Head & Neck Cancer

An estimated 85 percent of head and neck cancers, especially of the oral cavity, oropharynx, hypopharynx and larynx, are linked to cigarette smoking and chewing tobacco. Additional risk factors include alcohol consumption, sun exposure, radiation, inhalation of asbestos or wood or nickel dust, and poor oral hygiene.

HPV-related Head & Neck Cancer

Human papillomavirus (HPV) infection is the most commonly diagnosed sexually transmitted disease in the U.S. and is one of the highest risk factors for oral oropharyngeal cancers, particularly in the upper throat and base of tongue. It is therefore recommended that individuals speak with their physician about the benefits of the HPV vaccination for prevention of HPV related malignancies.

Diagnosing Head & Neck Cancer

Diagnosing head and neck cancer in its earliest stages can help your treatment to be more successful. Our expert team is highly skilled in diagnosing and staging head and neck tumors using the latest in state-of-the-art imaging studies, and other specialized tests, including office-based endoscopy. Upon analysis of test results, Hoag’s multidisciplinary team develops a personalized treatment plan that addresses all facets of care.

Endoscopy

Endoscopy is a minimally invasive procedure that utilizes an endoscope (a thin, tube-like device equipped with a camera) to enable physicians to view various areas inside the body. An anesthetic spray is often used to make the examination more comfortable. This examination is called a nasopharyngoscopy, pharyngoscopy, or laryngoscopy, depending on which area is examined. If your physician suspects the presence of head and neck cancer, a more thorough exam called a panendoscopy will be performed.

Indirect Pharyngoscopy and Laryngoscopy

A pharyngoscopy and laryngoscopy uses small mirrors at the back of the mouth to clearly examine the throat, base of the tongue and part of the larynx to check for any signs of head and neck cancer. As with endoscopy, an anesthetic spray is often used to make the examination more comfortable.

State-of-the-Art Imaging

Hoag also provides the latest in state-of-the-art imaging to help physicians diagnose head and neck cancers. Several imaging procedures may be utilized such as:

• Computed tomography (CT): A CT scan can provide information about the size, shape and position of any tumors, and may also help identify enlarged lymph nodes that may contain cancer cells.

• Magnetic resonance imaging (MRI): An MRI scan may be used to examine head and neck cancer.

• Positron emission tomography (PET) scan: For patients who have received a head and neck cancer diagnosis, a PET scan may be useful in determining the originating site of cancer, and if the cancer has spread to the lymph nodes and/or other areas in the body.

• Positron emission tomography/magnetic resonance (PET/MR) scan: A hybrid imaging technique that combines PET imaging with MR imaging.

Biopsy

If a suspicious area is noted, your physician may perform a biopsy, which is the removal of a small piece of tissue with either a scalpel or a needle. This tissue sample is carefully examined under a microscope to determine whether cells are benign or malignant.

For more information, or to schedule an appointment with a Hoag Head & Neck Cancer Program physician, please call (949) 764-5542.

State-of-the-Art Treatment Options

The treatment of head and neck cancer is often a complex process since it involves not only survival, but also quality of life issues, such as maintaining smell, hearing, speech, and swallowing.

To address each of these important concerns, Hoag’s Head & Neck Cancer Program provides a multidisciplinary team of specialists in surgery, radiation oncology, medical oncology, pathology, speech therapy, reconstructive surgery, dental oncology and nutrition. Hoag’s team also includes nurses and other professionals who help patients and their families to cope with the emotional and practical aspects of the disease.

This multidisciplinary team approach ensures that patients receive comprehensive and personalized treatment plans that take into account all facets of care. Treatment plans vary, but most often include surgical resection, radiation therapy and chemotherapy either individually or in combination, along with reconstructive surgery and physical/speech therapy, to help maintain and/or optimize breathing, swallowing and speech.

Surgical Treatment

Surgery is often the standard of care for head and neck cancers. Some patients may be treated with surgery alone. For other patients, combining head and neck cancer surgery with radiation therapy and/or chemotherapy may be the best option.

Whenever possible, Hoag surgeons use minimally invasive techniques, such as robotic surgery, to provide excellent surgical outcomes, reduce postoperative risks, and best preserve quality of life. Your surgeon will discuss the best type of procedure for you, depending on the size and location of your cancer, and whether it has spread to other areas in the body.

At Hoag, our surgeons have extensive experience in performing advanced surgical procedures for head and neck cancer, including but not limited to:

• Transoral Endoscopic Surgery – This is a minimally invasive technique in which surgeons remove small tumors in the mouth, throat and larynx through the mouth (transoral). Therefore, this procedure does not require large incisions to be made through the neck or face. This minimally invasive approach results in less swelling, less scarring and a lower risk of infection. It also helps to preserve function and appearance. Hoag Head & Neck Cancer Program surgeons are experts in transoral surgery using both the laser and robotic approach called transoral robotic surgery (or TORS).

