Head and Neck Cancer
What is Head and Neck Cancer?
Cancer is the abnormal growth of cells within the body. The behavior of these tumors are variable and are based on the cell origin (pathology), the location of origin, and other patient risk factors. These tumors can be benign with indolent courses, or they may be malignant and highly aggressive.
Cancer of the head and neck is unique from other cancers. The head, neck, and face region is a complex region responsible for many of the basic human functions. Treatment of head and neck lesions, whether surgically or medically, may compromise an individual’s ability to speak, swallow, or breath, as well as potentially impacting their physical appearance. Due to the complexity of the region, and the variability in the different sites in which cancer occurs, it is important to understand the exact type of cancer. Before embarking on a treatment plan, the patient should be well versed in the impact it will have on function and quality of life. Often treatment requires the involvement of physical therapists, speech pathologists, dentists, and voice specialists to maximize patient outcomes and enhance the quality of life.
Who are the Members of the Management Team?
The diagnosis, treatment, and management of head and neck cancer requires the efforts of many healthcare providers. This multidisciplinary team consists of head and neck surgeons, reconstructive and plastic surgeons, oral and maxillofacial surgeons, radiation and medical oncologists, and speech and swallow therapists. These members come together to form the core team ensuring the best possible outcomes.
What is a Head and Neck Surgeon?
Head and Neck Surgeons are individuals who have completed residency training in Otolaryngology-Head and Neck Surgery (OHNS) accredited by the American Board of Otolaryngology (Aboto). This 5-year training begins after four years of medical school and is highly structured providing the foundation for their surgical career. In order to be accredited as a Head and Neck Surgeon, physicians need only to complete their training in OHNS. However, some physicians elect to go on to complete an extra 1-2 years of additional training known as a fellowship. Such fellowships provide more opportunity to refine ones surgical techniques in addition to providing opportunities for research and career advancement. A fellowship is not a mandatory requirement and is highly dependent on the individual training received throughout residency. Fellowship training may be provided through the Advanced Training Council by the American Head and Neck Society (AHNS) or through other programs independent of the society. Each fellowship program provides different experiences and advanced skill sets specific to each institution.
Head and Neck Surgeons often times are the first physician a patient is referred to upon suspicion of cancer. They will often time complete initial workup of the patient, including physical examination, imaging, and perform any diagnostic procedures. Once a diagnosis of cancer is confirmed, they will coordinate the care and treatment of the patient with other members of the care team. The surgeon’s role includes the surgical management of the patient should treatment require surgery. After surgery, the surgeon is involved in a routine patient examination for surveillance purposes.
What is a Reconstructive and Plastic Surgeon?
Head and neck cancer often requires removal of the tumor from the most complex and intricate parts of the body responsible for swallowing, breathing, and speaking in addition to having a far-reaching impact on an individual’s physical appearance. Reconstructive and plastic surgeons with specialized training are usually involved in order to manage these complex defects.
In order to be qualified as a reconstructive surgeon, one must first have completed an ACGME accredited residency training in either Otolaryngology-Head and Neck Surgery or Integrated Plastics Surgery. Alternatively, some individuals may have completed a General Surgery Residency training program, followed by an ACGME accredited Plastic Surgery Fellowship. Once completed, individuals must seek further training in head and neck reconstructive surgery through a recognized training society. Reconstructive surgery training may be completed through the American Academy of Facial Plastics and Reconstructive Surgery (AAFPRS), the American Head and Neck Society (AHNS), or through the American Society for Reconstructive Microsurgery (ASRM). Specifically, the AHNS and AAFPRS provide reconstructive training of the Head and Neck only, whereas the ASRM will provide training for reconstruction of the rest of the body (e.g. hand). It is important to recognize these differences and identify the specific training that your reconstructive surgeon has received.
The reconstructive surgeon is tasked with the management of deformities and defects that result as a consequence of surgery. Reconstructive options vary depending on the location of the defects, size of defects, as well as patient-related factors. The surgeon may explore different reconstructive options and should individualize their treatment for each patient.
What is an Oral and Maxillofacial Surgeon?
Oral and maxillofacial surgeons are surgeons that specialize in the diagnosis, treatment, and management of diseases of the oral cavity, jaw, and face. Because a large proportion of head and neck cancer is localized to the oral cavity and face, these surgeons form an integral part of the team. Their role is vital in order to ensure the best functional and aesthetic outcomes.
Oral and Maxillofacial surgeons (OMFS) are recognized specialists within Dentistry. In order to complete training in OMFS, surgeons must first complete their training either in Doctor of Dental Surgery (DDS) or Doctor of Medicine in Dentistry (DMD) from a school accredited by the Commission on Dental Accreditation (CODA). Once completed, they must apply for further training in oral and maxillofacial training. Depending on the specific training program, practitioners may complete an additional Medical Degree (MD) as part of their training, or proceed directly to their surgical training. They may also proceed to continued advanced training in craniofacial and microvascular surgery.
The OMFS surgeon is part of the multidisciplinary team, whose role involves restoration and rehabilitation of patients with diseases that affect the mouth, jaw, face, and skull. They provide and manage prosthetics, dental implants, as well as assist in reconstruction.
Who are Radiation and Medical Oncologists?
Both radiation and medical oncologists form an integral part of the multidisciplinary team providing non-surgical options for patients suffering from head and neck cancer. Radiation oncologists are physicians specialized in the use of radiation delivered to areas affected by cancer. Medical oncologists are physicians that utilize medications in the treatment of these diseases.
In order to be credentialed as a radiation oncologist, after completing medical school, physicians must complete a 4-year ACGME accredited residency in Radiation Oncology. They must subsequently receive certification by the American Board of Radiology (ABR), American Board of Physician Specialties (ABPS), or American Board of Osteopathic Radiology (ABOR). Radiation oncologists may further seek subspecialty training in radiation oncology of the head and neck. Medical oncologists must first complete an ACGME residency in Internal Medicine and become certified by the American Board of Internal Medicine (ABIM). They must then go on to complete their training in an ACGME fellowship in medical oncology, and pass the Medical Oncology Certification Examination. Once completed, they are qualified to diagnose, treat, and manage many of the oncological processes that affect the head and neck.
Medical oncologists utilize medicines to target disease located throughout the body as well as at the primary site of cancer. In patients that are poor surgical candidates, or have advanced disease, radiation and medical treatments may form the cornerstone of their treatment plans, when surgery is not an option. Other disease pathologies, such as lymphomas, are usually managed through medical treatments as opposed to surgery. These physicians are integral in discussions regarding optimal treatment plans, and exploration of non-surgical options.
Who are Speech and Swallow Therapists?
Patients suffering from the effect of treatments on the head and neck often have issues with speech and swallowing abilities. Speech and swallow therapists assist in the rehabilitation of patients in order to improve quality of life. Speech-Language Pathologists have received master’s level training at a university accredited by American Speech-Language-Hearing Association (ASHA). Once credentialed they may go on to complete a doctorate (Ph.D.) in Speech-Language Pathology.
Speech and Swallow therapists are involved in the pre-treatment and post-treatment assessment of the patient. They provide valuable insight into the extent of disease and treatment impact on patient’s quality of life, performing physical and diagnostic examinations. Speech therapists provide physical therapy, and routine examination ensuring progression and rehabilitation of the patient.