Head and neck tumors
"We have a unit specialized in oncological and reconstructive head and neck surgery. We are pioneers in the use of robotic surgery for laryngeal cancer."
DR. JUAN MANUEL ALCALDE
SPECIALIST. OTORHINOLARYNGOLOGY DEPARTMENT
What is a head and neck tumour?
Head and neck tumours are malignant tumours located in the paranasal sinuses, nasopharynx, oropharynx (tonsil, soft palate, base of tongue), hypopharynx, larynx, oral cavity, tongue and salivary glands. Within this classification, skin, brain and thyroid tumours are excluded.
They represent 5% of all tumours. In Spain, according to the Spanish Society of Medical Oncology (SEOM), the most frequent location is the larynx, followed by the oropharynx, oral cavity and nasopharynx.
Although it is a tumour that predominantly affects men, there is an overall increase in women due to the increase in smoking among women. The average age of onset is above 50 years, although tumours of the nasopharynx and salivary glands may appear earlier.
At the Clínica Universidad de Navarra Cancer Centre we take a multidisciplinary approach, with all the professionals involved in the diagnosis, treatment and care of patients with head and neck tumours in order to offer the best possible treatment.
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Symptoms of head and neck tumours
The symptoms of head and neck tumours differ depending on the area in which they occur.
Symptoms in nasopharyngeal or cavum tumours
In nasopharyngeal or cavum tumours, symptoms are usually late and related to difficulty in breathing, hearing (due to obstruction of the tubes) or nosebleeds.
Symptoms in oropharyngeal tumours
In oropharyngeal lesions, the most characteristic symptoms are whitish or red lesions in the mouth (leukoplakia or erythroplakia), ulcers that do not heal well, constant bleeding from the mouth, non-specific pharyngeal discomfort associated with pain on swallowing (odynophagia) or ear pain, foreign body sensation in the mouth, changes in the tone of the voice or nasal voice (rhinolalia) or the appearance of a lump in the neck.
Symptoms of sinus tumours
Symptoms of sinus tumours are: unilateral nasal obstruction, constant nasal bleeding, constant tearing due to tear duct obstruction, enlargement of the bridge of the nose or orbit if there is tumour growth, pain and tooth immobility.
Symptoms of salivary gland tumours
In the salivary glands, most tumours are asymptomatic, appearing as a palpable mass at the location of the salivary glands. They may be associated with local pain, difficulty opening and closing the mouth and, in advanced cases, problems swallowing or speaking.
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
Risk factors for head and neck tumours
Head and neck tumours can be considered to have a fundamentally environmental or external aetiology. Their main risk factors are:
- Tobacco: is related to increased risk of tumours of the oral cavity, oropharynx, hypopharynx and larynx. The duration and magnitude of consumption is directly related to the risk of development.
- Alcohol: alcohol intake multiplies the risk of developing laryngeal cancer by a factor of 5 compared to the general population. The risk increases if it is associated with tobacco consumption. Other locations where the risk is increased by this factor are the oropharynx, hypopharynx and oral cavity.
- Diet: a lack of vitamins, mainly A and C, influences the possible appearance of these tumours.
- Oral hygiene: poor oral hygiene and rubbing areas of ill-fitting dentures are associated with oropharyngeal tumours.
- Viral infections: Epstein-Barr virus in the development of cavum carcinoma; and human papilloma virus in the development of cavity and oropharyngeal tumours, with a better prognosis, especially in non-smoking and non-drinking patients.
What is the prognosis of head and neck tumours?
Of the factors known to favour the development of pancreatic cancer, smoking is the one that has been shown to be most clearly associated in numerous studies.
Other factors such as alcohol, coffee and fat consumption are not clearly associated with pancreatic cancer.
A diet rich in vegetables and fruit has been shown to be beneficial in the prevention of this cancer, as with others.
How are head and neck tumours diagnosed?
Head and neck cancer is diagnosed by physical examination with flexible fibrolaryngoscopy, which allows the lesion to be visualised and a biopsy to be obtained. If the sample is insufficient, a fine needle aspiration-fine needle puncture (FNA) of affected lymph nodes is performed.
Head, neck and chest CT scans, MRI and/or PET-CT in advanced cases are used to assess the extent of the disease.
There is no effective early detection programme, so close follow-up is recommended for people with risk factors such as smokers and drinkers.
How are head and neck tumours treated?
