Q & A: MSK Leads the Way in Treating Head and Neck Cancers

By Jim Stallard,

Doctor in green surgical scrubs wearing glasses and cap looking at camera.
Summary

The chief of the Head and Neck Service describes Memorial Sloan Kettering’s expertise in diagnosing and treating these diseases.

In recognition of Head and Neck Cancer Awareness Month, we asked Richard Wong, Chief of the Head and Neck Service, to discuss his team’s approach to patient care.

What makes the care your team offers for head and neck cancers stand out?

It all starts with making sure that we have a correct diagnosis. To do this, we rely on our pathologists to conduct a careful analysis of a tumor’s genetics. Once a diagnosis is made, we do imaging tests that are interpreted by our neuroradiology and ultrasonography experts to carefully assess the extent and possible spread of the tumor. 

All of this information is analyzed by our team of experts from different areas, who all specifically focus on head and neck and thyroid cancers. This group, which includes surgeons, medical oncologists, radiation oncologists, and endocrinologists, meets to discuss the usefulness of every treatment approach. In some cases, we may decide that the best treatment is to monitor a particular tumor rather than intervene right away. This approach is known as active surveillance. We have a robust active surveillance program for low-risk thyroid cancers.

If a person needs surgery for any type of head and neck cancer, our specialists are experienced in minimally invasive methods, including robot-assisted surgery. We also take innovative surgical approaches to treat tumors. For example, we may reach tumors in the pituitary gland or at the skull base through the nasal cavity using scopes. For cancers of the larynx (the voice box), our surgeons can use laser microsurgery to remove tumors through the mouth.

We also offer other advanced treatments. For example, our radiation oncologists use proton therapy to destroy head and neck tumors with great precision, and with minimal impact to nearby healthy organs and tissues. Our medical oncologists employ targeted therapies to block the effects of a tumor’s genetic mutations and are leading the way in the development of new drugs that rally the immune system to fight cancer.

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How does quality of life factor into a treatment plan?

We place a premium on preserving a person’s quality of life — and we understand that any treatment could affect a person’s appearance, speech, and ability to swallow, taste, or hear.

To give one prominent example, there has been a striking increase in head and neck cancers related to human papillomavirus (HPV) infection in younger people. The good news is that they usually have an excellent prognosis, but it’s especially important to be mindful of the long-term impacts of treatment. Previously, these cancers were treated using combinations of surgery, radiation, and chemotherapy. The process is called trimodality therapy. Today at MSK, we create an individualized treatment plan for each person, and it’s led to a reduction in the intensity of therapy for many. At MSK, only 8% of people with throat cancer now receive trimodality therapy, compared with 41% at other North American institutions.

Today at MSK we create an individualized treatment plan for each person, and it's led to a reduction in the intensity of therapy for many.
Richard J. Wong
Richard J. Wong Chief, Head and Neck Service

We are in the process of implementing an online questionnaire called FACE-Q to help us learn more about the experiences of our patients before, during, and after treatment. With FACE-Q, we can measure more than whether the treatment worked. We can know how our patients feel, if they were they pleased with the results, and about any side effects they experienced.

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How does your team help ease the recovery process?

We have extremely knowledgeable speech and swallowing therapists, physical and occupational therapists, and dermatology experts to help patients during and after treatment. Our talented plastic and reconstructive surgeons can preserve form and function using the latest techniques. These methods include free tissue transfer, in which a plastic surgeon transfers a piece of the patient’s own tissue from a different location to the area where the cancer was removed. Our plastic surgeons can also restore facial appearance and movement that may have been lost as a result of cancer progression or treatment. MSK plastic surgeon Joseph Dayan uses a technique called facial reanimation. It uses precise methods of rewiring nerves and placing nerve grafts to help people who otherwise would have permanent facial paralysis. This can dramatically improve our patients’ cosmetic appearance.

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What research in head and neck cancer are you most excited about right now?

There are a number of exciting developments that should give us even more options to treat head and neck cancers more effectively and provide people with the best possible quality of life. One especially promising area is immunotherapy, which has become an effective option for some people with head and neck cancer. One class of immunotherapies, checkpoint inhibitor drugs, is already making an impact. In 2016 alone, the FDA approved two checkpoint inhibitors, nivolmab (Opdivo®) and pembrolizumab (Keytruda®), for squamous cell head and neck cancer.