• Neck Dissection with Nerve Preservation – Neck dissection involves taking out lymph nodes that may have cancer through an incision in the neck. Whenever possible Hoag Head & Neck Cancer Program surgeons perform minimally invasive modified, or selective neck dissection procedures to reduce risks and help to preserve function.

Your surgeon will discuss the different surgical options with you, to determine the best plan of care. For more information, or to schedule an appointment with a Hoag Head & Neck Cancer Program physician, please call (877) 432-4531.

Microvascular Reconstructive Surgery

An important step following head and neck surgery is microvascular reconstruction of the treated area. This procedure, which requires precise, technical skill, is when tissue grafts are taken from the arms, legs, abdomen and back, and are transferred to replace the missing tissue from the head and neck surgery – helping the physician to reconstruct the affected area.

Radiation Therapy

Radiation therapy is used on some patients with head and neck cancer. Radiation therapy can kill microscopic disease, reducing the risk of local recurrence (the cancer returning in the same location). Sometimes, radiation can shrink a tumor to facilitate surgery. Radiation therapy can be utilized before or after surgery, and is determined based on a case-by-case basis.

Intensity Modulated Radiation Therapy (IMRT)

Hoag Radiation Oncology offers advanced therapies to effectively treat head and neck cancer. One therapy that is often used in the treatment of head and neck cancer is Intensity Modulated Radiation Therapy (IMRT).

This advanced method of radiation therapy allows physicians to vary the intensity of the dose of radiation to the tumor, while minimizing the dose to surrounding health tissue and structures. This helps to reduce the risk of side-effects and also helps to reduce the risk of developing injury to important functions such as saliva production and swallowing. Hoag provides this advanced therapy option utilizing tomotherapy, which delivers a special form of IMRT called Helical IMRT.

Chemotherapy

At Hoag, our medical oncologists provide concurrent chemoradiation as the standard of care for head and neck cancer patients meeting the criteria indicating its benefits. Concurrent chemoradiation is a treatment modality that utilizes both chemotherapy and radiation therapy used in tandem to help increase the effectiveness of surgery and other treatments.

For other types of head and neck cancers, neoadjuvant chemotherapy may be utilized. This refers to chemotherapy that is used before radiation treatment, or before surgery, in order to reduce the size of the tumor and decrease distant metastasis. This option also helps increase the effectiveness of surgery and other treatments.

In addition, through an affiliation with USC Norris Comprehensive Cancer Center, Hoag’s Head & Neck Cancer Program has access to the latest clinical trials that will test and evaluate the efficacy of new drugs for cancer treatment.

Your cancer care team will discuss the different radiation treatment options with you, to determine the best plan of care. For more information, or to schedule an appointment with a Hoag Head & Neck Cancer Program physician, please call (877) 432-4531.

Speech and Swallowing Therapy

The multidisciplinary team at Hoag includes skilled Speech Language Pathologists who provide a comprehensive approach to evaluate and treat speech, voice and swallowing disorders. Since patients with head and neck cancer may be at risk for developing communication and swallowing issues, Hoag provides access to Speech Language Pathologists conveniently onsite in the Radiation Oncology department where they receive their treatment.

Initial assessments may include a clinical speech, voice or swallowing evaluation, a fiberoptic endoscopic evaluation of swallowing (FEES) or a Modified Barium Swallow Study (sometimes called a video swallow study or a X-ray swallow assessment). The Speech Pathologist will create an individualized treatment plan and collaborate with nurses, doctors, and other health professionals regarding the patient’s care. Treatment for swallowing disorders may include identifying appropriate diet textures that are specific consistencies of food and liquids that are safely swallowed, developing safe swallowing strategies, and providing exercises to improve or maintain strength and coordination of the swallowing mechanism during and after treatment while providing patient, family and caregiver training. This unique service helps patients to proactively optimize their ability to communicate and eat while incorporating each individual’s goals and preferences that are deemed important.

Oncology Dietitians

Many patients diagnosed with cancers of the head and neck may have been experiencing problems eating related the tumor, biopsy and surgery. Hoag assures all head and neck cancer patients are screened for any nutritional issues prior to the start of any treatment. Hoag’s registered dietitians are specially trained in the needs of oncology patients and best practice to assist these patients in meeting their nutritional needs. All patients are followed by the dietitian throughout their treatment and recovery.

