Cancers of the head and neck refers to any cancer found in the mouth, tongue, lips, nose, throat, salivary glands, voice box, or the tract from the oral cavity to the esophagus. The early stages of head and neck cancers are often painless and are frequently overlooked or can be mistaken for other problems. In some cases the cancer may not be noticed until it has spread to other areas of the head or neck; as the disease develops these tumors can grow and invade the nearby lymph nodes or migrate to the jaw and other bones in this region. In many cases by the time the disease is identified by a health care professional it has advanced to a serious condition.
Dr. Paul Friedlander and Dr. Rizwan Aslam, Head and Neck Surgeons, and the staff of the Head and Neck Cancer Center understand that being diagnosed with a benign or malignant tumor of any kind is a difficult event. If you suspect a problem, have been diagnosed with a tumor of the mouth, throat, head or neck and are seeking treatment options, or are seeking a second opinion, the Head and Neck Cancer Center can help. We have decades of combined experience working with patients from across the country to develop a comprehensive and compassionate treatment plan that incorporates the needs of the patient, their family and caregivers, and the patient’s local healthcare providers.
If you suspect a problem, or if your dentist or medical health care provider has referred you to the Head and Neck Cancer Center because of evidence of a tumor, you will be scheduled to have a comprehensive examination with one of our Head and Neck cancer surgeons. Diagnosing the tumor is the first step in the development of an appropriate and individualized treatment plan; the best way of doing this is through a clinical assessment involving a direct examination and possibly a biopsy of the area in question. If the area around the suspected tumor is easily accessible a Fine Needle Aspiration (FNA) may be performed. In some situations an outpatient surgical procedure for endoscopy or tissue biopsy may be required in order to diagnose a suspected tumor that is in a location that is difficult to access. Imaging exams such as a CT (Co-Axial Tomography) scan, MRI (Magnetic Resonance Imaging) scan, PET (Positron Emission Tomography) scan, PET/CT scan or other imaging techniques may also be used, depending on the location and suspected nature of the tumor. Tumors of the larynx may require a laryngoscopy which provides your physician with a visual examination of the nose and throat. All of these diagnostic elements are used to assist in your physician in making the correct diagnosis and planning the appropriate course of treatment.
If the biopsy indicates the presence of a malignant tumor the pathologist will "stage" the cancer in order to determine the extent of the disease, the other areas to which it may have spread, and how aggressive it is. After that information is available you will meet with your surgeon to discuss your options for care and to jointly map out a course of treatment. Surgery, radiation therapy, and chemotherapy are the most common treatment approaches to head and neck cancers. They may be used independently or in combination; the approach that is chosen depends upon the type and extent of the disease, the patient's age, and their overall health status. Each patient's needs are unique, and their individual circumstances will dictate the most appropriate course of action to treat their illness.
The surgeons and physicians of the Head and Neck Cancer Center work closely with medical oncologists, radiation oncologists, neurosurgeons, ophthalmologists, maxillofacial experts and other specialists in order to coordinate a comprehensive plan of care for each patient. Our Center offers the most advanced surgical options for the treatment of head and neck cancers including mandible-sparing procedures for oral cavity tumors, airway reconstruction and micro-vascular reconstruction of the head and neck, robotic-assisted oral procedures, and voice restoration procedures. Dr. Ernest Chiu, the Center’s facial and reconstructive plastic surgery specialist, is included in all surgical treatment planning.
Conventional surgery for tumors involving the mouth and throat may require a significant surgical intervention and extended recovery times. A relatively new surgical approach to treat head and neck tumors in adults, referred to as Trans-Oral Robotic Surgery (TORS), utilizes the da Vinci robotic-assisted surgical system to perform minimally invasive surgery. This system provides the surgeon an enhanced, 3D high-definition field of vision and allows for the use of miniaturized, high-precision surgical instruments to more easily access the confines of the mouth and throat, with less impact on the surrounding tissue, than traditional surgical approaches. The result is a lower rate of complications, no visible scarring or disfigurement, shorter hospital stays, and faster recovery times.
Dr. Friedlander was one of the earliest Head and Neck oncology surgeons to be approved to use the da Vinci robotic surgical system for minimally invasive mouth and throat procedures. To learn if you are candidate for Trans-Oral Robotic-Assisted surgery please .
Oral (mouth) Cancer
Oral cancers are the most commonly occurring type of head and neck cancers, comprising approximately 85% of all cases. Oral cancers can be especially difficult because they often start as small sores or areas of irritation that may be painless or difficult to notice. As a consequence the cancer is often discovered late in its development, after it has reached a stage where it has migrated to the nearby lymph nodes or bone structure. Anyone can get oral cancer although the use of tobacco products, excessive alcohol use, or HPV exposure can increase the risk of acquiring this disease.
