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 tumor?
Head and neck tumors are malignant tumors located in the sinuses, nasopharynx, oropharynx (tonsil, soft palate, base of tongue), hypopharynx, larynx, oral cavity, tongue and salivary glands. Within this classification, skin, brain and thyroid tumors are excluded.
They represent 5% of all tumors. 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 tumor that predominates in the male sex, an overall increase is observed in women due to the increase in their smoking habits.
The average age of onset is above 50 years, although tumors of the nasopharynx and salivary glands may appear earlier.
At the Clinica Universidad de Navarra we take a multidisciplinary approach, with all the professionals involved in the diagnosis, treatment and care of patients with head and neck tumors in order to offer the best possible treatment.
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What are the symptoms of head and neck tumors?
The symptoms of head and neck tumors differ depending on the area in which they appear.
- In nasopharyngeal or cavum tumors, symptoms are usually late and related to difficulty breathing, hearing (due to tubal obstruction) or nosebleeds.
- In those of oropharynx, the most characteristic symptoms are whitish or red lesions in the mouth (leukoplakia or erythroplakia), ulcers that do not heal well, constant mouth bleeding, non-specific pharyngeal discomfort associated with pain when swallowing (odynophagia) or ear pain, sensation of a foreign body 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 tumors are: unilateral nasal obstruction, constant nosebleeds, constant tearing due to obstruction of the tear duct, enlargement of the nasal bridge or orbit if there is tumor growth, pain and immobility of the teeth.
- In the salivary glands, most tumors are asymptomatic, appearing as a palpable mass in the location of the salivary glands. They can be associated with local pain, difficulty opening and closing the mouth and, in advanced cases, problems swallowing or speaking.
The most common symptoms are:
- Foreign body sensation.
- Difficulty swallowing or breathing.
- Nasal bleeding.
- Changes in voice tone.
Do you have any of these symptoms?
You may have a head and neck tumor
What are the risk factors?
It can be considered that head and neck tumors have a fundamentally environmental or external etiology.
Their main risk factors are:
Tobacco: it is related to the increased risk of tumors 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 suffering from laryngeal cancer by 5 with respect 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: the deficit of vitamins, mainly A and C, influences the possible appearance of these tumors.
- Oral hygiene: poor oral hygiene and areas of friction of poorly fitting dentures are associated with oropharyngeal tumors.
- Viral infections: Epstein-Barr virus in the development of cavum carcinoma; and human papilloma virus in the appearance of cavity and oropharynx tumors, with better prognosis, especially in non-smoking and nondrinking patients.
What is your prognosis?
Prognostic factors are defined as characteristics of the patient, the tumor or related to the treatment that influence the evolution of the patient's disease.
The most important are:
- Age: advanced age is associated with a worse prognosis due to a greater number of morbidities.
- General condition of the patient.
- Weight loss: this is considered a bad prognosis factor.
- Continuation of the smoking habit during treatment.
- Tumor stage: this is the most important factor, since it correlates with the patient's survival.
- Location of the primary tumor: oral cavity tumors are generally more accessible and more resectable, except when they are diagnosed in advanced stages, where larynx tumors have a better prognosis. In terms of cure rates, nasopharyngeal tumors have the best prognosis.
How are head and neck tumors diagnosed?
The diagnosis of head and neck cancer is made through physical examination, carried out by means of a flexible fibro-laryngoscopy (a very thin tube with a light at one end that is introduced through one of the nostrils). With this technique, the lesion is visualized and the diagnostic biopsy is obtained.
In some cases, the sample obtained is very small and is not definitive, so it is necessary to perform a fine needle puncture-aspiration (FNP) of the nodal involvement, if present.
The extension study requires a head and neck CT scan, a nuclear magnetic resonance scan prior to the surgical approach, as well as a chest CT scan and/or PET-CT scan to rule out distant metastatic disease in very locally advanced stages, which are candidates for radical treatment.
There is no effective program for early detection of head and neck cancer, so close follow-up is recommended for people with known risk factors (such as heavy smokers and drinkers).
How are head and neck tumors treated?
The participation of a multidisciplinary team of specialists who discuss each case in a personalized manner is essential.
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 tumores de cabeza y cuello?
Proton therapy against 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 it?
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.