Head & neck cancer

Cancers of the head and neck can begin in the:

• Oral cavity, which includes the inner surface of the lips, front area of the tongue, gums, lining of the cheeks and lips, bottom and top of the mouth, and the area of gum behind the wisdom teeth
• Paranasal sinuses and nasal cavity
• Nasopharynx (the upper part of the pharynx, or throat)
• Hypopharynx (the lower part of the pharynx, or throat)
• Salivary glands
• Supraglottic larynx (above the vocal cords)
• Larynx (vocal cords)
• Subglottic (below the vocal cords)

Head and neck cancers are designated in the location they start in. The most common types of head and neck cancer in the US are mouth (oral cavity) and larynx (the vocal cords). 

Your healthcare provider may use some combination of the following tests to diagnose your head and neck cancer:

• Physical examination. Your healthcare provider will examine your head and neck for abnormalities. They will also likely ask you questions about your health history and symptoms related to head and neck cancer.
• Biopsy. During this test, a small tissue sample (biopsy) is removed and sent to the laboratory for close analysis. Pathologists inspect the biopsy under a microscope for any signs of cancer.
• Blood test. You might have blood tests to check your general health or help your doctor diagnose what is causing any symptoms you have.
• Endoscopy. A thin, lighted tube called an endoscope is placed in the mouth or nose to get a closer look at the inside of your head and throat. The examination may be viewed on a computer monitor and photos may be taken to document the findings.
• Imaging tests. Imaging tests – such as X-rays, computerized tomography (CT) scan, magnetic resonance imaging (MRI) or PET/CT scans – may be ordered to get a closer look at various tissues in your body.

Your healthcare provider may use other diagnostic tests to find out more about your cancer, where it’s located and which treatments are likely to be most effective. He or she may use some of these tests to find out how well your treatment is working. Your doctor may also ask you to seek other specialists who focus their practices on diseases of the head and neck. 

The type of head and neck cancer treatment your care team recommends will depend on its stage, if the cancer has spread to other parts of your body, your general health and personal preferences. Depending on your exact situation, your care team may recommend one or a combination of the following treatment options:

• Surgery. We work with expert teams of surgeons who are specially trained in the removal of cancerous and benign (non-cancerous) tumors in the head and neck. Your surgeon may also recommend the removal of the regional lymph nodes if they suspect that the cancer has spread. In some cases, you may need to undergo reconstructive surgery and/or speech therapy after surgery, as it may affect your appearance and your ability to chew, talk or swallow.
  
  There are many different surgical procedures to treat head and neck cancer dependent on the primary site and stage of the disease:    
  • Glossectomy (removal of the tongue). For cancer of the tongue, your surgeon may recommend this treatment. A partial glossectomy is employed for smaller cancers and removes part – less than a third – of the tongue. A total glossectomy is reserved for larger cancers and removes the entire tongue.
  • Mandibulectomy (removal of the jawbone). If a tumor has grown into the jawbone, your surgeon may perform a mandibulectomy (also known as a mandibular resection). This procedure involves the removal of all or part of the jawbone (mandible). If the cancer has not spread to the jawbone, only a small portion of the bone may need to be removed. This procedure is called a partial-thickness mandibular resection or marginal mandibulectomy.
  • Maxillectomy. If the cancer has grown into the hard palate (front part of the roof of the mouth), your surgeon may recommend a maxillectomy or partial maxillectomy. During this procedure, the surgeon will remove all or part of the involved bone (maxilla). Your specialist may fit you for a special denture – or prosthesis – to fill the hole in the roof of your mouth following surgery.
  • Laryngectomy (removal of the voice box). In some instances, your surgeon may need to remove one of the two vocal cords (partial laryngectomy) or both vocal cords (total laryngectomy) to take out the cancer. Following removal of the larynx a stoma (hole) is made in the skin of the throat to allow air to enter the trachea (windpipe). This procedure is called a tracheotomy. It allows you to breathe and cough through the stoma, instead of through the mouth or nose.
  • Laser surgery. Laser surgery involves the insertion of an endoscope with a high-intensity laser tip into the mouth or throat. The endoscope vaporizes or cuts out the tumor. 
  • Transoral robotic surgery (TORS). During transoral robotic surgery, your surgeon uses a computer-enhanced system to guide surgical tools to remove mouth and throat cancers. By using a robotic system, your surgeon can make more precise movements in small spaces and work around corners. This type of surgery usually leads to a faster recovery with fewer complications.
  • Neck dissection. Some head and neck cancers may spread to the lymph nodes in the neck or have a high potential for that spread. These lymph nodes may require removal to determine if the cancer has spread or to remove cancer that has already spread. Neck dissections may be performed at the time of an initial surgical procedure or at a later date.
    
