Head and Neck Cancer Introduction Page
oral cavity
oropharynx (soft palate, tonsil, base of tongue)
larynx (voice box)
hypopharynx (pyriform sinus, posterior phanryngeal
wall, post-cricoid region)
nasal cavity/paranasal sinuses
nasopharynx
salivary glands
paragangliomas (glomus tumors)
thyroid
Oropharynx (soft palate, tonsil, base of tongue)
•Background
•Signs and Symptoms
•Clinical evaluation and treatment
•Follow-Up
Illustration courtesy of Lippincott Williams & Wilkins
© 2004
The oropharynx is an area in the back of the throat that consists of the soft palate, the tonsil, and the base of tongue. This area is functionally important for speech articulation and swallowing. The use of both tobacco products and alcohol is strongly associated with cancer of this area.
Illustration courtesy of Lippincott Williams & Wilkins
© 2004
Signs and symptoms include a sore throat, difficulty swallowing, a bad
taste in the mouth, blood in saliva and ear pain. Difficulty opening the
mouth (also called trismus) can also occur. This is usually a sign of
tumor spread into the pterygoid area, and into the muscles that open the
mouth.
Because the oropharynx has a rich lymphatic network, the incidence of
lymphatic spread of tumor to the neck is quite high. If left untreated,
between 30 and 80 percent of lesions that begin in the oropharynx spread
to the neck. This incidence is higher for base of tongue, where 70 to
80 percent of patients develop a mass in the neck.
Clinical evaluation and treatment
Patients with signs and symptoms of oropharyngeal cancer are referred to an otolaryngologist. The patient should see an otolaryngologist that is experienced in head and neck cancer management. A complete and comprehensive head and neck examination should be performed, including an endoscopy. An endoscopy, often done in the doctor’s office, involves placing a small, flexible instrument through the nose in order to see all the structures of the head and neck. The procedure is painless.
A CT scan, which uses X-rays to create a two-dimensional image of the area, and a PET scan, which creates computerized images of the metabolic changes that occur in tissue, may also be used in the diagnostic evaluation. Ultimately, a biopsy (which involves removing a piece of living tissue from the suspicious area and examining it with a microscope) is required to make the pathologic diagnosis of cancer. Many times a biopsy can be done in the doctor’s office, either by fine needle aspiration or direct biopsy. A fine needle aspiration biopsy involves inserting a small needle into the mass and withdrawing cells. The pathologist examines these cells under a microscope to see if they are cancerous. If a diagnosis of cancer is made, the decision as to the best therapy comes next.
The treatment of oropharyngeal cancer usually involves radiation therapy, surgery or some combination of both. Sometimes, chemotherapy may be used. If cancer is diagnosed, it is important for the patient to seek consultation with a multidisciplinary group of specialists that are expert in the management of this disease. At Continuum Cancer Centers of New York, we are committed to using state-of-the-art treatments for cancer, which includes a multidisciplinary, multi-institutional approach. Our patients are evaluated by a radiation oncologist, a head and neck surgical oncologist, and, often, a medical oncologist. These physicians, working together with the patient, formulate a treatment plan.
Most early stage lesions of the oropharynx are treated primarily with radiation therapy. This typically involves radiation therapy delivered to the primary tumor site, as well as the lymph nodes of the neck. Depending upon the exact location of the tumor, one or both sides of the neck are included in the treatment program. For early stage cancers of the tonsil, special radiation techniques can avoid many long-term problems. For example, doctors at Continuum Cancer Centers use intensity modulated radiation therapy (IMRT) or 3-dimensional conformal radiation therapy (3D-CRT). These procedures can help limit the radiation exposure to both the primary site, and the lymph nodes in the adjacent neck. They also help to spare the tissues of the other side from receiving radiation therapy. This significantly diminishes the long-term risk of dryness in the mouth, which often accompanies radiation to both sides of the neck. The medical team of Continuum Cancer Centers is committed to developing treatment strategies that is aimed at curing head and neck cancer while maximizing quality of life. By avoiding mouth dryness, the long-term quality of life of our patients is optimized after treatment.
For cancers of the base of tongue, the selective use of brachytherapy (radiation implants) has consistently been shown to improve the tumor control rates. At Beth Israel Medical Center, we have a highly recognized brachytherapy program for cancers of the base of tongue. In fact, we are one of just a few centers in the country with radiation oncologists who perform these procedures. Brachytherapy improves the tumor control rate in the tongue, and can provide an excellent quality of life outcome. It is usually combined with external beam radiation, as part of a comprehensive treatment program.
For patients whose tumors have spread to the lymph nodes of the neck, neck surgery is usually recommended at the conclusion of radiation therapy. We often wait until the effects of the radiation therapy have lessened before performing neck surgery.
For patients with more advanced neck disease, or advanced disease at
the primary site, chemotherapy is often considered as part of the treatment.
When chemotherapy is used, it is usually given along with the radiation,
so that the two can work together. There are a number of different protocols,
and the treatment of each patient must be individualized. Again, surgery
may be necessary if the patient has tumors that have spread to the lymph
nodes of the neck.
The close cooperation of all of the treating physicians is essential to
a successful outcome. However, in addition to the radiation oncologist,
head and neck surgeon, and medical oncologist, the participation of experts
in diagnostic imaging, pathology, dentistry, cancer support services,
nursing, nutrition, and other support services, is crucial. All of these
services are available as part of our comprehensive head and neck cancer
program at Continuum Cancer Centers of New York.
Click Here for more information about radiation oncology treatments for head and neck cancer.
After treatment is completed, the patient enters the follow-up phase. Usually, all of the treating physicians are involved in follow-up evaluations. For the first year, patients are usually seen every one to two months. During the second year, they are often seen every two to three months. After the second year, patients are usually seen every three to six months. Of course, the follow-up schedule is individualized for each patient.
Imaging procedures like CT scans, PET scans, or fused PET/CT scans, are done according to a routine that is individualized for each patient. Not all patients require these studies. A chest X-ray is usually done on an annual basis. Regular dental evaluation is done, because good dental care is essential to the head and neck health.