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Head and Neck Patient Information
Treatment of head and neck cancer requires a complex, multidisciplinary team that can deliver care in an efficient manner. Most patients will meet representatives from each of the major treating disciplines at some point during their diagnosis and/or treatment. Below you will find a simple guide to what you might expect as part of your experience.
Patients may refer themselves for evaluation or may be referred by an outside physician (e.g. primary care physician, oncologist, ENT). Each patient will be guided through their care pathway by staff dedicated to the care of head and neck cancer patients. Staff members will work with each patient to obtain as much information as possible about existing diagnosis (e.g. outside imaging, biopsy results) and to coordinate patient visits and testing within our group.
Most patients will see a head and neck surgical oncologist at their initial visit, but some patients may also be referred directly to one of our medical oncologists or radiation oncologists. At your initial visit, the physician will obtain a detailed history of your problem, review available outside imaging and biopsy results. Your exam may include an in-clinic endoscopic exam of the nose, throat or voice box in order to better understand the extent of the disease.
Your physician may order additional testing at your initial visit. Patients with a head and neck cancer often undergo a computed tomography (CT) scan of the head, neck and chest, to evaluate the extent of the tumor and whether it has spread to other parts of the body. Some patients may undergo a positron emission tomography (PET) scan depending on their diagnosis. Occasionally, other imaging such as ultrasound (US) or magnetic resonance imaging (MRI) will be used, and your physician will explain the reason for each ordered test.
For patients who have undergone a biopsy at another facility, we will need to obtain the pathology slides from that biopsy and have the diagnosis confirmed by our pathologists prior to initiating treatment. If the biopsy results are inconclusive, or more information is necessary, your physician may obtain a biopsy in clinic or an additional biopsy may be performed by our trained surgeons, cytopathologists or interventional radiologists.
Since tumors of the head and neck can often affect speech and swallowing, most patients will be referred to our speech and language pathologists for evaluation, and to registered dieticians who specialize in the care of cancer patients.
Presentation at Multidisciplinary Tumor Board
All new patients will be discussed by the multidisciplinary treatment team, which meets on a regular basis, and each patient will then be contacted by their physician with the recommendations of the tumor board.
The majority of patients will begin treatment for their cancer within 30 days of diagnosis. In some cases, some patients will begin treatment much sooner depending on their condition and location of the tumor. Some patients may require emergent or urgent surgery for tumors which may block the airway or be actively bleeding at the time of presentation to our group. For most patients however, it is crucial that we assemble all the required information for staging of the tumor and coordination of the required treatment plan before treatment begins. Some patients will be diagnosed with a benign (non-cancerous) tumor or condition. Those patients may choose to have that tumor removed surgically or choose to not have treatment at this time (watchful waiting) but undergo repeated imaging to make sure the tumor is not growing.
Surgery for head and neck cancer can often be complex and requires a team of surgeons skilled in removal of the tumor and reconstruction of the defect. Prior to proceeding with surgery, all patients must be evaluated by our anesthesia colleagues to determine pre-operative risks. All patients receive pre-operative counseling from the surgical team and are offered the opportunity to discuss their peri-operative course in detail. We encourage all patients to bring family members to participate in these discussions.
If a patient requires radiation as part of their treatment, our radiation oncologists will discuss with the treatment plan in detail with the patient and family members including length of time, structures that will receive radiation, and side effects that may be expected during and after treatment. Patients that undergo radiation for head and neck cancer will require an evaluation by a dentist prior to starting treatment. This may be done using their existing provider or a local provider trained in pre-radiation evaluation of dentition.
Chemotherapy, using conventional agents or newer targeted agents and immunotherapy, is often part of the treatment for head and neck cancer. A medical oncologist will discuss available options with the patient and family and how those options will be integrated into the tumor board recommendations.
Some patients with head and neck cancer will require treatment followed by a short post-treatment monitoring period. Many of our patients require close follow up for an extended period. For those patients, they will undergo regular clinic visits during the first year, and some times repeat CT and/or PET scans to closely monitor for return of the disease. For most cancers, we follow patients on a regular basis for the first five years following treatment completion and often continue to monitor them afterwards. Follow up is extremely important, both to make sure the cancer does not return and to address and late term side effects of surgery, radiation and chemotherapy that our patients may experience.