Head and Neck Cancer

The Head and Neck Cancer Center is a major provider in the Northeast for patients with early-stage, recurrent, or aggressive head and neck cancers. The nationally recognized team of multidisciplinary specialists who care for these patients collaborate to manage patient care from the first consultation through treatment and follow-up. They combine their expertise in patient care with state-of-the-art treatment options while actively participating in clinical trials to provide tomorrow’s treatments today.

For more information or to refer a patient, call 617.414.4913 or email [email protected]. Patients with a diagnosis or strong suspicion of cancer are seen within 72 hours.

What Is Head and Neck Cancer?

According to the National Cancer Institute, each year, approximately 55,000 Americans are diagnosed with cancers of the head and neck. These malignancies can disfigure the face and neck and affect a person’s speech, eyesight, hearing, ability to swallow, and sense of smell.

Fortunately, many of these cancers are curable if caught at an early stage.

Cancers of the head and neck generally develop in the squamous cells (the outermost layer of cells) that line the moist surfaces inside the mouth, nose, and throat. Cells, the body's basic unit of life, divide to form new cells, and after performing their functions for a while, they die. Cancer cells do not die. Instead, they morph into a new type of cell and divide and produce extra cells that merge into a tumor. If the tumor is benign, it does not metastasize (spread) elsewhere in the body. If the tumor is malignant, it is cancerous and can metastasize to other parts of the body.

Ninety percent of head and neck cancer cases are squamous cell carcinomas: malignant tumors on the surface of the oral cavity, the aerodigestive tract (respiratory and digestive passages), and other organs.

The location of the cancer determines its name and affects its diagnosis and treatment. Sites of head and neck cancer include

• Salivary glands
• Nasal cavity and sinuses
• Upper aerodigestive tract
  • throat (pharynx)
  • voice box (larynx)
  • oral cavity (lips, gums, cheeks, tongue, and roof and floor of the mouth
• Thyroid cancer
• Parathyroid cancer
• Eye cavity (orbital tumors in the bones surrounding the eye)
• Ear and temporal bone
• Sarcomas (clusters of malignant tumors) in the neck
• Tumors of the skull base, including squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, esthesioneuroblastoma, sinonasal undifferentiated carcinoma (SNUC), sarcomas, lymphoma, hemangiopericytoma
• Skin of the head and neck
• Laryngeal cancer
• Oropharyngeal cancer

Symptoms of Head and Neck Cancers

Many cancers of the head and neck produce early warning signs. General symptoms include a persistent sore, a lump, swelling, and soreness or pain in the face, neck, mouth, jaw, or throat.

Other symptoms vary with the type and location of the cancer, such as

• Paralysis or numbness in the face or neck
• Change in vision, pain, or bulging around the eye socket
• Hearing loss or ear pain
• Difficulty or pain when opening the mouth, chewing, swallowing, or speaking
• Bleeding from the mouth or nose
• Unusual white or red patches on the mouth lining, gums, tongue, or lips
• Changes in the voice, such as hoarseness
• Weight loss
• Looseness of upper teeth
• Dentures that no longer fit properly or comfortably

If any of these symptoms persist for more than two weeks, patients are advised to see their physician.

Causes of Head and Neck Cancers

Most head and neck cancers are linked to tobacco products, such as cigarettes, cigars, pipe tobacco, and smokeless tobaccos, such as chewing tobacco and snuff. Using both tobacco and alcohol puts an individual at greater risk than either of these habits alone. A subset of head and neck cancers may be caused by the human papillomavirus (HPV).

Other factors that may increase risk are

• Age: Most head and neck cancers are found in people ages 50 and older.
• Gender: Men are at greater risk to develop head and neck cancers than women.
• Race: African Americans have a higher rate of head and neck cancer than do Caucasians, Hispanics, or Asians.
• Radiation to the head and neck from previous radiation therapy
• Poor oral hygiene
• Exposure to airborne particles of asbestos, especially in the workplace
• Excessive sun exposure

Diagnosis of Head and Neck Cancers

How Is Head and Neck Cancer Diagnosed?

Timely screening and detection can significantly reduce deaths from head and neck cancers, which at early stages have a cure rate as high as 90 percent. Diagnosis and treatment vary with the type and location of the cancer. However, most diagnostic work-ups will include the following steps:

Physical Exam

Your physician will ask you a series of questions and is likely to do a physical exam. The physical exam will including examining any specific areas of concern, especially as they relate to the reason for your visit to the office.

Biopsy

Any suspicious mass of tissue or tumor is subject to a biopsy, or removal of cells from the mass. This is the only technique that can confirm the presence of cancer cells. The doctor will use a general or local anesthetic depending on the location of the mass, and then remove a sample of tissue to send to the lab. The sample is sent to a pathologist, a physician who is an expert at identifying diseased cells in tissue samples. Very often, a few stiches are used to help the area heal, and tenderness is felt for a short period of time.

Imaging Studies Head and Neck Cancer

In addition to laboratory tests of blood and urine, the diagnosis may involve imaging studies such as barium swallow x-ray, CAT (computed axial tomography) of MRI (magnetic resonance imaging) scans, or PET (positron emission tomography) scan, in which cancer cells become visible after absorbing treated sugar.

Based on these findings, patients may also meet with other BMC experts in a variety of specialties, including head and neck surgical oncology; neurosurgery; ophthalmology; pathology; radiology; dentistry, oral surgery, and prosthetics; speech and swallow rehabilitation; audiology; gastrointestinal surgery and nutrition; medical and radiation oncology; vascular surgery; and microvascular, reconstructive, and plastic surgery.

The results of these consultations and procedures are reviewed in a weekly multidisciplinary Head and Neck Tumor Board meeting. Each patient receives a comprehensive, individualized care plan, designed to meet his or her specific needs. Following this review, the patient’s BMC physician will discuss the recommendations of the Head and Neck Tumor Board with the patient and his or her family, and together they will develop a treatment plan that meets the patient’s specific needs.

Quality Metrics

The Head and Neck Oncology Team at Boston Medical Center is committed to providing the highest quality of comprehensive cancer care through our robust, multidisciplinary care team approach and our strong clinical trials program. 

In a recent American Head and Neck Society Quality Metrics database, BMC showed a superior performance to the nationwide study averages’ quality metrics, including: 

• Lower rates of unplanned reoperations after cancer surgery, 
• Providing multidisciplinary tumor board review to all patients, and 
• Timely initiation of adjuvant therapy. 

We also outperformed the average in clinical trial enrollment, illustrating our commitment to improve access to therapeutic clinical trials for all patients. 

In addition to our comprehensive medical teams, which include oncologic surgeons, reconstructive surgeons, medical and radiation oncologists, and specialists in neuro-radiology and nuclear medicine, our multidisciplinary care teams encompass a wide array of other specialists to support and aid patients on their treatment journey. Staff include specialized speech language pathologists, patient navigators, oncology social workers, smoking cessation counselors, registered dieticians, and integrative medicine professionals. Many patients benefit from accessing acupuncture, yoga and cooking classes, and support groups. 

Along with providing excellence in cancer care, BMC’s Head and Neck Oncology team is committed to cancer prevention. The Human Papillomavirus (HPV) is a virus that causes many cancers, including cancers of the tonsil and back of the tongue. In an effort to improve access to the vaccine and reduce vaccine-preventable cancers in our community, the HPV vaccine is now available to all BMC patients in the Otolaryngology clinic. 
 

References

National Cancer Institute. 2013. “What are the side effects of treatment?” In “Head and Neck Cancers.” Last reviewed February 1, 2013. Accessed June 14, 2015. http://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet#q7