By and large, head and neck cancer refers to cancers of the lining of our mouths and throat, oral cavity, tongue, larynx, nose and nasal cavity. In addition, head and neck cancer specialists also tend to treat cancer of the salivary glands, thyroid, and endocrine system. Because of the anatomy of this area of the body — and its complexity — these cancers are all generally lumped together.
At Memorial Hermann, we encounter many of these cancer types and employ aggressive therapy that is both patient-centered, collaborative and prompt to help you achieve positive outcomes. In addition, our teams work with you beyond your diagnosis to help your recovery go as smoothly as possible.
Cancers of the oral cavity, like those of the mouth, lip, and oral cavity, require a high level of care because of the complex structures and organs involved. Oropharynx (throat) cancer also requires similar specialization because of how fragile and important those structures are to speech, swallowing and breathing. In addition, because squamous cell carcinoma (skin cancer) can quickly spread to the lymph nodes, we treat it in much the same way as throat cancer.
Dr. Adan A. Rios, a medical oncologist affiliated with Memorial Hermann, suddenly saw his life’s work from a new perspective when he himself was diagnosed with head and neck cancer.
There are several symptoms of head and neck cancer that are apparent and others that may be hidden. In many cases, some of these symptoms may be misdiagnosed as other issues; for example, a sore throat that lingers for months or a spot on the tongue that won’t heal could be diagnosed as thrush. In general, you should be aware of the following:
If you or someone you love have noticed any of the above symptoms, contact your doctor or schedule an appointment with us as soon as possible.
The majority of head and neck cancers don’t have identifiable risk factors that can be modified, especially in the case of thyroid or endocrine cancers. While there are some historically well-known risks — such as smoking and tobacco use, alcohol consumption, and sun exposure (skin cancer) — most salivary gland cancers rarely have risk factors, and thyroid cancer is sometimes associated with radiation exposure.
The most common factors for oral, head and neck cancers are alcohol and tobacco use, including chewing tobacco.
Approximately 20 million people in the U.S. currently have HPV infection. Most sexually active people have had an HPV infection at some point in their lives, although many never know they were infected, and most people will not have any health problems related to it.
Infection with human papillomavirus (HPV) is a risk factor for some types of oral head and neck cancers, particularly cancer that involves the tonsils or base of the tongue. In the United States, the incidence of these cancers caused by HPV infection is increasing. HPV-related head and neck cancer occurs in people who smoke and those who do not smoke. Over the past decade, an increasing number of young, non-smokers have developed mouth and throat cancer associated with HPV.
If you notice a lump or other symptoms, it’s important to get a diagnosis quickly. At our clinics, we use patient-centered care to ensure a prompt diagnosis and a seamless process. Your doctor will examine you and perform an ultrasound right then and there, move along to do a needle biopsy almost immediately and then hand off the sample for a pathologist to read.
Once you know your diagnosis, you will work with our tumor board to create a personalized treatment plan. Our teams coordinate care based on your current health needs, the presentation of the cancer and all the options available to you.
Many head and neck cancers are complex. Because complexity requires collaboration, our team works together to determine the best course of treatment, including radiation therapy, surgery and chemotherapy.
Radiation can be used as the primary mode of treatment for small cancers, but larger tumors or those that have spread may require some combination of radiation, chemotherapy and surgery. Radiation may be used either prior to surgery (often called neoadjuvant therapy) to help shrink a tumor before the operation. After surgery, radiation may be used to kill any remaining cancer cells. This is called adjuvant treatment.
The most common form of radiation treatment for head and neck cancers, external beam radiation therapy (EBRT), involves carefully focusing a beam of radiation on the cancer and using an exact dose to affect the tumor. This form of treatment is similar to a traditional X-ray but is often at a much stronger dose. While it is usually a painless outpatient procedure, EBRT can take much more time than a regular X-ray to prepare physically due to getting you into a specific place for treatment.
Another type of radiation therapy, known as brachytherapy, is used to place radioactive material directly into or near the cancer. This radiation only travels a short distance and can have fewer effects on nearby healthy tissue. Brachytherapy is not typically used in throat or oral cavity cancers thanks to the advent of newer therapies, such as IMRT, which are much more precise, but it can be used to treat lip and mouth cancers.
