Tumors of the head and neck
The group of tumors located in the cervical region and head are called head and neck tumors, as well as those located in:
- Oral cavity (lips, tongue, floor of the mouth, gums and palate).
- Posterior region of the mouth (tonsils, nasopharynx, oropharynx and hypopharynx).
- Nasal cavities and sinuses.
- Saliva Glands (parotid, submandibular and sublingual salivary glands).
- Thyroid gland.
- Lymph nodes of the neck
- Skin of the face, scalp and neck.
- The ear.
- Base of the skull.
Head and neck tumors account for approximately 10% to 12% of all the types of cancer in men and 4% to 5% in women.
The overall survival rate is better than cancers in other locations which are generally more aggressive. The cure rate is between 50% and 60% and almost 90% in the thyroid.
- Tobacco and alcohol are two of the most important risk factors of head and neck tumors: 8 out 10 cancers in this area are related to the use of tobacco or consumption of alcohol.
- Virus infections (such as the Ebstein Barr or HPV virus) have been identified as predisposing factors.
- Poor oral hygiene and the lack of fruits and vegetables in the diet have been considered to be risk factors in the occurrence of tumors in this area.
The presence of lesions (tumors, ulcers) in the mouth that do not heal within a short time, bleeding, changes in the voice maintained over time, difficulty swallowing or pain radiating to the ear, the appearance of lumps in the lateral regions of the neck, nasal bleeding or severe headaches may be symptoms of different diseases in this area including tumors.
The diagnosis of these tumors is based on:
Medical history and a complete physical examination.
They are the first approach in obtaining a correct diagnosis. A clinical evaluation by the specialist must include a series of tests:
- Endoscopy: endoscopic examinations with a camera connected to a monitor and recording systems are essential to properly evaluate each clinical case as well as its progress.
- A biopsy involves taking a sample of the tumor to analyze in order to reach a definitive diagnosis. It can be performed under local or general anesthesia. Tissue samples are sent to the pathology department where a microscopic evaluation is done by a specialist.
- A FNA (fine needle aspiration) can be performed in lesions of the lateral neck regions using ultrasound guidance in order to evaluate a particular lesion.
- An ultrasound of the neck can be a first approach in order to assess the presence of cervical nodes.
- Computed tomography (CT) with contrast allows for the evaluation of the patient’s condition. It is even more valuable for determining the distant spread of the disease (chest, brain).
- The MRI is the most appropriate test to define the extent of the tumor and its relationship to surrounding structures. It is also the basis for patient re-evaluation and evaluating post treatment progress.
- The PET-CT scan is a test that can identify the extent of the disease with great precision, at the level of both regional and distant lymph nodes. The high sensitivity of this method makes it essential for the proper management of patients.
The determination of levels of calcitonin is very important in the diagnosis medullary thyroid cancer.
Los niveles de PTH, realizado durante y después de la extirpación quirúrgica de adenomas paratiroideos, sirve para el seguimiento, control y evaluación del éxito del tratamiento.
The PTH levels attained during and after surgical removal of parathyroid adenomas serve for monitoring, control and evaluating the success of the treatment.
The treatment approach should be defined by a multidisciplinary committee which evaluates each case individually. In iTAcC this committee is composed of an otolaryngologist, a maxillofacial surgeon, a radiation and a medical oncologist, a radiologist and a pathologist. When necessary other specialists such as a neurosurgeon, an ophthalmologist, a vascular surgeon, thoracic surgeon, a surgeon plastic and a dermatologist participate in the decision process. The committee is also open to the opinions of those professionals trusted by the patient.
The purpose of this group of professionals is to offer each patient the best treatment options with the greatest curative powers as well as better functional and aesthetic results.
The three foundations in the treatment of head and neck tumors are:
Most often surgery is the first therapeutic choice in head and neck tumors. Since a few years ago, some specialized centers like iTAcC proposed performing minimally invasive approaches on patients thanks to new technologies and a better understanding of the biology of these tumors. This meant avoiding aggressive interventions that may cause disabilities and undesirable sequelae while reducing recovery time and offering an early return to a normal lifestyle.
Using transoral laser microsurgery or a surgical microscope helps reduce functional impairment that may be caused by these interventions.
Malignant tumors of the larynx can be treated with conserving surgery techniques. This prevents complete removal of the larynx with ensuing loss of speech and permanent placement of a tracheostomy.
Sometimes it is necessary that different surgical teams are involved in the surgical intervention. On many occasions neurosurgeons, vascular surgeons and plastic surgeons are required in order to achieve the primary goal of surgery and lay the foundation for the patient’s recovery.
Radiotherapy is one of the principal methods in the treatment of tumors of the head and neck.
Radiation therapy alone, with its curative objective, is often indicated as the primary treatment of choice. One example is when it is used in the treatment of nasopharynx or larynx tumors in the initial stage representing a non-invasive alternative to surgery.
Radiation therapy in itself is indicated in some situations to control symptoms resulting from the progression of the disease on a local level. This involves palliative treatments aimed at improving the quality of life of patients.
In the case of locally advanced disease radiation therapy is used in combination with chemotherapy to preserve organs and their purpose while eradicating the tumor.
Post-operative radiotherapy treatments can be done if surgery was not able to completely remove the tumor or doubts exist about its extension.
Modern radiotherapy based on intensity modulated radiation therapy and image-guided radiation therapy (IMRT/IGRT) techniques allows experienced specialists to perform treatments with a much lower incidence of side effects than in other centers not using this technique. With a low rate of side effects, specialists and modern equipment, the dose delivered to the tumor can be increased. This achieves a greater rate of treatment success.
iTAcC radiotherapy treatments are performed using the Truebeam-STX system. It is recognized as the world’s most accurate and is able to meet the high quality demands in IMRT / IGRT that specialists so desire.
In select cases another treatment with sub-millimeter precision is done in 1 to 5 sessions after treatment by radiotherapy. These types of treatments are called stereotactic body radiation therapy (SBRT) or radiosurgery. The target is small tumors or their remnants.
Chemotherapy has different functions in the area of the head and neck:
En los casos de enfermedad avanzada, con el fin de reducir el volumen del tumor antes de una extirpación quirúrgica.
- Prior to surgical removal it is used in cases of advanced disease in order to reduce tumor size.
- Secondly, chemotherapy may be combined with radiotherapy in case of advanced tumors with the intention-to-cure. One example is in the case of nasopharyngeal tumors.
- In addition chemotherapy is one of the treatments of choice when the disease has spread.
The introduction in recent years of biological therapies and active drugs against some tumor growth factors has provided to this group of patients once-in-a-lifetime opportunities.
Specialists in Medical Oncology at iTAcC have extensive experience in the administration of these types of drugs.
In order to rule out the possibility of disease recurrence iTAcC has the means to monitor and control the progress of patients who have suffered head and neck cancer.
As an open institution, iTAcC works with the patients’ physicians. Follow up is done as is all oncological all activity at iTAcC, in a personalized manner and in cooperation of doctors who have been involved in the diagnosis and treatment of each case.
Patients may on occasion require therapy in the recovery of their daily functions in the form of physical or speech therapists. These professionals help the patients with recovering the use of their voice as well as with swallowing.