Head and Neck Cancers Require Multidisciplinary Approach

Abstract: One of the most experienced teams in treating head and neck cancers anywhere, Drs. Christopher Sullivan and J. Dale Browne see about 250 cases a year and perform about 1,000 head and neck cancer procedures annually.

From Clinical Update, Spring 2008

“When she first picked up the phone, you were impressed how understandable her speech was. In spite of her extensive surgery, she was eating a regular diet.”

That description given by Christopher A. Sullivan, M.D., was, amazingly, of a patient about six months after she had lost the front half of her tongue to squamous cell carcinoma, the most common cancer of the head and neck.

Sullivan, a surgeon in the Department of Otolaryngology at Wake Forest Baptist, is part of the head and neck cancer team in the Comprehensive Cancer Center. He said the Center sees about 250 head and neck cancer cases a year, about half of them involving the oral cavity. The team of Sullivan and J. Dale Browne, M.D., performs about 1,000 head and neck cancer procedures yearly.

Head and neck cancers most often seem related to smoking and alcohol use, Sullivan said, although clinical researchers have begun to see a correlation to viral etiologies in cancers involving the tonsils and base of tongue. An increasing proportion of patients with throat cancers involving these structures, he said, will test positive for human papillomavirus (HPV).

The Cancer Center has begun to study the treatment outcomes of patients who are HPV positive.

“It’s most important that patients have access to multiple avenues of research and development to use in the treatment of their cancer,” Sullivan said.

Typically in new head and neck cancer patients, the lesions are biopsied, then the patients will undergo an upper aerodigestive tract endoscopy, to accurately assess the extent of the tumor and to look for additional cancers in the throat, in addition to CT and PET scans to check for involvement of the lymph nodes in the neck.

“After their tumors are fully assessed, a treatment plan is developed and such patients become candidates for surgical treatment followed by radiation therapy, and in some cases, chemotherapy, or nonsurgical therapy with radiation and chemotherapy,” Sullivan said.

He said all cases are assessed by the Comprehensive Cancer Center’s “tumor board,” comprised of surgeons, radiation oncologists, medical oncologists, radiologists, dentists and other representatives of Cancer Center-based services.

Head and neck cancer surgeries are almost always performed in one session, with Sullivan and Browne removing the cancer and repairing the defect with grafts, including the microvascular transfer of tissue. Browne has vast experience in microvascular reconstruction of virtually every part of the head and neck, including the tongue, mandible, palate, pharynx and palate, cheek bone and eye socket, providing optimal restoration of function and form for the majority of the team’s patients.

Without complications, most hospital stays are a week or so. Typically a patient will have speech and swallowing deficits that require a feeding tube and speech and swallowing rehabilitation. Sullivan said patients have “complete and ready access to state-of-the-art speech and swallowing diagnostics and therapeutic modalities.

“Such extensive multidisciplinary cancer assessment and treatment is the gold standard in the United States. Unique to the region, our Comprehensive Cancer Center provides these services to this community.”