Symptoms can include a white or red patch of tissue in the mouth, a small ulcer which looks like a common canker sore but doesn’t heal, a lump or mass which can be felt inside the mouth or neck, pain or difficulty in swallowing, speaking, or chewing, hoarseness which lasts for an extended period of time, persistent ear pain, numbness in the oral/facial region, swelling of the jaw, blood in the saliva, or dentures that have changed their fit. These symptoms can be caused by other problems but they may be an indicator of something serious.
Throat cancer refers to cancerous tumors that develop in your throat (pharynx), voice box (larynx) or tonsils. Cancer of the throat is also referred to as cancer of the larynx or cancer of the vocal cords. The larynx sits above the lower respiratory passages (trachea, bronchi, and lungs) and houses the muscles that form the voice box (vocal cords). The larynx acts like a valve over the windpipe and helps to control breathing and keep food out of the lungs, as well as produces the sound of your voice. Cancer can also affect the piece of cartilage that acts as a valve (epiglottis) for the windpipe or the tonsils, which are located on the back of the throat.
Symptoms can include trouble speaking or breathing, pain or ringing in the ears, unusual (high-pitched) breathing sounds, a steady cough or coughing up blood, difficulty swallowing, constant hoarseness, unexplained neck pain, constant sore throat, swelling or lumps in the neck, or unexplained weight loss. Smoking or other tobacco use increases the risk of developing this disease, as does the excessive use of alcohol. The combination of tobacco and alcohol use increases the risk further. Most cases of throat cancer occur in adults over the age of 50 although this cancer is starting to be seen in younger populations due to HPV exposure.
Cancer of the tongue is a serious type of head and neck cancer that affects over 10,000 people each year. When cancer forms in the front two-thirds of the tongue it is classified as a specific type of oral cavity cancer called oral tongue cancer. Cancer that develops in the remaining third of the tongue is called tongue base cancer and is considered a form of throat (oropharyngeal) cancer. The symptoms of tongue cancer on the front two-thirds of the tongue include a lump on the side of the tongue that touches the teeth, a grayish-pink to red colored ulcer, or a lump bleeds easily if bitten or touched. Tumors on the remaining third of the tongue are more difficult to identify and are usually diagnosed when they are larger; at that point the tumor may cause pain, a sense of fullness in the throat, difficulty swallowing, ear pain, or changes in the voice.
Lip cancer is the most common form of oral cancer but it is often ignored or incorrectly diagnosed as a cold sore or other skin condition. Lip cancer affects the outside of the lips and may not be obvious at first but later in its development may appear as a sore or lesion that bleeds easily and fails to heal, or as a thickening or lump in the lips. Lip cancer occurs most often in people over the age of 40 and is more common in men than women. People with light skin are more prone to develop lip cancer as are people who spend a great deal of time in the sun, smoke, or have been exposed to HPV.
Salivary Gland Cancer
There are over 600 major and minor salivary glands throughout the lining of the mouth and the throat. It is more common for a problem in these glands to be the result of a benign (non-cancerous) growth but malignant (cancerous) tumors can develop in these glands as well. Refer to the for additional information.
There are over 120 known types of Human Papilloma Virus (HPV), with different types infecting different areas of the body. Several of these types are sexually transmitted and two types, HPV 16 and HPV 18, are known to cause the vast majority of cervical cancers. Research has indicated that HPV16 is also linked to oral cancers as well. HPV16 in the oral cavity presents itself primarily in the rear areas of the mouth such as the base of the tongue, the back of the throat, the tonsils and the tonsillar pillars, which are areas of the mouth do not always produce the visible lesions or discolorations that have historically been the early warning signs of oral cancers.
Historically, the majority of oral cancers have occurred in older populations and/or populations that have experienced heavy tobacco use or combined alcohol and tobacco use. Research indicates that oral cancers are moving into a much younger population, primarily because of the increasing prevalence of the HPV virus.
The symptoms of head and neck cancers can be associated with other problems but they may be an indicator of something serious. The only way to know definitively is to get an examination of the affected area. An oral screening is a simple, non-intrusive examination that takes only a few minutes. During the screening your physician will conduct a visual examination of all the tissues in your mouth and throat looking for white or red patches, ulcerations, lumps or dental problems. The physician will use his fingers to feel the floor of your mouth and portions of the back of your throat, as well as feel the exterior of your throat to check for swollen lymph nodes, hardened masses, or other irregularities. In addition to the physical examination your physician may also use a small flexible camera to view the areas of the tongue and throat that are not readily visible during a visual examination. You will also be asked about your medical history, including the use of alcohol and tobacco products.
Experience has shown that early detection results in significantly improved outcomes. The only way to know for certain if your problem is something minor or serious is to get an oral examination. The physicians of the Head and Neck Cancer Center are specialists in the diagnosis and treatment of head and neck diseases.
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