Surgery is the primary treatment of choice in early stage, potentially resectable tumors. The main objective of this surgery is to completely remove the tumor and preserve all functions: swallowing, speaking with good voice quality and avoiding aspiration when eating, as well as a good aesthetic result.
The Clinic's Department of Otolaryngology has been the first center in Spain to perform robotic surgery in advanced cases of larynx cancer with excellent results. Likewise, the DaVinci robot is used in the transoral removal of tumors of the tonsil, base of the tongue and hypopharynx, as an alternative to laser surgery or open surgical procedures.
In addition, we work closely with the Department of Plastic, Reconstructive and Aesthetic Surgery to offer patients the latest techniques in microsurgical reconstruction to ensure an adequate quality of life.
In order to treat possible associated complications correctly and early, a Nutrition Department is available to carry out a personal assessment and an individualized therapeutic plan.
Chemotherapy can be administered as:
- Adjuvant treatment: after the complete surgery of the operated and cured patients.
- Neoadjuvant treatment: prior to a possible surgical resection and/or radiotherapy with the aim of reducing the size of the tumour.
- Concomitant or concurrent treatment: in combination with radiotherapy.
Given the profile of adverse effects of this treatment modality, alone or in combination with radiotherapy, the Clinic has a Palliative Medicine Service (recognized by the European Society of Medical Oncology (ESMO) as a center of excellence) providing comprehensive care to the patient in association with his medical treatment so that his survival and quality of life are maximized.
One of the most important objectives of head and neck tumor surgery is to preserve the functionality of the affected region to minimize the impact that cancer has on patients' quality of life. In this sense, when surgery is not possible, either because of the advanced stage of the tumor and/or the physical condition of the patient, radiotherapy treatment takes on its greatest importance, since it also aims to achieve the eradication of the tumor while preserving the function of the treated area.
The Clínica Universidad de Navarra, with its multidisciplinary treatment program combining surgery, perioperative brachytherapy and postoperative radiotherapy, has achieved local tumor control in 80% of the patients at 5 years.
Likewise, this modality of treatment has been used in tumor relapses, obtaining local tumor control in 60% of the cases at 5 years.
All this is reinforced with the creation of the Proton Therapy Unit in its Madrid headquarters.
Monoclonal antibodies are drugs directed against proteins that act on certain receptors on the surface of the tumor cell, modulating its proliferation and survival.
In the context of head and neck tumors, Cetuximab (Erbitux®), a monoclonal antibody that acts against epidermal growth factor (EGFR), is approved for use in combination with radiotherapy and chemotherapy.
Immunotherapy has appeared as an effective treatment strategy in advanced stage head and neck tumors refractory to classic treatment with or without chemo-radiotherapy.
The Clinic has been a pioneer in its development and implementation with a comprehensive program that combines basic and translational research (Immunology and Immunotherapy Program) with the application of new therapeutic approaches (Oncology Service).
Recently, as a further step in its specialization, the Clinic has created the Cellular Therapy Area, which has the technology and facilities necessary for the manufacture of all immunotherapy products related to adoptive cell therapy.
What clinical trials do we have on Head and Neck Tumors?
Proton therapy for cancer
Proton therapy is the most precise external radiotherapy modality, providing better distribution of radiation dose and therefore less irradiation of healthy tissues.
The Proton Therapy Unit of the Cancer Center Clínica Universidad de Navarra in its Madrid headquarters is the most advanced in Europe and the first in a Cancer Center, with all its healthcare, academic and research support.
Where do we treat them?
IN NAVARRA AND MADRID
The Department of Otolaryngology
of the Clínica Universidad de Navarra
The Department of Otorhinolaryngology of the University of Navarra Clinic is a national and world reference in numerous highly specialized surgical procedures.
We have the latest technology and we perform all diagnostic tests in less than 48 hours in order to offer our patients the best solution in the shortest time possible.
We were one of the first centers in Spain to use robotic surgery in the surgical treatment with the Da Vinci® System.
Organized in specialized units:
- Otology - Hearing.
- Rhinology - Nose.
- Pharyngology - Throat.
- Laryngology - Voice.
- Balance disorders.
- Head and neck problems.
Why at the Clinica?
- Experts in the treatment of hearing problems.
- Pioneers in axillary surgery to avoid scarring.
- National reference center in tissue sealing for tonsil removal.
Our team of experts in head and neck tumours
