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.
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 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.
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.
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.
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.
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.