Head and neck cancers represent a wide range of possible tumor sites including the throat, larynx, nose, sinuses and mouth and salivary glands.
The majority of head and neck cancers are considered squamous cell carcinomas, tumors that begin in the cells that form the inner lining of the head and neck.
At Guthrie we treat these cancers using a team approach to care and advanced surgical techniques from experienced fellowship-trained surgeons.
Dr. Phillip Pellitteri is here to discuss all the latest advancements in head and neck cancer treatment at Guthrie.
Head and Neck Cancer: Guthrie Can Help
Featured Speaker:
Learn more about Dr. Phillip Pellitteri
Phillip Pellitteri, MD
Dr. Phillip Pellitteri is the Chief of Otolaryngology at Guthrie.Learn more about Dr. Phillip Pellitteri
Transcription:
Head and Neck Cancer: Guthrie Can Help
Bill Klaproth (Host): Head and neck cancer are cancers of the mouth, nose, throat and sinus areas. They are particularly distressing because they affect basic human functions such as talking, eating swallowing, etc. Head and neck cancer requires a multi-specialist approach and Guthrie’s integrated system provides an excellent platform to ensure patients receive the best care. Here to talk with us about head and neck cancer today is Dr. Phillip Pellitteri, Chief of Otolaryngology at Guthrie. Dr. Pellitteri thanks for your time today. Head and neck cancer. How common is this?
Dr. Phillip Pellitteri (Guest): It’s becoming more and more common as people are exposed to tobacco products with a resurgence in smoking, especially in females. We’re seeing it to a somewhat greater extent than we had in the past. The other influence, of course, is those head/neck cancers that may be influenced by a viral infection, specifically, the human papillomavirus infection.
Bill: And when we talk about head and neck cancer that would include the lips, tongue, gums, lining of the mouth, the floor and roof of the mouth, also the throat, voice box, sinuses, nasal cavity as well as the salivary glands. Is there any other part of the mouth, nose or throat that should be mentioned?
Dr. Pellitteri: Well, there are extensions from those areas that you mentioned. Specifically, the lymph nodes of the neck that harbor deposits from these primary areas of malignancy. And, of course, the thyroid gland also can be a cancer reservoir.
Bill: So, out of these areas is there one that’s more commonly affected than the others?
Dr. Pellitteri: I would say that we see more malignancies of the tongue, the tonsil and the back of the throat area more than any of the other cancers that we see in the areas described. In many instances these cancers present as enlarged lymph nodes in the neck with smaller cancers involving the structures that we just talked about. It used to be that we saw these cancers as being very large masses within the structures of the throat and the oral cavity but now we’re seeing a greater incidence of those cancers presenting in lymph nodes which indicate that the cancer has already spread beyond the primary site, the site of origin.
Bill: What type of symptoms do you see with head and neck cancers?
Dr. Pellitteri: Well, it really depends on where it occurs and to what extent it is not attended to in a timely fashion. So called “silent areas” of malignancy can occur in the nose and the sinuses where, you know, the tumor can grow to great dimensions before it obstructs the airway or causes a symptom of bleeding or problems with pain. On the other hand, cancers that occur in the oral cavity, especially the tongue or the inner lining of the mouth, may present fairly early because of an ulceration that becomes painful or, importantly, where a dental consultant or a dental hygienist actually sees the cancer when the patient presents for dental cleansing or some other type of dental procedure.
Bill: With any of these symptoms, at what point should someone come see you at Guthrie?
Dr. Pellitteri: Well, certainly if they have a neck mass, if you’re an adult with a neck mass, they should be seen. If they’re seen by their primary care physician and there’s a strong feeling that the patent has an infectious history, they might be treated with an antibiotic for a week or two and if that neck mass doesn’t resolve, the patient should be sent to see an otolaryngologist and we here at Guthrie can take care of that quite readily. Certainly, if a patient has a growth on the tongue that they can see or feel if they have problems with swallowing and feel as if they have pain on swallowing and notice a mass legion or an ulceration or some type of process that becomes painful and impedes their speech or breathing or swallowing, they should come directly to see us.
Bill: When it comes to diagnosis and treatment Guthrie provides a multi-specialist integrated approach. How does that work?
Dr. Pellitteri: Well, we’ve established what’s called a multi-disciplinary clinic, where patients who either are suspected of having malignancies of the head/neck, head/neck cancer, so to speak, or have already been diagnosed will be presented at our conference. What happens is that a number of specialists in different disciplines, such as surgeons, medical oncologists, radiation therapists, together with some of the supporting professionals in pathology and radiology, come together in a common conference. The patients attend that conference, they’re presented to all of the participants and then the unique aspect of the conference is that these patients are then examined by the participants all under one setting. Really, what that allows for is the patients to meet the people who are going to be treating them, to offer a consensus opinion right on the spot and then be able to direct any kind of scheduling, either for tests or for therapy, right when the patient is there. You know, patients who have gone through this process here at Guthrie have really found the benefit in that because it saves time, it expedites their care and it provides them a one-to-one meeting place with the people who are going to be very influential in their therapeutic program.