Side effects of radiation therapy for head and neck cancers can include skin changes resembling a sunburn, loss of taste senses, soreness and pain in the throat and hoarseness. Long-term effects may include damage to the jaw bone or salivary glands and pituitary and thyroid gland problems. These problems may be even more prominent if radiation is given at the same time as chemotherapy (chemoradiation). If you have questions about side effects and how to manage them, your oncology nurse navigator can help.
Using chemotherapy in the treatment of head and neck cancers usually involves a combination of both chemotherapy drugs as well as radiation treatment. These drugs are typically platinum compounds such as cisplatin and carboplatin delivered via IV. Chemotherapy and radiation may be used to shrink some larger cancers before surgery (a process known as neoadjuvant treatment) or after surgery to kill any cancer cells not removed by surgery, which is called adjuvant treatment.
Head and neck cancer treatment with radiation and chemotherapy can often result in oral and throat side effects, such as trouble eating and swallowing and the development of mouth sores. These side effects, known as stomatitis and mucositis, can make it nearly impossible for patients to tolerate eating and swallowing. Most patients who have head and neck cancer will have a feeding tube put into place prior to beginning your treatment, so you can continue to receive nourishment during treatment. Once you are able to eat again, the feeding tube may be removed.
When surgery is used to treat head and neck cancers, multiple procedures can be done depending on the exact type of cancer you have. Surgery for head and neck cancers will always have three major objectives:
Traditionally done by dermatologists for skin cancers, the Mohs micrographic surgery may be applied in the cases of lip cancers or near other critical areas, like the eyes. In surgeries where we need to remove tissue inside the mouth or throat, we do our best to ensure the smallest possible margins are used.
For cancers of the tongue, a glossectomy is removal of the tissue of the tongue — or sometimes the tongue entirely may be necessary. If the affected area is small, we may be able to repair it; if the entire organ must be removed, we can reconstruct the tongue by using a totally different part of the body and transplant it. Our ultimate goal is to make your new or repaired tongue a functional organ that can assume the vital functions of speech and swallowing.
A mandibulectomy (lower jaw) or maxillectomy (upper jaw), or removal of the jawbone, may be necessary in cases of jaw cancer. In these cases, we try to ensure the margins of tissue removed are as small as possible. In many cases, it is possible to do reconstructive surgery by borrowing bones from the lower parts of the body and building a functional replica of your existing jawbone.
Robotic surgery is an important development in surgical treatment for head and neck cancers because it allows surgeons a greater degree of control over manipulating and removing cancer than with their eyes and hands. It also allows for faster recovery time.
A laryngectomy is one of the most invasive types of surgery for head and neck cancer. In general, surgery for larynx cancer is often seen as a last resort. Because voice boxes are critical for swallowing and keeping food out of your lungs, removing bigger cancers (and the voice box entirely) can cause lots of side effects.
Even after radiation, some patients will need a laryngectomy. At Memorial Hermann, our goal is to provide holistic care from start to finish. This is why we help laryngectomy patients with resources from wound care clinics to help navigate scar management and vocal rehab. Because these patients have a unique set of survivorship needs, we work to create a medical home to serve their needs with voice rehabilitation, swallowing experts and surgeons.
All treatments have side effects from functional complications to cosmetic considerations. Medical problems in the mouth are common in patients who receive chemotherapy or undergo radiation therapy to the head and neck. However, your multi-disciplinary team is proactive when it comes to dealing with potential scarring, issues with swallowing or voice and adjusting to life after treatment.
Cancer is not a single health episode and dealing with it is not limited to treatment. We understand cancer draws upon the experience of many providers, and head and neck cancers often have multiple specialties. This is why Memorial Hermann focuses on collaboration among care providers. If you need multiple procedures to prepare you for treatment, we do our best to maximize surgical efficiency.
This also extends to after-care for beyond treatment. For follow-up appointments, we do our best to include multiple clinicians and therapists in one appointment, creating a “one-stop shop” for your care needs. Our mission is to be patient-centered and multidisciplinary — using our experience and technology to ease anxiety and provide comfort for patients and their families.
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