Head & Neck Cancers Diagnosis & Treatment

Because lung cancer and emphysema are caused by many of the same risk factors as head and neck cancer, a routine chest X-ray is performed. Any suspicious lesions on the chest X-ray may require a CT scan of the chest for further evaluation.

CT scans are a special form of X-ray that enable pictures of the body to be taken in cross section, greatly enhancing your doctor’s ability to visualize tumors of the head and neck region. CT scans have been an important asset in determining the extent of disease and whether tumors in these regions are able to be surgically removed. A CT pulmogram is faster and uses less radiation than a standard CT. This procedure is used to improve the early diagnosis and treatment of lung cancers.

An MRI combines a magnetic field and radio waves to create an image of the body’s internal organs.

A PET scan can be used in the treatment of certain cancers for staging a malignancy, detecting recurrence of disease and monitoring response to therapy.

Occasionally, in evaluating swallowing problems, which may lead to the diagnosis of a hypopharyngeal tumor, a barium swallow may be performed. This is a series of X-rays performed while the patient swallows a liquid that can be seen on the X-rays.

A biopsy is the removal of tissue for inspection under a microscope. A biopsy is the only way to confirm the cancer diagnosis. Because many areas of the throat may not be accessible for easy and safe biopsying in the office, biopsies of these areas may be performed in the operating room. Special scopes used to perform this exam are called laryngoscopes, esophagoscopes and bronchoscopes.

If a patient has a neck mass that can be felt, a needle may be placed into the mass and cells can be withdrawn for inspection under the microscope. However, cancerous neck masses often are the result of spread of cancer from another area and further examination in the operating room is often still needed.

A thorough exam of the larynx, hypopharynx and esophagus, called a panendoscopy, uses scopes that allow your doctor to see and biopsy tissue. At this time, the size of the tumor and the extent of spread to surrounding areas may be determined, and a biopsy is performed.

The surgeons at Virginia Mason Franciscan Health provide state-of-the-art organ preservation and reconstruction to minimize the functional and cosmetic impacts of treatment. Surgery is often done using minimally invasive procedures, including the use of an endoscopic laser, that provide for shorter hospital stays and faster recovery times.

Many tumors, particularly those of the larynx (voice box) and pharynx (throat) that had traditionally required large operations, can now be removed through a scope without incisions on the neck, which can minimize the impact of surgery and reduce recovery time.

Larger tumors of the voice box that traditionally required removal of the entire voice box may now be amenable to creative reconstructive techniques not available at all institutions. Even if surgery must be performed, surgeons can now use the latest techniques in extended partial laryngeal removal to preserve function of the voice box.

For patients diagnosed with benign or malignant tumors of the mouth and throat, transoral robotic surgery (TORS) provides a minimally invasive, virtually scarless treatment. This surgery uses miniaturized robotic tools inserted through the mouth to reach tumors of the voice box, tonsils, base of the tongue and other areas of the throat.

Chemotherapy is the use of powerful anti-cancer drugs that kill cancer cells by interfering with their ability to reproduce. The decision to treat with chemotherapy depends upon many factors, including tumor size and whether or not cancer has spread to the neck lymph nodes. Chemotherapy is often used in combination with surgery or radiation.

Radiation therapy uses high-energy rays aimed at the tumor site to kill cancer cells. In many cases, this treatment is used after surgery to destroy any remaining cancerous cells. At Virginia Mason Franciscan Health, we offer intensity-modulated radiation therapy (IMRT). With IMRT, a 3D plan is constructed that precisely contours the radiation dose to treat the head and neck and avoid normal structures such as the eyes and brain. This treatment is more rapid, and the dose distribution is more uniform, resulting in less skin and soft-tissue reactions than conventional radiation therapy.

Some forms of head and neck cancer surgery may result in alterations in a person's ability to talk or swallow. In these situations, working with the speech pathologist on exercises and strategies to improve the ability to communicate or swallow will be a part of your treatment plan. If you’ll have radiation after your surgery, swallowing exercises are sometimes recommended to help reduce the impact that radiation can have on the movement of structures involved with speech and swallowing. In instances where more extensive cancer surgery is required, the speech pathologist may work with you on alternatives to verbal communication or with various forms of alaryngeal (without a voice box) communication.