Head & Neck Cancers: Treatment

Pictured: David Pfister Medical oncologist David Pfister examines a patient with throat cancer — one of the many kinds of head and neck cancer diagnosed and treated at Memorial Sloan Kettering every year.

Many cancers of the head and neck can be cured, especially if they are found early. Treatment varies according to the type, location, and extent of the cancer, and often includes a combination of surgery, radiation therapy, and chemotherapy.

Curing head and neck cancer is the physician's primary goal, but preserving patients' quality of life — including appearance and ability to function — is an equally important consideration. Recent advances in surgical techniques, reconstruction, and nonsurgical therapies allow us to help nearly every patient preserve quality of life while offering the most effective treatment.

Surgery

Surgery is the primary (first) treatment for most cancers of the head and neck. Improvements in surgical techniques allow surgeons to remove many more tumors while preserving nearby structures involved in sensory and physical functioning.

Pictured: Jatin Shah
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Head and neck surgeons at Memorial Sloan Kettering Cancer Center discuss minimally invasive approaches to removing tumors.

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Some patients may require surgical examination of the lymph nodes in the neck (called neck dissection) to determine if any cancer cells have spread beyond their original site. New techniques allow surgeons to remove these lymph nodes while sparing nerves that are important for shoulder function. Complex surgery to remove tumors at the base of the skull — once considered nearly impossible — can now be safely performed. The skull base surgery team at Memorial Sloan Kettering performs approximately 30 of these rare surgical procedures annually.

Reconstruction of bones and other structures is often possible immediately following surgery. For example, in cases where the jaw bone must be removed, the surgeon can create a new jaw using part of a bone in the patient's own leg. Our surgeons developed a microsurgery technique that uses miniaturized surgical instruments and a microscope to connect blood vessels in the leg bone (fibula) to blood vessels in the neck. Similarly, surgeons can use skin and muscle from a patient's back or abdomen to replace part of the scalp, neck, tongue, and throat. Dental and maxillofacial surgeons use implants to replace teeth lost during treatment.

Minimally Invasive Surgery

Minimally invasive surgical techniques are used when possible to remove tumors that are located near structures involved in sensory and physical functioning. In many cases, patients can recover more quickly when treated with minimally invasive surgery compared with traditional, open surgery.

Endoscopic Laser Surgery

This technique may be used to remove tumors in the larynx (voice box) or pharynx (throat) while preserving the structures involved in speech and swallowing. The surgeon inserts a thin, lighted tube called an endoscope through the patient's mouth and into the throat. Surgeons remove the tumor using a special laser that is attached to the endoscope. Endoscopic laser surgery is often performed on an outpatient basis with a safe, fast-acting anesthetic that wears off quickly after the procedure.

Minimally Invasive Video-Assisted Thyroidectomy (MIVAT)

A tiny video camera that is attached to an endoscope is used to remove thyroid tumors through a small incision.

Robotic Surgery

Tumors of the tongue and tonsils can be removed with the aid of small robotic arms that are placed in the mouth, avoiding the need to make a large incision or to split the jawbone.

Radiation Therapy

Pictured: Nancy Lee
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Highly precise radiation therapy techniques offer effective, localized treatment for many head and neck cancer patients.

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Radiation therapy alone or in combination with chemotherapy is standard curative treatment for many patients with head and neck cancers. Which approach is used depends on the extent of the tumor; radiation and chemotherapy are used in combination when treating more advanced disease. In select situations, such as oral cavity tumors, the patient undergoes surgery followed by radiation therapy and/or chemotherapy.(1) Radiation therapy, or a combination of radiation and chemotherapy, may be used to treat patients who would develop significant side effects from surgery, those with inoperable cancers, or those who have a poor prognosis after surgery.

Patients may be treated with one or both of the following types of radiation therapy:

External-beam radiation therapy

Our radiation oncologists use a type of external-beam radiation therapy called intensity-modulated radiation therapy (IMRT), which uses highly sophisticated computer software and three-dimensional images from CT scans to deliver radiation to tumors with greater precision than conventional radiation therapy. Using this technique, the radiation oncologist can “mold” the dose of radiation to the tumor, delivering higher, more effective doses, while sparing healthy tissue and reducing the risk of side effects. Memorial Sloan Kettering also offers image-guided radiation therapy (IGRT), which offers additional precision and effectiveness of radiation treatments.

Brachytherapy

Tiny, radioactive seeds are implanted into the tumor site, where they deliver the highest dose of radiation possible with minimal effect on nearby healthy tissue.

Chemotherapy

Increasingly, chemotherapy — in combination with radiation therapy — is used to treat head and neck cancers that are difficult to reach surgically or that cannot be cured by surgery alone. This approach is also used to treat patients for whom surgery would cause significant functional or cosmetic disability, such as loss of the larynx (voice box), with its associated loss of natural voice and the need for a permanent stoma (hole) in the front of the neck. Chemotherapy has been shown to enhance the effectiveness of radiation therapy, improving cure rates compared to radiation therapy alone for advanced cancers such as those originating in the nasopharynx.

Chemotherapy is also used for patients with incurable disease, in an attempt to improve survival and decrease cancer-related symptoms. The most commonly used chemotherapy drugs include cisplatin, fluorouracil, methotrexate, carboplatin, paclitaxel, docetaxel, and, more recently, cetuximab.

Investigational Approaches

Memorial Sloan Kettering continues to evaluate novel chemotherapy drugs, new drug combinations, and other strategies to improve the standard of care for head and neck cancer. Our physicians sometimes offer these investigational therapies to eligible patients through clinical trials. Some of these studies are limited to patients with head and neck cancers and are primarily lead by members of the head and neck cancer team, while others are done in collaboration with our drug development group, allowing patients access to new drugs that are promising but less well studied. Find out more about our clinical trials.

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When John McPeak was diagnosed with base-of-tongue cancer, radiation oncologist Nancy Lee eliminated the tumor while preserving his quality of life.

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Scientists in Memorial Sloan Kettering's Laboratory of Epithelial Cancer Biology are at the forefront of research to identify genes that play a role in head and neck cancers. Our researchers are evaluating new techniques to identify these genetic markers using novel hybridization assays (tests that search for specific DNA or RNA sequences linked to head and neck cancers) and karyotyping (tests to determine the chromosomal makeup of a cell). Our clinical investigators are using this information to develop new therapies that target these genes, or may be used to help deliver cancer therapy directly to a tumor. These investigational medications may offer hope for patients with tumors that are difficult to control with standard chemotherapy drugs.

Memorial Sloan Kettering researchers are also developing new tests that have the potential to rapidly determine whether an individual patient's tumor cells will respond to a specific treatment before it has begun. Such tests could help doctors select treatments that will be most effective for each patient.

In addition, Memorial Sloan Kettering investigators are developing effective cancer prevention strategies for tobacco-related cancers.

  1. J. P. Pignon, J. Bourhis, C. Domenge, and L. Designé, Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data, Lancet 355(9208), 2000: 949-55.