Bill: Obviously, the severity and stage of the cancers determine the treatment, but can you briefly tell us about treatment?
Dr. Pellitteri: You know, early stage cancer, that is, smaller malignancies of accessible sites especially in the oral cavity, might actually be treated by surgery and nothing else. On the other, hand larger cancers which may involve important structures that play a role in speech, articulation, swallowing and breathing, those malignancies may be treated up front with both chemotherapy and radiotherapy initially with an intent to cure and then, depending upon the response, the response both by the primary site in the head/neck as well as any lymph node metastasis, they may be candidates for surgical resection of those components, most notably in the neck afterward. The way we’re able to determine the completeness of therapy is not only by clinical evaluation-- actually feeling and looking and seeing where these cancers are--but also in specialized imaging techniques which provide appropriate orientation of the anatomic aspects of the head and neck relative to the cancer as well as the functional aspect of the cancer; that is the ability of the cancer to image through specific metabolic activities. In this way, we’re able to assess response for therapy. Depending upon response, the patient may be able to have either single or double modality therapy, sparing surgery, or surgery only sparing radiation and chemotherapy. It really depends upon the stage. Earlier stages, less therapy. Later stages, more therapy.
Bill: In overview, quit smoking, and if you feel something is wrong get to the doctor right away.
Dr. Pellitteri: There is no question that smoking cessation should be promoted and in younger people, we’re finding that vaccination against the HPV virus, which has been most effectively used in girls can now be extended to boys as well because these are viruses that may be sexually transmitted and may remain latent for long periods of time before becoming active in adult life. Then, of course, as you mention the recognition of symptoms. Changes that require more expedient evaluation and institution of therapy.
Bill: Great advice. Dr. Pellitteri, thanks for your time today. Last question, for someone with head and neck cancer or if someone fears they may have this type of cancer, why should they choose Guthrie for their care?
Dr. Pellitteri: Well, I think as far as our ability to both diagnose appropriately and comprehensively evaluate patients and integrate and institute a complete and comprehensive cutting-edge management program, Guthrie really stands second to none. We’ve been able to develop our program according to guidelines that are set aside for national standards. We, I think, are able to comprehensibly address patients through our multi-disciplinary conferences and, thus far, our outcomes have been absolutely excellent. You know, we stand ready to address those patients who have had neck cancer and we try to do that with the individual in mind and the individual’s family in mind. So we try and provide not only quality clinical care but quality service as well.
Bill: Absolutely. Dr. Pellitteri, thanks for your time today. We appreciate it. For more information visit Guthrie.org. That’s Guthrie.org. I’m Bill Klaproth. This is Guthrie Radio. Thanks for listening.
Head and Neck Cancer: Guthrie Can Help
Bill Klaproth (Host): Head and neck cancer are cancers of the mouth, nose, throat and sinus areas. They are particularly distressing because they affect basic human functions such as talking, eating swallowing, etc. Head and neck cancer requires a multi-specialist approach and Guthrie’s integrated system provides an excellent platform to ensure patients receive the best care. Here to talk with us about head and neck cancer today is Dr. Phillip Pellitteri, Chief of Otolaryngology at Guthrie. Dr. Pellitteri thanks for your time today. Head and neck cancer. How common is this?
Dr. Phillip Pellitteri (Guest): It’s becoming more and more common as people are exposed to tobacco products with a resurgence in smoking, especially in females. We’re seeing it to a somewhat greater extent than we had in the past. The other influence, of course, is those head/neck cancers that may be influenced by a viral infection, specifically, the human papillomavirus infection.
Bill: And when we talk about head and neck cancer that would include the lips, tongue, gums, lining of the mouth, the floor and roof of the mouth, also the throat, voice box, sinuses, nasal cavity as well as the salivary glands. Is there any other part of the mouth, nose or throat that should be mentioned?
Dr. Pellitteri: Well, there are extensions from those areas that you mentioned. Specifically, the lymph nodes of the neck that harbor deposits from these primary areas of malignancy. And, of course, the thyroid gland also can be a cancer reservoir.
Bill: So, out of these areas is there one that’s more commonly affected than the others?
Dr. Pellitteri: I would say that we see more malignancies of the tongue, the tonsil and the back of the throat area more than any of the other cancers that we see in the areas described. In many instances these cancers present as enlarged lymph nodes in the neck with smaller cancers involving the structures that we just talked about. It used to be that we saw these cancers as being very large masses within the structures of the throat and the oral cavity but now we’re seeing a greater incidence of those cancers presenting in lymph nodes which indicate that the cancer has already spread beyond the primary site, the site of origin.
Bill: What type of symptoms do you see with head and neck cancers?
