Head and Neck Surgical Oncology

Head and Neck Surgical Oncology

Head and Neck cancers account for approximately 4% of all cancers in the developed countries. These cancers are more than twice as common among men as they are among women. Head and Neck cancers are also diagnosed more often among people over the age of 50.

Alcohol and tobacco use are the two most important risk factors for Head and Neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx, and larynx. Tobacco and alcohol use cause at least 75% of Head and Neck cancers. People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone.

Infection with certain types of human papillomavirus (HPV), especially HPV type 16, is a risk factor for some types of Head and Neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue. Other risk factors include long-lasting exposure to sunlight, chronic irritation associated with poor oral hygiene, Vit A and C deficiencies, premalignant conditions such as lichen planus or leukoplakia, immune system deficiency.

The symptoms of Head and Neck cancers may include a lump on the face or neck, a sore in the moth that does not heal, a sore throat that persists for long, difficulty in swallowing, and a change in the voice. Although other benign conditions may also cause the same symptoms, it is important to seek medical advice when the condition remains for more than two weeks.

Oral cavity. A sore that doesn't heal, a sore that bleeds, a growth, lump or thickening of the skin or lining of your mouth, loose teeth, poorly fitting dentures, tongue pain, jaw pain or stiffness, difficult or painful chewing, difficult or painful swallowing, sore throat, a white or red patch on the gums, the tongue, or the lining of the mouth, unusual bleeding or pain in the mouth, a lump on your neck.

Pharynx. Trouble breathing or speaking, pain when swallowing, pain in the neck or the throat that does not go away, frequent headaches, pain or ringing in the ears or trouble hearing, chronic sore throat, a lump in the nose or back of the mouth, throat or neck, a change in voice, or unusual hoarseness, difficulty breathing, frequent nosebleeds, headaches, a dull pain behind the breastbone, persistent cough, unexplained weight loss.

Larynx. Pain when swallowing or ear pain, a change in your voice, such as sounding hoarse,a lump or swelling in your neck, a long-lasting cough, a persistent sore throat or earache, a difficulty in breathing.

Paranasal sinuses and nasal cavity. Sinuses that are blocked and do not clear, chronic sinus infections that do not respond to treatment with antibiotics, bleeding through the nose, frequent headaches, swelling or other trouble with the eyes, pain in the upper teeth, or problems with dentures. Nasal congestion and stuffiness that doesn’t get better or even worsens, pain above or below the eyes, blockage of one side of the nose, post-nasal drip (nasal drainage in the back of the nose and throat), pus draining from the nose, decreased or loss of sense of smell, numbness or pain in parts of the face, loosening or numbness of the upper teeth, growth or mass of the face, nose, or palate, constant watery eyes, bulging of one eye, change in vision, pain or pressure in one of the ears, hearing loss, headache, trouble opening the mouth, enlarging lumps in the neck.

Salivary glands. A lump or swelling under the chin or around the jawbone or in your neck or mouth, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away, difficulty swallowing, trouble opening your mouth widely.

None of the above symptoms alone indicate cancer, as they may be the consequence of many other benign conditions. In cases of persistence though, the patients need to see a medical professional who will perform the necessary diagnostic work up to rule out or confirm a malignant condition. The physician evaluates the patient’s medical history, performs a physical examination, and orders diagnostic tests. The exams and tests may vary depending on the symptoms. The diagnoses of cancer will always require confirmation from a biopsy.

In cases of a confirmed malignancy, the doctor will classify the case according to the extent of the disease. To complete staging of the disease the physician will ask for further examinations to evaluate if the disease has spread to other parts of the body. Staging may involve an examination under anesthesia, x-rays, scans and other imaging procedures, and laboratory tests. Staging is very important as it fundamental to all decisions regarding the treatment plan.

Our surgical team manages the removal and related reconstruction of benign and malignant tumors of the Head and Neck, including the oral cavity, the upper and lower jaw, the salivary glands, the sinuses, the facial skin and the neck.

Treating these lesions requires a multidisciplinary approach and tumor board meetings. The comprehensive approach to head and neck cancers involves specialists from multiple disciplines. Our surgeons collaborate with other experts such as radiation oncologists, medical oncologists, radiologists, pathologists, nutritional therapists, speech pathologists, restorative dentists and nurse specialists. After a comprehensive evaluation, each patient is offered an individualized treatment plan.

The treatment plan and sequence depends on a number of factors, including the exact location of the tumor, the size of the tumor, the stage of cancer, and the person’s age and general health.

Treatment for Head and Neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments.

All possible combinations of treatments are described in the literature in forms of protocols of treatment. Although there are areas of controversy or disagreement as well as different philosophies regarding specific details of treatment, general uniformly accepted rules exist.

Each case is very carefully evaluated and individualized. All updated treatment protocols regarding head and neck malignancies are implemented. Our clinic’s Facial Surgeons will follow what is best accepted by the medical community worldwide for the treatment of each patient.

Below there is a list of malignant lesions which may develop on the face and neck.

1. Malignant epithelial tumors

  1. Squamous cell carcinoma
  2. Verrucous carcinoma
  3. Basaloid squamous cell carcinoma
  4. Papillary squamous cell carcinoma
  5. Spindle cell carcinoma
  6. Acantholytic squamous cell carcinoma
  7. Adenosquamous carcinoma
  8. Carcinoma cuniculatum
  9. Lymphoepithelial carcinoma

2. Malignant salivary gland tumors

  1. Acinic cell carcinoma
  2. Mucoepidermoid carcinoma
  3. Adenoid cystic carcinoma
  4. Polymorphous low-grade adenocarcinoma
  5. Basal cell adenocarcinoma
  6. Epithelial-myoepithelial carcinoma
  7. Clear cell carcinoma, not otherwise specified
  8. Cystadenocarcinoma
  9. Mucinous adenocarcinoma
  10. Oncocytic carcinoma
  11. Salivary duct carcinoma
  12. Myoepithelial carcinoma
  13. Carcinoma ex-pleomorphic adenoma

3. Malignant soft tissue tumors

  1. Diffuse large B-cell lymphoma (DLBCL)
  2. Mantle cell lymphoma
  3. Follicular lymphoma
  4. Extranodal marginal zone B-cell lymphoma of MALT type
  5. Burkitt lymphoma
  6. T-cell lymphoma (including anaplastic large cell lymphoma
  7. Extramedullary plasmacytoma
  8. Langerhans cell histiocytosis
  9. Extramedullary myeloid sarcoma
  10. Follicular dendritic cell sarcoma/tumor
  11. Mucosal malignant melanoma
  12. Metastatic tumors

4. Malignant bone (jaw) tumors

  1. Malignant ameloblastoma
  2. Ameloblastic carcinoma
  3. Peripheral primary intraosseous squamous cell carcinoma
  4. Malignant epithelial odontogenic ghost cell tumor
  5. Clear cell odontogenic carcinoma
  6. Ameloblastic fibrosarcoma
  7. Odontogenic Sarcoma
  8. Osteosarcoma
  9. Fibrosarcoma
  10. Chondrosarcoma
  11. Malignant fibrous histiocytoma
  12. Myxosarcoma
  13. Plasmacytoma
  14. Myeloma
  15. Secondary (metastatic) bone tumors