Head and neck cancer represents a wide spectrum of disease. Some tumors such as lymphomas are treated just with chemotherapy and possibly radiation. Some cancers such as those in the thyroid gland and salivary glands are predominantly treated with surgery with radiation used only in a postoperative setting.
The most common cancer, squamous cell carcinoma, has its treatment tailored based on location and size. Squamous cell carcinoma is treatable and potentially curable if it has remained confined to the head and neck region. Thus, we will often order surveillance scans such as PET scan or a series of CT and or MRI scans. We prefer a team approach and will have you seen by Oncology and Radiation Oncology if we expect them to be potentially involved in your treatment plan. Treatment of head and neck squamous cell carcinoma will often result in changes in speech and or swallowing thus we will often obtain a baseline speech therapy evaluation will be ordered in one of our speech therapy centers.
For most cancers in the oral cavity including lining of the mouth, upper and lower jaw and front two thirds of the tongue, surgery is the initial treatment and further postoperative radiation and or chemotherapy or immunotherapy is guided by size of the cancer in the mouth and any high risk features found on examination of the specimen such as small vessel, nerve or bone involvement. Often lymph nodes are removed as part of staging even if they are not obviously enlarged on exam or on CT or PET. It is part of treatment and staging. It is called a neck dissection. The neck dissection goals are to remove the nodes and preserve all the nerves and muscles in the neck that we can. In large cancers, it may be necessary to sacrifice some of these structures if they are involved or too closely related to the cancer. Thus, early diagnosis and treatment are important not only to improve the long term prognosis but also improve the quality of life as we are able to be less aggressive surgically. We must always be more aggressive than the cancer if we are to have a good chance of cure. Dr Ducic has also researched when it is necessary to remove nodes after initial radiation treatment.
Planned Neck Dissection Following Primary Chemoradiation for Advanced-Stage Head and Neck Cancer
In cancers of the base of tongue (part of tongue that attaches to the voice box or larynx) or larynx or throat lining (pharynx) surgery is usually reserved for salvage (meaning only do surgery if the radiation with or without chemotherapy has not worked) except in very large or advanced cancers (such as those that destroy the cartilage of the voice box, or are so large as to obstruct the breathing). Esophageal cancer treatment depends on the size with some treated with initial surgery and some with surgery only if chemoradiation fails.
TORS or transoral robotic surgery and CO2 laser are tools we use occasionally for surgical management of certain usually very limited cancers.
TORS excision of lingual thyroid carcinoma: Technique and systematic review
There are some traditional limits to excision of head and neck cancers. These include involvement of the carotid artery, involvement of the skull base and brain and an aggressive form of thyroid cancer called anaplastic carcinoma. The team at the Head and Neck Cancer Center of Texas has developed techniques described in the literature that have enabled us to cure some of these previously incurable cancers.
- Carotid Artery Sacrifice and Reconstruction in the Setting of Advanced Head and Neck Cancer
- Aggressive Surgical Resection of Anaplastic Thyroid Carcinoma May Provide Long-term Survival in Selected Patients
- Extending the Traditional Resection Limits of Squamous Cell Carcinoma of the Anterior Skull Base
Almost as important as curing head and neck cancers is the reconstruction of the deficits created by the cancer and its treatment. Head and neck cancer affects all that identifies us as the person that we are to others: our appearance, our voice and our ability to swallow and chew.
The team at the Head and Neck Cancer Center of Texas has devoted a lot of effort and research to improve all aspects of the patient’s appearance and function. We have trained over 100 surgeons in various aspects of head and neck reconstruction and provide for advanced fellowship training for surgeons who have already completed all of their head and neck surgery training and wish to master the more finesse aspects of Facial Plastic Surgery. Drs Ducic and Saman are both fellowship trained in Facial Plastic Surgery and focus much of their energy on this aspect of cancer care.
We are able to do simple reconstructions and closures of wounds as well as complex reconstructions of virtually any of the structures that may be removed in surgery of the head and neck including reconstruction to replace the volume of the tongue, upper and lower jaw, skin cancer defects and throat lining. Esophageal reconstruction may also be performed with either tissue transplants or utilization of the stomach.
Free flaps or microvascular free tissue transfers are the most advanced way of bringing large amounts of skin, muscle and bone from one part of a person’s body and transplanting them elsewhere. This allows us to rebuild the jaws and tongue as well as throat lining, improving function and appearance. Dental implants can also be put into the reconstructed jaw bones allowing for truly life changing results.
The exact surgery required and reconstruction options will of course vary patient to patient and will be reviewed with you at your consultation.