Dr. Pellitteri: Well, it really depends on where it occurs and to what extent it is not attended to in a timely fashion. So called “silent areas” of malignancy can occur in the nose and the sinuses where, you know, the tumor can grow to great dimensions before it obstructs the airway or causes a symptom of bleeding or problems with pain. On the other hand, cancers that occur in the oral cavity, especially the tongue or the inner lining of the mouth, may present fairly early because of an ulceration that becomes painful or, importantly, where a dental consultant or a dental hygienist actually sees the cancer when the patient presents for dental cleansing or some other type of dental procedure.
Bill: With any of these symptoms, at what point should someone come see you at Guthrie?
Dr. Pellitteri: Well, certainly if they have a neck mass, if you’re an adult with a neck mass, they should be seen. If they’re seen by their primary care physician and there’s a strong feeling that the patent has an infectious history, they might be treated with an antibiotic for a week or two and if that neck mass doesn’t resolve, the patient should be sent to see an otolaryngologist and we here at Guthrie can take care of that quite readily. Certainly, if a patient has a growth on the tongue that they can see or feel if they have problems with swallowing and feel as if they have pain on swallowing and notice a mass legion or an ulceration or some type of process that becomes painful and impedes their speech or breathing or swallowing, they should come directly to see us.
Bill: When it comes to diagnosis and treatment Guthrie provides a multi-specialist integrated approach. How does that work?
Dr. Pellitteri: Well, we’ve established what’s called a multi-disciplinary clinic, where patients who either are suspected of having malignancies of the head/neck, head/neck cancer, so to speak, or have already been diagnosed will be presented at our conference. What happens is that a number of specialists in different disciplines, such as surgeons, medical oncologists, radiation therapists, together with some of the supporting professionals in pathology and radiology, come together in a common conference. The patients attend that conference, they’re presented to all of the participants and then the unique aspect of the conference is that these patients are then examined by the participants all under one setting. Really, what that allows for is the patients to meet the people who are going to be treating them, to offer a consensus opinion right on the spot and then be able to direct any kind of scheduling, either for tests or for therapy, right when the patient is there. You know, patients who have gone through this process here at Guthrie have really found the benefit in that because it saves time, it expedites their care and it provides them a one-to-one meeting place with the people who are going to be very influential in their therapeutic program.
Bill: Obviously, the severity and stage of the cancers determine the treatment, but can you briefly tell us about treatment?
Dr. Pellitteri: You know, early stage cancer, that is, smaller malignancies of accessible sites especially in the oral cavity, might actually be treated by surgery and nothing else. On the other, hand larger cancers which may involve important structures that play a role in speech, articulation, swallowing and breathing, those malignancies may be treated up front with both chemotherapy and radiotherapy initially with an intent to cure and then, depending upon the response, the response both by the primary site in the head/neck as well as any lymph node metastasis, they may be candidates for surgical resection of those components, most notably in the neck afterward. The way we’re able to determine the completeness of therapy is not only by clinical evaluation-- actually feeling and looking and seeing where these cancers are--but also in specialized imaging techniques which provide appropriate orientation of the anatomic aspects of the head and neck relative to the cancer as well as the functional aspect of the cancer; that is the ability of the cancer to image through specific metabolic activities. In this way, we’re able to assess response for therapy. Depending upon response, the patient may be able to have either single or double modality therapy, sparing surgery, or surgery only sparing radiation and chemotherapy. It really depends upon the stage. Earlier stages, less therapy. Later stages, more therapy.
Bill: In overview, quit smoking, and if you feel something is wrong get to the doctor right away.
Dr. Pellitteri: There is no question that smoking cessation should be promoted and in younger people, we’re finding that vaccination against the HPV virus, which has been most effectively used in girls can now be extended to boys as well because these are viruses that may be sexually transmitted and may remain latent for long periods of time before becoming active in adult life. Then, of course, as you mention the recognition of symptoms. Changes that require more expedient evaluation and institution of therapy.
Bill: Great advice. Dr. Pellitteri, thanks for your time today. Last question, for someone with head and neck cancer or if someone fears they may have this type of cancer, why should they choose Guthrie for their care?
Dr. Pellitteri: Well, I think as far as our ability to both diagnose appropriately and comprehensively evaluate patients and integrate and institute a complete and comprehensive cutting-edge management program, Guthrie really stands second to none. We’ve been able to develop our program according to guidelines that are set aside for national standards. We, I think, are able to comprehensibly address patients through our multi-disciplinary conferences and, thus far, our outcomes have been absolutely excellent. You know, we stand ready to address those patients who have had neck cancer and we try to do that with the individual in mind and the individual’s family in mind. So we try and provide not only quality clinical care but quality service as well.
Bill: Absolutely. Dr. Pellitteri, thanks for your time today. We appreciate it. For more information visit Guthrie.org. That’s Guthrie.org. I’m Bill Klaproth. This is Guthrie Radio. Thanks for listening.