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Wake Forest Baptist Approach Head and Neck Cancer -------------------------------------- View Head and Neck Cancer Clinic Video -------------------------------------- With the incidence of head and neck tumors at twice the national average in our region, the Head and Neck Cancer Program is of prime importance.  A multidisciplinary physician team meets regularly to evaluate cases. Each new patient is evaluated by the appropriate clinicians (surgeons, medical and radiation oncologists), and a treatment plan is recommended to the patient and referring physician.  This multidisciplinary coordination allows for better patient convenience and timing of appointments, as well as closer and more effective physician consultative planning and disease management decisions. Active research is being conducted in the areas of tumor biology and Positron Emission Tomography (PET) scanning of head and neck tumors.  Clinical trials in the areas of cancer prevention, cancer treatment and symptom management are offered to our patients with head and neck cancer.  3D Conformal and Intensity Modulated Radiation Therapy Among the newer treatment options for cancer of the prostate, brain, lung, and head and neck are two methods of focusing radiation on the tumor and surrounding at-risk tissues while optimally sparing nearby normal tissues, 3-dimensional (3D) conformal radiation therapy, and intensity modulated radiation therapy (IMRT).  This approach uses anatomic computed tomogrphic and/or magnetic resonance images of the patient, computer-generated radiation dose calculations, and a computer-controlled linear accelerator to conform or “paint” the radiation dose very precisely to match the shape of the tumor to be treated, avoiding critical structures that may be only millimeters away. When the linear accelerator radiation beam intensity is varied, or modulated, over space and time during the patient’s treatment, hence the term “Intensity Modulated” radiation therapy. In combination with advanced imaging techniques like magnetic resonance spectroscopy and positron emission tomography that image both tumor anatomy and biology, IMRT holds great promise for improving local tumor control and survival, even in the most resistant and aggressive human cancers.  Brachytherapy Brachytherapy, which literally means “short therapy”, involves the implantation of radioactive sources in or near a tumor, a procedure which typically involves the collaboration of a surgical oncologist and radiation oncologist.  A full range of brachytherapy treatment options are available for treating cancers of the prostate, breast cervix, uterus, vagina, head and neck, soft tissues, brain, and eye.  In fact, with the availability of both high dose rate (HDR) and low dose rate (LDR) brachytherapy technology and expertise, virtually any area of the body can be implanted if appropriate.  Brachytherapy is often used as a “boost” in conjunction with external beam radiation, particularly for locally advanced cancers.   Oral cancer Throat anatomy Mouth anatomy Definition: Oral cancer is cancer of the mouth. Alternative Names: Cancer - mouth; Mouth cancer; Head and neck cancer; Squamous cell cancer - mouth Causes, incidence, and risk factors: Oral or mouth cancer most commonly involves the tissue of the lips or the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), or palate (roof of the mouth). Most oral cancers look very similar under the microscope and are called squamous cell carcinomas. These are malignant and tend to spread rapidly. Smoking and other tobacco use are associated with 70 - 80% of oral cancer cases. Smoke and heat from cigarettes, cigars, and pipes irritate the mucous membranes of the mouth. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes. Heavy alcohol use is another high-risk activity associated with oral cancer. Other risks include poor dental and oral hygiene and chronic irritation (such as that from rough teeth, dentures, or fillings). Some oral cancers begin as leukoplakia or mouth ulcers. Oral cancer accounts for about 8% of all malignant growths. Men get oral cancer twice as often as women, particularly men older than 40. Symptoms: Skin lesion, lump, or ulcer: May be a deep, hard-edged crack in the tissue Most often pale colored, may be dark or discolored On the tongue, lip, or other mouth area Usually painless at first (may develop a burning sensation or pain when the tumor is advanced) Usually small Additional symptoms that may be associated with this disease: Abnormal taste in the mouth Mouth sores Swallowing difficulty Tongue problems Signs and tests: An examination of the mouth by the health care provider or dentist shows a visible or palpable (can be felt) lesion of the lip, tongue, or other mouth area. As the tumor enlarges, it may become an ulcer and bleed. Speech difficulties, chewing problems, or swallowing difficulties may develop, particularly if the cancer is on the tongue. A tongue biopsy, gum biopsy, and microscopic examination of the lesion confirm the diagnosis of oral cancer. Treatment: Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough. Radiation therapy and chemotherapy would likely be used when the tumor is larger or has spread to lymph nodes in the neck. Surgery may be necessary for large tumors. Rehabilitation may include speech therapy or other therapy to improve movement, chewing, swallowing, and speech. Support Groups: The stress of illness can often be eased by joining a support group of people who share common experiences and problems. See cancer - support group. Expectations (prognosis): Approximately 50% of people with oral cancer will live more than 5 years after diagnosis and treatment. If the cancer is detected early, before it has spread to other tissues, the cure rate is nearly 75%. Unfortunately, more than 50% of oral cancers are advanced at the time the cancer is detected. Most have spread to the throat or neck. Approximately 25% of people with oral cancer die because of delayed diagnosis and treatment. Complications: Complications of radiation therapy, including dry mouth and difficulty swallowing Other metastasis (spread) of the cancer Postoperative disfigurement of the face, head, and neck Calling your health care provider: Oral cancer may be discovered when the dentist performs a routine cleaning and examination. Call for an appointment with your health care provider if you have a lesion of the mouth or lip or a lump in the neck that does not go away within 1 month. Early diagnosis and treatment of oral cancer greatly increases the chances of survival. Prevention: You should have the soft tissue of the mouth examined once a year. Many oral cancers are discovered by routine dental examination. Other tips: Have dental problems corrected. Minimize or avoid alcohol use. Minimize or avoid smoking or other tobacco use. Practice good oral hygiene.

Review Date:3/21/2008 Reviewed By:Stephen Grund, MD, PhD, Chief of Hematology/Oncology and Director of the George Bray Cancer Center at New Britain General Hospital, New Britain, CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.