Head and Neck Cancer

     Overview

    Head and neck cancer is a compilation of several disease sites.These are cancers of the aerodigestive tract and are found at some point from the lips to the hypopharynx. Skin cancers of the face and neck are generally not considered in this category, nor are tumors that arise in the brain or eye. Specifically, head and neck cancers are located in the following areas: lips and oral cavity (oral tongue, floor of mouth, buccal mucosa, hard palate, alveolar ridges, and retromolar trigones), nasopharynx, nasal cavity and paranasal sinuses, oropharynx (the soft palate, base of tongue, tonsils, tonsillar pillars, and pharyngeal walls), larynx (supraglottic, glottic, and subglottic), hypopharynx, salivary glands, and thyroid gland. Overall, in the United States, there are approximately 45,000 cases diagnosed per year. Head and neck cancers are more common in men than women. There is a clear association between tobacco use and alcohol consumption and cancers of the head and neck. Some sites have been associated with infection with a specific virus and some are associated with living in certain parts of the world.

     In-depth Information

     The general signs and symptoms are dependent on the location of the tumor. The most common reasons that patients seek medical attention are hoarseness or soreness of the throat as well as a painless but enlarging lump in the neck. Some patients may also develop difficulty swallowing or notice a sore or mass in the mouth. Generally patients first see their primary care physicians regarding one of these symptoms. If the primary care physician suspects cancer, the patient is usually referred to an otolaryngologist (ENT). It is not uncommon for the primary physician to try a course of antibiotics before making the referral. The ENT is a specialist in the ear, nose and throat. They are expert in the examination of those areas and will perform a careful examination. They may use a piece of equipment called a fiberoptic laryngoscope to exam the area of concern carefully. If necessary, the patient may also have a panendoscopy, which involves general anesthesia and careful examination by the ENT of the entire upper aerodigestive tract. This is especially valuable since it is not uncommon for patients with head and neck cancer also to have a tumor of the esophagus or lung. At the time of the panendoscopy, the ENT will obtain a biopsy. If there is a neck mass, that will also be biopsied with a small needle (fine needle aspiration). If the diagnosis of cancer is made, a CT scan of the neck is frequently obtained to help evaluate and clearly define the extent of the disease. Also, a chest x-ray is routinely performed to verify that the cancer has not metastasized (spread beyond the local area). A thorough dental evaluation is recommended for all patients who will undergo radiation treatments for head and neck cancers.

     The staging of head and neck cancer is based on the size of the tumor, invasion of other structures or sites, lymph node involvement, and distant spread. Although the staging still depends somewhat on the specific location involved, in recent years there has been an effort to standardize staging across all head and neck sites. The following stage descriptions are a simplified composite for these sites.


  • Stage I: The tumor is less than 2 cm in size and confined to the site of origin.
  • Stage II: The tumor is greater than 2 cm but not more than 4 cm in size, without involvement of critical structures or lymph nodes Relatively small tumors with spread to the closest lung lymph nodes. 
  • Stage III:  The cancer is more than 4 cm in size or involves a single lymph node that is less than 3 cm in size.
  • Stage IVA:  The tumor invades adjacent structures but is still resectable, or there is more extensive lymph node involvement (more than 3 cm but less than 6 cm in size, possibly with involvement of the lymph nodes on the opposite side of the neck). lymph nodes.
  • Stage IVB:  The tumor is more locally advanced, with involvement of critical structures that render it unresectable or there is at least one involved lymph node that is greater than 6 cm in size.  
  • Stage IVC:  The cancer has spread to distant organs.
     The treatment of head and neck cancer depends on the site as well as the stage of the disease. The three general treatment modalities are surgery, radiation, and chemotherapy. Surgery may consist of resection of the primary tumor, removal of several lymph nodes in the neck, or both procedures. Often several of the modalities are combined to maximize the benefit of treatment. In recent years there has been a trend toward giving radiation therapy and chemotherapy concurrently to improve outcomes.


     Research & Clinical Trials

    At Emory there are several active areas of investigation and innovation for patients with head and neck cancers. One such area is the use of IMRT (intensity modulated radiotherapy). IMRT is a dynamic method in which the treatment is planned and delivered using special computer software to control the radiation strength at different areas within the beams, thereby improving dose conformity to the tumor and reducing side effects. Click here to visit our IMRT Research and Treatment Center. Another area of innovation at Emory is the use in some cases of computer software to fuse PET scans with CT scans for radiation therapy planning; the two types of scans yield different information about the extent of the cancer that may affect treatment for a substantial number of patients. There are also several ongoing protocols in which radiation and different chemotherapy agents are given in a variety of ways to maximize the beneficial effect. Click here to visit our clinical trials center.

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