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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, click here or call 949-764-5764.

For more information, or to schedule an appointment with a Hoag Head & Neck Cancer Program physician, please call 877-432-4531.