Head and Neck Cancer Program
Head and neck cancer is a complex disease. Though an increasing number of younger patients in their 40s and 50s are being diagnosed with the disease, more head and neck cancer patients overall are surviving it, thanks in part to technological advances that have made more treatments available. Many of those treatments may cause side effects that may impair patients’ function and quality of life.
We developed the Head and Neck Cancer Program at Cancer Treatment Centers of America® (CTCA) at Southwestern Regional Medical Center (Southwestern) with these patients in mind. We use innovative technologies to treat the disease while also helping patients manage and, when possible, avoid side effects and improve their quality of life. These advances in medicine are designed to reduce damage to healthy tissue and organs, helping to limit the severity of side effects that may diminish patients’ ability to swallow, eat, speak and perform other important everyday functions. Our multidisciplinary team of head and neck cancer experts work together, all under one roof, to develop a treatment plan tailored to each patient’s needs, communicating regularly and making adjustments when necessary.
The team treats head and neck cancers, which include those of the oral cavity, larynx, pharynx, salivary glands and nasal cavities. The team also treats thyroid cancer, given its proximity.
Our comprehensive team approach
The Head and Neck Cancer Program at Southwestern is committed to the CTCA® integrative care model, treating cancer with conventional treatments like surgery, chemotherapy and radiation, while supporting patients’ quality of life and well-being with supportive therapies that help them manage cancer-related side effects.
Led by board-certified Otolaryngologist and Head, Neck and Microvascular Reconstructive Surgeon Dr. Brad Mons, the Head and Neck Cancer Program team includes Medical Oncologist Dr. Sagun Shrestha, Radiation Oncologist Dr. Douglas Kelly, Plastic & Reconstructive Surgeon Dr. Rola Eid and Thoracic Surgeon Dr. Peter Baik. Members of the Head and Neck Cancer Program at Southwestern collaborate on complex and new cases at a weekly meeting. Because they all work in the same building, they also are able to evaluate patients’ progress and discuss issues that may arise on any given day.
Our comprehensive program also includes clinicians who provide supportive care services to help patients manage the side effects of treatment and get back to living their lives. Depending on each patient’s needs and preferences, these services may include oncology rehabilitation, nutrition, naturopathic medicine and pain management.
The Head and Neck Cancer Program team of cancer experts at Southwestern may help diagnose your cancer, or confirm the diagnosis, in addition to treating it. If you have symptoms of head and neck cancer, such as voice changes, a neck mass, a sore throat that lasts longer than two weeks and/or doesn’t respond to an antibiotic, or you are coughing up blood, you may request an appointment with our team and begin your diagnostic evaluation within a few days. “Many times, if you start with your primary care physician, are prescribed an antibiotic that doesn’t help and then wait a month for an appointment with an ENT physician, two months may have gone by,” Dr. Mons says. “But any time you’re dealing with cancer, time is of the essence. The sooner you can treat it, the better.”
Our team uses a variety of diagnostic evaluations, such as chest X-ray, biopsy, CT scan and PET scan, to diagnose and stage the disease. Once the cancer has been diagnosed, the team will use the information to develop an individualized treatment plan.
Your treatment options
Treatment for head and neck cancer often involves surgery, radiation therapy, chemotherapy, immunotherapy or targeted therapy, either alone or in a combination of two or more.
Surgery is typically the first line of treatment for this cancer. Its goal is to remove the tumor and affected surrounding tissue.
Among the technologies the Head and Neck Cancer Program surgical team at Southwestern offers is the Flex® Robotic System, a next-generation surgical system with a flexible robotic endoscope that allows the surgeon to access hard-to-reach areas of the throat in a minimally invasive way. The Flex Robotic System may lead to shorter recovery times, less pain and less damage to tissues and muscles critical to eating and other daily activities.
Our board-certified plastic surgeons also use a variety of technologies to repair areas of the head and neck using reconstructive microsurgery techniques. These procedures are designed to rebuild the nose, tongue or throat using tissues from other areas of the body, such as the thigh, abdomen or forearm. Patients who have had a laryngectomy to remove their voice box may also choose to undergo a tracheoesophageal puncture, which is used to help patients speak again.
Radiation therapy may be recommended to destroy cancer cells, shrink tumors and alleviate symptoms, using highly targeted X-rays or radioactive substances. Radiation for head and neck cancer patients may be used either as the main treatment or after surgery to kill microscopic disease. Brachytherapy, a form of radiation therapy, may be used during surgery to radiate small areas of cancer and reduce damage to healthy tissue.