    There are various types of neck dissection procedures depending on how much tissue the surgeon must remove from the neck. In a partial or selection neck dissection, your surgeon removes only a few lymph nodes. In a modified radical neck dissection, your surgeon removes most lymph nodes on one side of your neck between the jawbone and collar bone – along with some muscle and nerve tissue. With a radical neck dissection, your surgeon removes nearly all nodes on one side of the neck, as well as some muscles, nerves and veins.
• Radiation therapy. Radiation therapy kills cancer cells. At GenesisCare, our head and neck cancer treatments primarily include external beam radiation therapy (EBRT), in which a device from outside the body delivers radiation. In certain selected instances we may also employ internally placed radiation sources (brachytherapy) in which a radiation source is implanted directly within the tumor tissue.
  EBRT radiation therapy for head and neck cancer includes:
  • Intensity-modulated radiation therapy (IMRT). IMRT uses advanced computer-assisted technology to precisely shape the radiation around your tumor, while limiting exposure to surrounding healthy tissues. IMRT is performed with a machine called a medical linear accelerator, or a LINAC.
  • Hyperfractionated radiation therapy. In some instances, it may be appropriate to treat head and neck cancer in more frequent and smaller doses of radiation. Hyperfractionated radiation is typically administered twice a day instead of the more common once-a-day approach.  
  • Brachytherapy. This internally administered radiation therapy delivers radioactive pellets or wires to the tumor site through small plastic tubes called catheters or directly into the tissue. Brachytherapy may be used in conjunction with EBRT for early-stage tumors of the lips or mouth. There are two different types of brachytherapy employed for head and neck cancer:
    • High-dose rate (HDR) brachytherapy. This is usually completed in one session with the radioactive sources removed after each treatment. 
    • Low-dose rate (LDR) brachytherapy. The radioactive sources remain in the body until they diminish on their own.
• Chemotherapy. Chemotherapy refers to drugs that may have the ability to destroy cancer cells. Our expert teams may recommend chemotherapy before, during or after other treatments, or on its own. Your head and neck cancer care team may also recommend combining chemotherapy with radiation therapy (chemoradiation) before or after surgery.
  
  The type of chemotherapy you may receive will depend on the location, stage and tissue type of your head and neck cancer. If you have head and neck cancer that has spread to other parts of your body, chemotherapy may help control its growth, relieve symptoms and improve your head and neck cancer prognosis.
• Targeted therapy As we have learned more about head and neck cancer, new treatments that can specifically target it have been developed. We sometimes use targeted therapy to seek and attack cellular activity that the cancer needs to survive and grow. Your head and neck cancer care team may use targeted therapy depending on the specific genetic makeup of your cancer. The main type of targeted therapy for head and neck cancer is a monoclonal antibody that targets a protein on the surface of the cells in the oral cavity and may be an effective head and neck cancer treatment. By interfering with the protein, the cells can no longer grow and divide – which slows or even stops the cancer’s growth.
• Immunotherapy. Immunotherapy helps your body’s own immune system to recognize and fight cancer. Checkpoint inhibitors are effective immunotherapy against some head and neck cancers. These work by blocking the signals that stop the immune system from attacking the head and neck cancer cells.

Drains have been placed in the neck to help you heal from surgery. Please see below for general instructions on how to care for your drains. If you have any questions or concerns, please contact our office.

• Wash your hands with soap and water after the drain is emptied.
• Firmly hold the tubing near your skin so you don’t pull out the drain. Pinch the tube with your other hand and slide your fingers down towards the drain bulb.   
  
  Your care team will advise if you need to repeat this step more frequently throughout the day to avoid any clotting in the drains.
• Open the cap on the drain and empty the liquid into the cup provided by your care team.
• Write down the amount of fluid drained (in milliliters), which drain the fluid came from, and what color the drainage was.
• Compress (squish) the bulb and then replace the cap on the drain. The drain must be compressed to work properly.
• After you have recorded the drainage information, you may discard the drained fluid down the sink or toilet.
• In general, drains should be emptied at least twice daily, and more as needed. Your care team will advise how often your drains should be emptied.
• Contact your care team immediately if you have an increase in drainage from your drains, or there is a change in color.