In surgery, we are trying to improve the methods that allow us to visualize tumors during an operation. Better images give us confidence that we are removing all the cancerous tissue. We’re also refining our robotic and laser surgery techniques to be even less invasive and allow people to recover more easily.

Genomic research is playing an increasingly important role. With a tool like MSK-IMPACT™, we can build on our personalized approach and can match individual patients with therapies that will work better and cause fewer side effects.

Of course, the key to bringing new research advances into clinical practice is showing that they work in clinical trials. MSK-IMPACT™ also helps us develop new drugs to help patients in the future. 

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Comments

Thank you so much for your comprehensive care. You are currently treating a very good friend of mine who has a complex tongue cancer, and equally challenging issues in the recovery phase.

It's very important to me that I let Dr. Rich Wong know he did a good job. I'm doing well. I'm very grateful to him and your staff. I think he's a very good doctor and a good, kind person. So, thank you.

Dear Kim, thank you for sharing these kind words. We'll share them with Dr. Wong. Best wishes to you.

Often, we do not get a second chance to choose the correct path in life.
I have been given that chance by Dr. Wong, my surgeon, and an outstanding team of doctors and health care proffesionals at Memorial Sloan Kettering.
I'm going to use that chance and
"Go confidently in the direction of my dreams, and live the life I have imagined." ~ Thoreau
Thank you Dr Wong and my team.

Thank you for your kind words. We will share them with Dr. Wong and his team.

Eight rears ago, Dr. Wong saved my life. I told myself "If only I could live to see my daughter graduate," She's graduating next week. No recurrence. Thank you, Dr. Wong and the whole head and neck team.

Dear Harry, these are the type of stories we love to hear! Congratulations to your daughter, and to you. We'll share your message with Dr. Wong.

Dr. Richard Wong and Nurse Jill are two of the most competent and compassionate medical professionals I have come across in my career. As a nurse myself, I know quality care and patient advocacy when it is presented to me. My family and I are eternally grateful to Dr. Wong, and the entire staff at Sloan Memorial Kettering Hospital for the comprehensive, exceptional care given to my husband. The professionalism was beyond what I've ever experienced and Dr. Wong is the most humble, personable physician I've ever had the pleasure of meeting. Most physicians of his caliber would never display such an unassuming demeanor. He is a wonderful human being and his entire family should be immensely proud of his abilities. I HIGHLY recommend Dr. Wong and his team of esteemed doctors to anyone faced with thyroid cancer. I don't believe could have gotten better treatment anywhere. Thank you again and again from the bottom of my heart, Dr. Wong and may God continue to bless your hands that heal.

J. Farrington

Dear Jeaneth, thank you very much for your kinds words. We will share your message with Dr. Wong and his team.

As a oral surgeon and former resident who rotated to MSKCC when Elliot Strong was the chief there, I have sent numerous patients there. I hope that Dr. Wong adds to his discussion a kind word about early detection by dental and oral health professionals. In addition, you should recognize the role of your dental staff and maxillofacial prosthodontists in the reconstruction of function in you patients. In my career I have detected many very early severely dysplastic and malignant lesions and have hopefully helped many patients, many of whom I still follow.

My grandmother-Rose K. Naiman-was dx with ca of the R hard palette. Dr Eliot Strong treated and operated several times as the ca metasticized to the L side of the palette, mandible, maxilla, tongue. She was dx at the age of 67 and-with the unbelievably proficient care and incredible hands of Dr Strong-lived to 97. I attended all appointments with her since I live in NYC and she lived in Baltimore. On her passing Dr Strong sent a most caring note to me. I have to thank MSK for their total care also with maxillofacial surgery. Thank you for protecting her. Rose raised me and your surgeons allowed her to spend 30 more years. Ms Denny Cohen Steinman

Dear Denny, we're glad to hear that your grandmother did so well with her treatment. Thank you for your comment, and best wishes to you and your family.