Radiation therapy may also be delivered to head and neck cancer patients via robotic radiosurgery, a non-invasive option for patients with inoperable or surgically complex tumors as an alternative to surgery. The robotic radiosurgery system allows radiation oncologists to deliver high doses of radiation to a targeted area.
Concentrated doses of radiation may also be delivered to a tumor or tumors during surgery via intraoperative radiation therapy.
Chemotherapy is often used to treat head and neck cancer patients when the disease has spread to the lungs or elsewhere in the body. The drugs are designed to help slow or stop the growth of cancer cells. The chemotherapy drug most commonly used to treat head and neck cancer is cisplatin (Platinol®).
Precision cancer treatments
Every head and neck cancer is as different as the patient battling it. Each has genomic differences unique to that patient’s tumor. The tools of precision cancer treatment allow us to examine certain cancers at a cellular level in search of abnormalities that may be driving the cancer’s behavior, and if possible, match those mutations to drugs that are designed to target them. The precision cancer treatment program at CTCA has three main components: immunotherapy, targeted therapy and advanced genomic testing. These options are not recommended to all patients. The Head and Neck Cancer Program team at Southwestern will work with you to determine whether any of these options are recommended for your specific cancer.
Immunotherapy uses drugs to trigger the body’s immune system to fight cancer cells. Checkpoint inhibitors are a type of immunotherapy designed to disrupt the signaling proteins that allow cancer cells to disguise themselves from the immune system. The U.S. Food and Drug Administration has approved two checkpoint inhibitors to treat recurrent or metastatic head and neck cancer that hasn’t responded to chemotherapy: pembrolizumab (Keytruda®) and nivolumab (Opdivo®).
Targeted therapy uses drugs that target a specific tumor behavior. Advanced genomic testing may be used to sequence the tumor’s DNA profile to help identify whether the tumor has mutations that may be targeted with existing drugs. One such drug often used in head and neck cancer is designed to block epidermal growth factor receptor (EGFR). Research has found that drugs that block EGFR may help slow or stop the growth of certain types of head and neck cancer.
After your treatment has ended, your head and neck cancer team will continue to follow up on your progress with scans, bloodwork and routine physical exams to monitor for cancer recurrence. Head and neck cancer most commonly recurs in the first one to two years after treatment has ended. The frequency of your follow-up appointments may follow this schedule:
- Every four to six weeks during the first year after treatment
- Every two to three months during the second year
- Every three to four months during the third year
- Every four to six months during the fourth year
- Once a year after five years have passed since treatment ended
Quality of life
Many head and neck cancer patients experience a number of side effects, which may be severe, and may linger well after treatment has ended. Our multidisciplinary care team works closely with patients to help anticipate, manage and, when possible, avoid cancer-related side effects as part of our patient-centered integrative care model.
The two most common side effects of treatment for head and neck cancer are changes in voice and difficulty swallowing. Typically, voice changes are caused by surgery to remove the vocal cords. Radiation therapy may also cause hoarseness. Trouble swallowing, called dysphagia, may range from chronic dry mouth to an inability to swallow anything, including saliva.
Surgery also may affect a patient’s appearance, which may be improved with reconstructive microsurgery or other flap techniques.
Other common side effects of head and neck cancer treatment include:
- Temporary or permanent loss of voice
- Hearing loss
- Difficulty chewing
- Decreased thyroid gland functioning
- Swelling of the mouth and throat area
- Changes in taste
- Loss of appetite
- Redness or skin irritation
- Dry mouth
- Thickened saliva
- Bone pain
- Mouth sores
- Sore throat
The Head and Neck Cancer Program team at Southwestern includes pain management physicians, dietitians, speech therapists, physical therapists and naturopathic clinicians who are trained and experienced in working with head and neck cancer patients. Depending on your needs and preferences, you may choose to receive oncology rehabilitation, nutrition therapy, naturopathic medicine, pain management or other supportive care services before, during or after treatment to help prevent and reduce the impacts of side effects.
As part of our commitment to bringing our patients new and innovative treatment options, our research team carefully selects clinical trials that we believe may have a benefit for our patients. The Head and Neck Cancer Program team at Southwestern will work with you to determine whether you may be a candidate for one of our ongoing trials. Clinical trials may offer patients treatment options that may not have otherwise been available to them. Learn more about the clinical trials we offer.