Cancers of the head and neck can affect a variety of sites within the region, including the larynx, pharynx, oral cavity, thyroid gland, and parotid and salivary glands. Approximately 3,000 new head and neck cancer cases are diagnosed annually in the state of Texas. Risk factors for cancers affecting this region often relate to tobacco and alcohol but also include the human papillomavirus (HPV). Currently, there is an unmet need to develop new therapies that will further improve the quality and quantity of life of patients with head and neck cancers.
The Head and Neck Oncology Multidisciplinary Clinic, under the direction of Frank R. Miller, M.D., FACS and Ethan Argiris, M.D, FACP is the only multidisciplinary head and neck cancer clinic in South and Central Texas. The clinic team is comprised of subspecialty trained physicians with diverse clinical interests including Medical Oncology, Head and Neck Surgery, Radiation Oncology, Plastic Surgery, Dentistry, Neuroradiology, and Nutrition. The group is dedicated to providing optimal cancer care for patients while preserving function as relates to swallowing, voice, and cosmesis. A range of treatments including conventional and robotic surgery, radiation, chemotherapy and cutting edge experimental treatments are available for patients on one campus. As part of a National Cancer Institute designated Cancer Center, it is our mission to deliver state of the art cancer care and offer opportunities for patients to enroll in clinical trials.
Head and Neck cancers represent a wide variety of tumors in different locations in the head and neck region. Cancers of the head and neck can affect a variety of anatomic sites within the region including;
The initial symptoms of head and neck cancer are related to the tumor location. It is common that patients may initially present to the primary care physician with ear pain, difficulty swallowing, voice changes/hoarseness, non-healing sore, thyroid nodule, or a neck mass. Symptoms that persist beyond 2-3 weeks are best assessed by a Head and Neck Surgeon to rule out any type of tumor.
Initial Consultation in Office
If symptoms persist for greater than 2-3 weeks a formal consultation with a Head and Neck Surgeon is indicated. The initial evaluation will consist of a careful review of your history including smoking and alcohol. The physician will perform a complete head and neck examination to assess for any tumor, mass, or lesion of the upper aerodigestive tract. During this initial office visit it is common that a flexible laryngoscopy will be performed to assess the back of the tongue and voicebox. This simple procedure is painless and provides a detailed view of the entire lower throat and voicebox/larynx.
Once the physician identifies a suspicious lesion/mass there are a number of diagnostic studies that may be indicated. Radiographic imaging may include CT scan, MRI scan, and PET-CT scan. These studies help the surgeon delineate the mass and begin the staging process for any new tumor. In the case of thyroid nodules an ultrasound is a non-invasive x-ray that measures the size and characteristic of any nodule/mass.
The next critical step is to obtain a tissue sample of the mass to have it examined under the microscope by a pathologist. The tissue may be obtained by direct biopsy (similar to minor dental procedure) or via fine needle aspiration biopsy (small needle inserted into the mass to obtain cells for analysis). The goal is to obtain an adequate tissue sample to classify the tumor since this directs the appropriate therapy. If outside tissue biopsies have been done we will help you obtain those pathology slides so they may be reviewed here for a second opinion by our pathologist.
Tumor Staging and Treatment
Once the work-up including radiographic imaging and tissue biopsy the tumor can be staged. Many patients with head and neck cancer may also undergo a panendoscopy which is an examination under anesthesia in the outpatient OR setting to measure the tumor size/location.
Staging a cancer simply means that the size and extent of the tumor are categorized. Most cancers are staged based on the American Joint Commission on Cancer (AJCC) standards. Tumors can be staged from Stage I through Stage IV. In general in the head and neck cancer system early stage tumors (Stage I and II) can be treated with single modality treatment (surgery alone or radiation therapy alone).
More advanced head and neck cancers often require some combination of surgery, radiation, and chemotherapy. We will review your case at our weekly Head and Neck Cancer Tumor Board where each case is reviewed by the multidisciplinary team including head and neck surgeon, medical oncology, radiation oncology, dental, and radiology. Once the case is reviewed formal recommendations are made as to the optimal treatment plan.
One of the newer technologies to help manage head and neck cancer is trans-oral robotic surgery (TORS). The TORS program is under the direction of Frank R. Miller, MD, FACS and is based at St. Lukes Baptist Hospital and University Hospital in San Antonio. This new minimally invasive technique can be utilized to manage a wide variety of head and neck tumors and in many cases can provide less invasive approaches to head and neck cancer and quicker patient recovery. Your surgeon can provide you an assessment to advise if your particular cancer is amenable to robotic surgery.
We have been very successful at achieving excellent cure rates using combinations of chemotherapy, novel targeted agents, radiation therapy, and minimally invasive surgery with the ultimate goal of preserving speech, swallowing, and voice. Your treatment team will discuss the specific recommendations with you based on the careful review of all the diagnostic information and the tumor board recommendations.