Genetic Testing for Head & Neck Cancers

Although most head and neck cancers are not hereditary, the following cancers may be passed down from one generation to the next.

Paraganglioma

A paraganglioma is rare neuroendocrine neoplasm that may develop at various body sites (including the head, neck, thorax and abdomen). Approximately 30 percent of paragangliomas are hereditary. Risk assessment and genetic consultation are recommended for all individuals with a diagnosis of paraganglioma, even if there is no further family history of paraganglioma.

Thyroid Cancer

Approximately 5-10 percent of thyroid cancer cases are considered to be hereditary. There are a number of hereditary cancer conditions which can include a diagnosis of thyroid cancer, such as Cowden syndrome, Familial Adenomatous Polyposis (FAP) and Multiple Endocrine Neoplasia. The type of thyroid cancer is very important in classifying which, if any, hereditary condition may be involved. Hereditary cancer risk assessment and genetic consultation is recommended for all individuals with a diagnosis of medullary thyroid cancer and for other types, depending upon the family history.

Confidential genetic counseling and testing is available through Hoag’s Hereditary Cancer Program to provide patients with the information necessary to create a plan for early detection and/or reducing the risk of developing cancer.

For more information, or to schedule an appointment with a genetic counselor affiliated with Hoag’s Hereditary Cancer Program or call (949) 764-5764.

For more information, or to schedule an appointment with a Hoag Head & Neck Cancer Program physician, please call (949) 764-5542.

If you have head or neck cancer and wish to have your case reviewed for a second opinion by Hoag’s comprehensive team, please contact us at (949) 764-5542. Your call will be directed to Hoag’s Head & Neck Cancer Nurse Navigator, who works closely with Hoag’s Head & Neck Tumor Board and clinical team, who will help facilitate this review. We will collaborate with your physician to ensure the best possible course of treatment.

The complexity of head and neck cancer requires the input from various experts skilled in different medical specialties. At Hoag, we are unique in offering a multidisciplinary clinic where specialists come together to offer patients the opportunity to be seen in a timely manner. Patients enrolled in the clinic would be seen by each specialist individually, then have their case reviewed at a multidisciplinary case conference, followed by a meeting with all their physicians to discuss a comprehensive treatment plan. The team also includes a dedicated clinical nurse navigator there to provide support and education. Learn more by calling (949) 764-5542.

At Hoag, we offer a variety of support services led by a caring clinical and social work team.

Head & Neck Cancer Clinical Nurse Navigator – Tina Corriere, B.S.N., R.N., O.C.N.

Clinical Nurse Navigators are a unique asset at Hoag. As a Clinical Nurse Navigator for Hoag’s Head & Neck Cancer Program, Tina serves as a guide for patients, answering questions, providing education, identifying social resources to overcome any barriers to care and providing support through each phase of treatment and recovery.

As the Head & Neck Cancer Clinical Nurse Navigator, Tina provides:

• Emotional support and guidance for the newly diagnosed Head and Neck cancer patient and their family

• Education for patients and family members about Head and Neck cancers

• Information about community resources and Hoag support services

• Help in coordinating the patient’s multidisciplinary care plan

• Assistance in navigating the healthcare system during and after treatment

Cancer Support Services

Cancer Support Services offers a variety of classes to support and educate patients during and after cancer. These classes and workshops are all free of charge:

• Oral, Head & Neck Cancer Support Group is an educational and supportive group for patients. Family and friends are also encouraged to attend. The group meets the second Monday of each month, from 6:00-7:30 p.m. in the Patty & George Hoag Cancer Center, Conference Room A.

• One-On-One Counseling with an oncology social worker

• Fitter Image Exercise Programs, including yoga, pilates and energizing cardio and toning

• Workshops for Well-Being, including free flow writing, meditation, reiki and creative art classes

• The Next Six Months – A survival and Food Guide after oral cancer treatment.

Other Support Programs/Teams include:

• Speech Language Pathologist – Unique to Hoag’s Head & Neck Cancer Program are Speech Language Pathologists who provide a comprehensive approach to evaluate and treat speech, voice and swallowing disorders.

• CARES Program – For patients experiencing high pain or symptom burden during treatment, the Hoag CARES Team can help. Board-certified Palliative Care physicians, nurses and social workers are available to help manage physical and emotional symptoms alongside your cancer care team.

• Oncology Dietitians – Hoag Family Cancer Institute provides two dedicated Registered Dietitians who are available to advise patients on nutrition and provide resources for a healthier diet before, during and after cancer treatment.

• Hereditary Cancer Program – Hoag offers both genetic counseling and genetic testing for individuals concerned about hereditary cancer.

• Pastoral Care – provides spiritual support & counseling services to patients, families, and the community.