Treating head and neck cancers

This year, more than 60,000 people in the U.S. will develop head and neck cancer, according to the American Cancer Society and National Cancer Institute. If you or someone you love is diagnosed with a head and neck cancer, or is at higher risk to develop head and neck cancer, it’s important to know why a team approach to treatment and survivorship is important.

What are head and neck cancers?

Cancers known collectively as “head and neck cancers” usually begin in the squamous cells lining the inside of the mouth, nose and throat and can be found in the oral cavity, pharynx, larynx, sinus and nasal cavities and salivary glands. At least 75 percent of head and neck cancers are caused by tobacco and alcohol use, however infection with cancer-causing types of human papillomavirus, especially HPV-16, is a leading cause for rising rates of head and neck cancers in the U.S., according to the National Cancer Institute.

Symptoms of head and neck cancer may include a lump or sore throat that does not heal, a sore throat that does not go away, difficulty swallowing and a change or hoarseness in the voice. Unlike some cancers, there is no definitive blood test, imaging or screening diagnostic that can be performed to diagnose head and neck cancers. Diagnosis relies on evaluation of medical history, a physical exam and diagnostic testing.

How are these cancers treated?

If cancer is found, treatment can vary greatly depending on the cancer’s location, stage and the patient’s age and general health. Because of the location of head and neck cancers and the variance in treatments, side effects also can vary widely and can affect patients’ physical appearance; ability to chew, swallow or talk; and cause swelling, numbness, weakness, fatigue, weight loss, stiffness, sores, nausea and more, depending on the treatment.

“While all cancer patients would benefit from a multidisciplinary approach to treatment that involves communication and planning among a large health care team, head and neck cancer patients are a great example of the value of this approach, especially because their cancer provides some unique challenges,” said Dr. Alfred J. Newman, hematologist/oncologist with Novant Health Cancer Specialists – Matthews and Novant Health Multidisciplinary Cancer Clinic.

Newman explained that head and neck cancer patients often have complicated diagnosis and treatment paths, and a range of side effects and symptoms that require involvement from many different disciplines.

“It’s critical to have accurate, and often second, opinions regarding radiology imaging and pathology, as well as opinions from all three disciplines – ear, nose and throat surgery, radiation oncology and medical oncology – to not only provide reassurance to patients, families and treating physicians, but also to aid as treatment changes along the way,” Newman said.

“Head and neck cancers require probably the largest group of ancillary helpers to get someone through a treatment course,” added Dr. Douglas Villaret, an otolaryngologist with Charlotte Eye Ear Nose & Throat Associate, P.A.

Newman noted that due to the wide range of symptoms from the cancer and side effects from its treatment, head and neck cancer patients benefit uniquely from the involvement of speech pathologists, nutritionists, social workers, audiologists, cancer nurse navigators and others.

“These health care partners can be invaluable to help patients and their families navigate the health care system and utilize all these resources,” Newman said.

Better together

Newman and Villaret, along with radiation oncologist Kevin Roof, have been instrumental in orchestrating a formal multidisciplinary team approach to reviewing cases of head and neck cancers within the Novant Health system of cancer care in the greater Charlotte and greater Winston-Salem areas.

“Several studies have shown you provide better care and the patients have better outcomes if their cases are presented at a tumor conference – the biggest reason being that it’s not a single person making decisions on behalf of a patient’s care,” Villaret said.

“We now have a focused group that includes everyone from surgeons, radiologists and pathologists, to speech, physical and nutritional therapists, social workers and nurse navigators,” he said. Sept. 13, 2016 marked their first official meeting. “It’s been really great; we’ve had two tumor boards so far and are doing them every other week and building to doing them weekly as we pick up volume,” Villaret said.

Collaboration that shapes care

And the collaboration is already making a difference for patients.

“I recently had a young patient with a very aggressive, locally advanced cancer of the tongue,” Newman said. “Despite aggressive chemotherapy and radiation, the patient’s cancer rapidly returned.”

Newman said he had planned for the patient to start standard chemotherapy, and it was already scheduled and authorized. “I brought the case to the multidisciplinary team, mostly out of interest given the cancer’s rapid recurrence. I didn’t expect the treatment to change,” he said.

In presenting the case, a colleague offered the idea of treatment with immunotherapy, which the FDA had approved only shortly before the presentation. Within a few days, the patient started immunotherapy instead of chemotherapy.

“The patient is tolerating it beautifully and responding so far,” Newman said.

Villaret recounted a recent case of a young patient with a paraganglioma, a tumor of cells that regulates blood pressure. One large tumor ran along the carotid artery and a smaller tumor was on the other side.

“We surgically removed the large tumor. The debate was whether to operate on or radiate the smaller tumor on the other side,” Villaret said. “By presenting the case at the tumor conference, the radiation therapist was able to chime in with the recommendation that we wait and monitor the situation, arguing the smaller tumor could grow very slowly.”

Villaret said that not treating the second tumor so aggressively right now allows the care team to see how it will grow while also protecting the young patient from radiation and potential blood pressure issues before they are necessary.

“There was a definite change in plan because it was presented at the tumor conference,” Villaret said.

He added, “It’s important to get in with a system like Novant Health where there is multidisciplinary care and good communication between all phases of your cancer care, including access to a great survivorship program,” he said. “It really makes a difference.”