Head & Neck Cancer Care

We’ll examine you for lumps on the neck, lips, gums and cheeks. We also will check for abnormalities in the nose, mouth, throat and tongue. You may need blood or urine tests as part of your exam.

An endoscopy helps your doctor see inside your throat. Your doctor inserts a thin, lighted, flexible tube (endoscope) gently through your nose, into your throat and down your esophagus. You will receive sedation to help you relax during this procedure.

During a biopsy, your doctor removes a small tissue sample. Then your doctor sends the sample to our lab to learn whether or not the tissue is cancerous.

One common type of biopsy is called a fine needle aspiration. During this procedure, the doctor removes cells using a thin needle inserted directly into your tumor or lymph node. 

An X-ray with barium swallow creates detailed images of inside your swallowing passageway. During a barium swallow, you will drink a liquid containing barium. Then, a technician will take a series of X-rays. The barium shows details that wouldn’t otherwise show up on the X-ray.

Your doctor might recommend a CT scan to help determine size of your tumor. A CT scan creates a 3D picture from different angles that provides a clear image of abnormalities.

In some cases, your doctor will give you a special dye (contrast) before the CT scan. Contrast helps enhance detail in the final images. Your doctor can inject this dye through an intravenous (IV) line or give it to you as a liquid to swallow.

Another way to measure a tumor’s size is with an MRI scans. An MRI uses magnetic fields to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue. Your doctor gives you contrast dye through an IV line or as a liquid. The contrast helps enhance detail in the final images.

Similar to an MRI, a positron emission tomography (PET) or PET-CT scan creates pictures of organs and tissues inside the body. One advantage is that a PET scan can detect changes in cells early. A CT or MRI detect changes a little later, as the disease begins to cause changes in the structure of organs or tissues.

Our world-class surgeons remove tumors while sparing surrounding healthy tissue. BIDMC head and neck surgeons offer advanced head and neck, minimally invasive and robotic procedures to treat oral, pharyngeal, laryngeal and skin cancers.

Before head and neck surgery, you may receive radiation therapy and/or chemotherapy to shrink the tumor. These therapies may follow surgery to destroy any remaining cancer cells.

Reconstructive Surgery

Our team of experienced, board-certified surgeons provides reconstructive surgery to restore or improve your function, quality of life and appearance using the latest, most effective surgical approaches. Some of the reconstructive procedures we offer are:

• Dental rehabilitation. This involves collaboration between a highly skilled oral surgeon, an otolaryngologist (ear, nose and throat surgeon) and a prosthodontist (a dentist who specializes on missing teeth).
• Microvascular reconstruction. This involves transferring tissue from one part of the body to another to restore function and appearance.

In many cases, your surgeon will use a surgical robot to remove the tumor from the mouth or throat. During the procedure, your surgeon strategically places the arms of the robot inside your mouth. The surgeon sits in a console away from you while controlling the arms of the robot.

An assistant sits at the head of your bed to help in whatever way your surgeon may need. The main advantage to robotic surgery is allowing the surgeon access — through the mouth — to areas that their hands couldn’t reach. In addition, there is typically less scarring and a quicker recovery time with robotic surgery versus traditional surgery.

Our head and neck cancer surgeons are experts with advanced training in removing complex skull base tumors. Surgeons can remove many of these tumors with minimally invasive approaches, which don’t require going through the skull.

The type of surgery that your surgeon chooses for a skull base tumor depends on a number of factors:

• Location of the tumor
• Size of the tumor
• Degree to which the tumor entwines blood vessels and nerves

Our surgeons are experienced in all possible surgical approaches to these tumors and will discuss all options with you.

Endoscopic Endonasal Surgery

Surgeons can remove some tumors — usually those in the central part of the skull base — by surgery they perform through the nostrils. This is called endoscopic endonasal surgery. It’s a minimally invasive procedure because the surgeon does not have to make incisions in the skull or move parts of the brain to get to the tumor.

During the surgery, surgeons use an endoscope (thin, lighted tube with a tiny camera on it) to view the inside of the nose. They place the endoscope through the nasal cavity and sinuses and then into the skull base.

These are the types of tumors that our surgeons can remove via endoscopic endonasal surgery:

• Craniopharyngiomas: A non-cancerous tumor that occurs at the base of the brain, usually above the pituitary gland
• Esthesioneuroblastomas: A rare cancer of the nasal cavity
• Meningioma: Usually a non-cancerous tumor that arises from the membranes surrounding the brain and spinal cord
• Nasopharyngeal carcinoma: A cancerous tumor that forms in the upper part of the throat, behind the nose
• Pituitary tumor: A non-cancerous tumor in the pituitary gland that doesn't spread beyond the skull

Eyebrow Craniotomy

Our surgeons may remove a skull base tumor using an eyebrow craniotomy. In this procedure, they make an incision in the eyebrow to create a small opening in the skull. This approach provides access to tumors located in the front portion of the skull base.

Craniotomy

If the surgeon can’t easily reach a tumor using an endoscopic procedure or an eyebrow craniotomy, they may need to perform a traditional craniotomy. During this procedure, they make an incision in the scalp and through the skull to remove the tumor.

This procedure may be necessary for tumors located farther back in the skull base, like an acoustic neuroma (a non-cancerous tumor that develops on the balance and hearing, or auditory nerves, leading from your inner ear to the brain). Even with this approach, our surgeons place incisions in the creases of your head and face to make the scar less obvious.

Radiation therapy uses special equipment to deliver high-energy particles — such as X-rays, gamma rays, electron beams or protons — to kill or damage cancer cells. In most cases, radiation oncologists deliver radiation treatment for head and neck cancer through the non-invasive CyberKnife image-guided therapy system. CyberKnife delivers highly precise and focused radiation directly to the tumor, while sparing surrounding healthy tissue.

If you are receiving chemotherapy, your doctor will let you know whether you can take it orally (as a pill) or through an intravenous (IV) line in your vein. Chemotherapy schedules vary. They generally repeat several times in cycles, with three to four weeks separating each cycle to allow damaged, normal cells time to recover.

Cancer specialists successfully use immunotherapy to treat head and neck cancer. Immunotherapy boosts the body’s own immune system and uses it to fight cancer.

Oral cancer surgery may affect your throat, tongue and other areas inside your mouth. As part of the treatment plan, therapists from our Voice, Speech and Swallowing Clinic will work with you. Speech therapy and voice therapy specialists can help you to eat and swallow safely, ensuring that food and liquid goes down the esophagus and not the wrong way into the lungs.

Your therapy process begins with a swallowing evaluation by a speech-language pathologist. We may recommend that you have a video swallow or modified barium swallow. This can help show therapists if foods or liquids are entering your airway.

Other services we offer:

• Artificial larynx (voice box) training
• Comprehensive supportive and communication services if you need a laryngectomy (larynx removal)
• Esophageal speech training
• Support groups
• Tacheoesophageal voice prosthesis training and management