Head and Neck Cancer
Diseases of the head and neck can affect one's ability to smile, speak and eat. Speech makes us unique as humans, and our faces are the signature of our individuality. A preventive screening or annual check-up by a specially trained ear, nose and throat (ENT) physician is the often the first weapon in treatment.
The Head and Neck Cancers Program at Smilow Cancer Hospital includes an experienced, multidisciplinary team that offers broad-based specialized care in early detection, treatment and prevention of various head and neck diseases including those of the lip, mouth, nasal cavity, sinuses, larynx, pharynx, ear and skull base.
Check with your doctor if you experience any of the following symptoms:
- A sore throat that does not go away.
- Ear pain.
- A lump in the neck.
- Painful or difficult swallowing.
- A change in voice.
Some of the tests to help diagnose throat and neck cancer include:
- Physical exam and health history: To check for signs of disease such as lumps or anything unusual.The doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror.
- Neurological exam: Questions to check mental status plus ability to walk, muscles, senses and reflexes. It may also involve tests to check the brain, spinal cord and nerve function.
- CT scan (CAT scan): A series of detailed pictures inside the body such as the head, neck, chest and lymph nodes taken from different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected or swallowed to help show organs or tissues more clearly.
- PET scan (positron emission tomography scan): A small amount of radioactive glucose is injected into a vein. The PET scanner rotates around the body to get a picture of where glucose is being used. Malignant cells show up brighter in the picture because they take up more glucose than normal cells.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside the body such as the head, neck, chest and lymph nodes.
- Endoscopy: An endoscope (thin, lighted tube) is inserted through the nose or mouth to check the throat for anything unusual. Tissue samples may be taken for biopsy.
- Biopsy: Removal of cells or tissues so they can be checked for signs of cancer.
- Bone scan: A very small amount of radioactive material is injected into a vein and collects in the bones with cancer detected by a scanner.
- Barium esophagogram: The patient drinks a liquid that contains barium and coats the esophagus for X-rays to be taken.
Head and neck cancers can spread to the lymph nodes of the neck. Patients may develop a second primary tumor. However, when detected early, head and neck cancer is highly curable, usually with some form of surgery, although chemotherapy and radiation therapy may also play an important role.
Why Smilow Cancer Hospital for Head and Neck Cancers
At Smilow Cancer Hospital, healthcare professionals, including head and neck surgeons, radiation oncologists, medical oncologists, physical and speech therapists, rehabilitation specialists skilled in the areas of swallowing and hearing restoration, nutritionists, advanced practice nurses and social workers, as well as a patient advocate all make up the healthcare team. This team approach gives newly diagnosed patients a carefully determined treatment plan focused on providing the most comprehensive, effective care possible.
Less invasive surgeries; reconstructive breakthroughs
Radical neck dissections that used to be the standard of care have been replaced in many cases by less radical surgeries that preserve nerves, arteries, and muscles in the neck. Patients continue to move, speak, breathe and eat normally after surgery. Patients with certain throat cancers, who a few years ago would have lost their vocal cords and their voices, can often be treated with a supraglottic laryngectomy, a less invasive surgery that preserves critical structures. Patients who undergo this surgery maintain their ability to speak, although they need to learn new ways to swallow. Our rehabilitative specialists work with patients to help them adjust to and overcome some of these impairments.
One of the most exciting new surgical advances is the use of laser surgery to remove certain throat cancers using an endoscopic probe in the mouth. This technique allows surgeons to remove tumors without an open incision in the neck.
Breakthroughs in reconstructive surgery has dramatically improved certain procedures, yielding previously unattainable cosmetic and functional outcomes. Research data indicate that the results of complex surgical procedures like these reconstructions are best accomplished by specialists who perform them on a regular basis.
Radiation oncology: yielding new-age weapons
Radiation oncology at Smilow Cancer Hospital has a whole new arsenal: external beam radiotherapy machines, such as linear accelerators, which produce x-rays of increasingly greater energy. Intensity modulated radiation therapy, also known as IMRT, when used alone or combined with surgery, has been shown to allow targeting of the tumor while either eliminating or substantially decreasing the dose of radiation to normal tissues. IMRT delivers high doses of radiation directly to cancer cells in a very targeted way, much more precisely than is possible with conventional radiotherapy.
Brachytherapy, which is a technique that allows for the implantation of small radioactive seeds into or in close proximity to a tumor, can provide radiation to tumors in a very specific and controlled fashion. Brachytherapy, combined with external radiation therapy, can be used to cure head and neck cancers that could not be removed surgically without injury to speech and swallowing functions. These new approaches can often preserve the ability to speak and swallow normally, even in patients with advanced disease.
Patients who receive chemotherapy with radiation have a decreased risk of distant tumor spread. They experience both prolonged disease-free survival and prolonged overall survival. Thus, the integration of chemotherapy with radiation at Smilow Cancer Hospital has changed our standard of care while enhancing efforts toward organ preservation.
Learn more about the Yale Head and Neck Program