Surgical Oncology — Head and Neck cancer
UC Davis Comprehensive Cancer Center offers comprehensive, multidisciplinary care for patients with all stages of head and neck (otolaryngological) cancers — including the skin, thyroid, parathyroid, nasal cavity, sinuses, skull base, lips, mouth, salivary glands, throat, or voice box — aimed at cure or control of disease, prevention of cancer recurrence and optimization of quality of life. Your team of cancer specialists will be individualized and include experts in head and neck surgical oncology and reconstructive surgery, radiation oncology, chemotherapy, hematology and oncology, endocrinology, radiology and pathology.
The Head and Neck Oncology Service manages the removal and related reconstruction of benign and malignant tumors in the head and neck, including the voice box (larynx), oral cavity, throat (pharynx), thyroid and parathyroid, sinuses, skin, skull base, ear and neck.
The Head and Neck Oncology Multidisciplinary Team meets every Tuesday. A tumor board is held from 4 - 5:30 p.m. in which patient cases are individually examined and discussed by specialists in attendance. The tumor board is attended by UC Davis head and neck surgical oncologists, radiation oncologists, medical oncologists, endocrinologists, radiologists, pathologists, nutritional therapists, and nurse specialists. After a comprehensive evaluation at the tumor conference, each patient’s case receives an individualized treatment recommendation.
The comprehensive approach to head and neck cancers, involving experts and specialists from multiple disciplines, ensures patients get the best treatment possible. By aggressively treating with a coordinated team, patients are given their best chance of cure.
UC Davis Comprehensive Cancer Center surgeons are skilled at treating head and neck cancers using advanced medical and surgical techniques. Often our experience allows a minimally invasive surgical approach to optimize the functional outcomes of our patients after successful cancer surgery. Small tumors are treated with surgery, possibly involving robotic resection or laser excision or radiation therapy. Large tumors are often treated with a combination of surgery and postoperative radiotherapy and potentially chemotherapy. Speech and hearing rehabilitation and prosthetic dentistry are essential parts of this program.
Specific surgical procedures may include:
- Thyroidectomy: The removal of all or part of the thyroid gland.
- Parathyroidectomy: The removal of abnormal parathyroid glands.
- Laser larynx surgery (cordectomy): The removal of the vocal cords, leaving no visible scar.
- Supraglottic laryngectomy: The removal of the supraglottis, the area above the vocal cords. It includes the epiglottis, the little flap that prevents food from being swallowed into the lung. This is often done through the mouth with a laser and leaves no visible scar.
- Partial laryngectomy: This surgery removes part of the voice box, which can help preserve the patient's ability to talk.
- Hemilaryngectomy: This surgery removes half of the voice box, and also saves the voice.
- Total laryngectomy: This surgery removes the whole voice box. The procedure results in a tracheostomy, an opening created in the front of the neck that allows the patient to breathe.
- Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
- Advanced cancer surgery: The tumor may require aggressive surgery to optimize cure. This often results in large wounds that our team of skilled reconstructive surgeons are able to address with their advanced microvascular training (see below).
Intensity-modulated radiation therapy (IMRT) is a type of 3-dimensional radiation therapy that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles. This type of therapy causes less damage to healthy tissue near the tumor. [cancer.gov]
Stereotactic radiation therapy uses a rigid head frame attached to the skull to aim radiation directly to a tumor, causing less damage to nearby healthy tissue. The total dose of radiation is divided into several smaller doses given over several days. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.
When surgery is required in the head and neck, structures important for appearance and function are oftentimes removed. This is necessary to remove the cancer but may result in disfigurement or loss of functions such as swallowing or speaking. UC Davis surgeons can use microvascular surgical techniques to optimally reconstruct and rehabilitate those defects by transferring new tissue into the defects, such as bone, skin or muscle from the leg, hip, arm, abdomen or back. These tissues are then placed to reconstruct the patient as well as possible. The blood vessels of the donated tissue are then sutured into place with sutures one-third the size of a human hair to provide nutrition for the flap. While our head and neck surgeons at UC Davis did perform the world’s second laryngeal transplant in a unique and remarkable case, currently these reconstructive procedures use the patient’s own tissues and not transplants.
Your surgeon may request preoperative testing to ensure normal anatomy and help predict the greatest success possible for the reconstruction.
Clinical Trials at UC Davis Comprehensive Cancer Center
Patients seen at the UC Davis Comprehensive Cancer Center will be eligible for trials that offer cutting edge and state-of-the-art therapy. You may be a candidate for a clinical trial for your head and neck tumor.
Below is an example of our active clinical trials:
RTOG 0920: Phase III Randomized Trial of Radiation Therapy With or Without Cetuximab in Treating Patients Who Have Undergone Surgery for Locally Advanced Head and Neck Cancer:
This trial is designed to study if radiation therapy is more effective when given alone or together with cetuximab, antibodies that can block tumor growth in different ways.
VIEW STUDY DETAILS
Chen AM, Farwell DG, Luu Q, Chen LM, Vijayakumar S, Purdy JA. Marginal misses after postoperative intensity-modulated radiotherapy for head and neck cancer. International Journal of Radiation Oncology, Biology, Physics. 2011 August; 1;80(5):1423-9.
Chen AM, Chen LM, Vaughan A, Farwell DG, Luu Q, Purdy JA, Vijayakumar S. Head and neck cancer among lifelong never-smokers and ever-smokers: matched-pair analysis of outcomes after radiation therapy. American Journal of Clinical Oncology. 2011 June; 34(3):270-5.
Lau V, Chen LM, Farwell DG, Luu Q, Donald P, Chen AM. Postoperative radiation therapy for head and neck cancer in the setting of orocutaneous and phyngocutaneous fistula. American Journal of Clinical Oncology. 2011 June; 34(3):276-80.
Chen AM, Chen LM, Vaughan A, Sreeraman R, Farwell DG, Luu Q, Lau DH, Stuart K, Purdy JA, Vijayakumar S. Tobacco smoking during radiation therapy for head-and-neck cancer is associated with unfavorable outcome. International Journal of Radiation Oncology, Biology, Physics. 2011 February; 79(2):414-9.
Farwell DG, Rees CJ, Mouadeb DA, Allen J, Chen AM, Enepekides DJ, Belafsky PC. Esophageal pathology in patients after treatment for head and neck cancer. Otolaryngology Head and Neck Surgery. 2010 September; 143(3):375-8.
Donald, PJ. Diagnosis and Treatment of Facial Fractures. Ballenger’s Otorhinolaryngology Head and Neck Surgery, 17th Edition. Singular Publishing Group, 2007.
Donald PJ, Brodie A. Chapter 7: Skull Base Surgery. K.J. Lee’s Essential Otolaryngology: Head and Neck Surgery, 8th Edition. McGraw-Hill, 2007.
Donald PJ. Tumors of the Infratemporal Fossa. Comprehensive Management of Tumors of the Skull Base, 1st Edition. