to help distinguish benign from malignant, but can have limited accuracy, and surgery is generally required to make a definitive diagnosis. The treatment for these tumors is surgical removal, and in some cases if cancer is found then further surgery of the lymph nodes or radiation may be indicated.
Skin Cancer The head and neck are one of the most frequent areas where skin cancer arises, and the most common types are Basal cell, Squamous cell, and melanoma. Previous sun exposure is the largest risk factor, but there are also genetic factors as well. Skin lesions that are increasing in size, bleeding, have irregular borders, or are not healing properly may need to be biopsied. Basal cell and Squamous cell types have an excellent prognosis with prompt recognition and surgical excision. If recurrent or large tumors, a larger area may need to be removed with reconstruction, usually from adjacent tissue that can be rotated over as a “flap”. In certain locations on the face, this may need Mohs surgery ( a special type of margin mapping ) and we work closely with our dermatology and plastic surgery colleagues for this. Melanoma is a very aggressive type and prognosis worsens quickly as the depth of the lesion increases, and this requires surgery with large margins of tissue to ensure complete removal. Melanoma tends to spread to lymph nodes and distant sites in many cases. Lymph nodes of the head and neck can also be involved in skin cancer, and may also need to be addressed in more advanced cases of squamous cell carcinoma and in melanoma, which would require sentinel node biopsy or neck dissection.
Lymphoma – While often this presents with enlarged lymph nodes throughout the body, it can also present in the head and neck. This often can present with progressive enlargement of a neck mass, and sometimes symptoms of fatigue, fevers, chills, or weight loss. Diagnosis is usually made with a combination of needle biopsy or often lymph node excision to provide the pathologist with enough tissue to accurately define the type of tumor and for treatment planning. The treatment for head and neck lymphoma usually involves chemotherapy and sometimes radiation therapy.
Unknown primary Squamous cell carcinoma – This refers to a squamous cell carcinoma that has been found in a lymph node in the neck, which is a mestastasis, but from which the location of the original “primary” tumor, has not been found. Often this is due to a very small tumor hidden in the upper aerodigestive tract, often in locations such as the tonsils, base of tongue, and nasopharynx. If after thorough office examination the tumor is still unknown, the patient is brought to the operating room for examination under anesthesia, and pan-endoscopy with biopsy, which involves examination of the aerodigestive tract using endoscopic instruments and taking biopsies of suspicious locations. If the tumor is located, treatment is based on the location and feasibility for surgical excision or radiation therapy. When the tumor is not found, treatments consist of neck dissection and radiation, or radiation/chemoradiation. Radiation is used to treat the “at risk” locations where small tumors may be located.
Sarcoma – Sarcomas encompass a wide variety of malignancies of the head and neck, which derive from specific types of tissues such as blood vessels, fat, fibrous tissues, bone, cartilage, muscle, nerves, or endocrine tissue. There are many different variants and treatment is individualized based on the type of tumor, location, and microscopic features of the tumor ( tumor grade ). Low grade tumors in general have a better prognosis than high grade. Some types of sarcomas often metastasize to other parts of the body, whereas others are less likely. Treatment can involve surgery, radiation, or chemotherapy.
Nasopharyngeal cancer – This is squamous cell carcinoma which arises in the tissues behing the nose and adjacent to the eustachian tubes. There is a predisposition to people of Chinese descent, although this occurs in people of all backgrounds and ages. This may present with an enlarged lymph node ( node metastasis ), or local symptoms in the nose including nasal obstruction, pain, bleeding, hearing loss or middle ear fluid, or visual symptoms. Office endoscopy and biopsy is necessary to diagnose, and treatment usually involves radiation/chemotherapy. Surgery has a role if the disease persists or recurs after treatment, or for smaller tumors accessable to endoscopic surgery.