Dr. Wong treated me 5years ago what a wonderful doctor never doubted him for one second full confidence in his skills and his bedside manners were beyond reproach.Thank you James Sollecito

Dear James, thank you for your comment. We will forward it to Dr. Wong. Best wishes to you.

I had surgery in the Head and Neck dept for neuroblastoma in 1956 and I'd like to report that I am doing great 60 years later. I was two years old. I went back to Memorial Hospital every year until I was 12-13 for follow ups. Thank you!!!

Dear Vicki, this is so amazing to hear! Thank you so much for sharing your story, and best wishes to you.

Dr Wong and Dr Shaw saved my mother life 28 years ago.Dr Shaw did a surgery on my mother.He saved her life.She had cancer wrapped around her jaw and in here neck.Dr Wong looked after my mother for her yearly doctors appointments for years.Dr Shaw,Dr Wong and all the nurses were all so wonderful to my mother.My mother loved all the doctor and nurses.I thank god that you were able to save my mother's life.She was able to be see her granddaughters be born and grow up ..Our gratitude for the Dr. wang ,Dr. Shaw and the nurses for such great and caring attention.My mother lived for another 26 years.Thank you so much from Helen Mailhot and Robert Mailhot

Dear Robert, thank you so much for sharing your story. We are so glad to hear your mother was well cared for. Best wishes to you and your family.

My husband was treated for salivary gland adenocarcinoma 6 years ago at MSK, and he's been cancer free since then. We will never forget the kindness and first-rate care he received there, from his first appointment to his final radiation treatment.

Dear Julie, we're so glad to hear your husband is doing well. Thank you for sharing your story, and best wishes to both of you!

My husband was just diagnosed on 04/02/2018 with a Squamous Cell Carcinoma well differentiated, Carcinoma Cuniculatum type involving underlying bone. I found out there is not much information about this rare Carcinoma. My husband's is a 35 year man with a very good health. His description is not of the typical patient who have had this cancer. At this point not even the MD who are seeing him knows what to do with him because of the rareness of this type of cancer. Any suggestions of who I could go and see to get help?

Dear Natalia, we're very sorry to hear about your husband's diagnosis. If he would like to come to MSK in New York for a consultation, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. If you are not in the area and not able to travel here, we recommend that you seek out a National Cancer Institute-designated cancer center that is close to where you live. You can find a list here: https://www.cancer.gov/research/nci-role/cancer-centers

Thank you for your comment and best wishes to both of you.

I falsely and naively followed the mind set of Thyroid Cancer being the "Good Cancer", and therefore, did not take my treatment seriously enough to seek the best to handle my case. My first local surgeon opened me up with no prior testing other than a ultrasound to go on and tried to be a hero when he saw the aggressive and advanced stage of the cancer. Thankfully, I was lucky enough to get an appointment with Dr. Wong who, along with Dr Sabra, my endocrinologist, ordered the correct tests and scans so they knew what they were dealing with. Dr. Wong's skillset is above and beyond and he worked his magic for the long surgical procedure to complete my thyroidectomy. I owe him and his awesome team so much. It was a long road with many challenges but I am grateful for the lease on life he and his team have given me.

Dear Sherry, we're sorry to hear about your earlier experiences but so glad to hear that you've been happy with your care at MSK. Thank you for your comment, and best wishes to you.

In 2006 my father received a larengyeal cancer dx. His treatment protocol was radiation and now, 12 years later he is cancer free. Many, many thanks to Dr. Jay Boyle and MSKCC.

Dear Christina, we're so glad to hear your father is doing well. We have sent your comment to Dr. Boyle. Thank you for your comment and best wishes to you and your family.

my mom who lives in Miami just had surgery to remove a 4 centimeter tumor in her saliva gland. She woke up and she cannot close her eye and her mouth is sagging on one side. My sister had surgery at MSK and I wish we pushed her to come to you. What do you suggest for follow up - will she always have dry mouth and no function in her eyelid?

Dear Renee, we're so sorry to hear your mom is going through this. We recommend that you discuss your concerns with the doctor who did her surgery. If she would like to come to MSK for a consultation, the number to call is 800-525-2225. You can go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment and best wishes to you and your family.

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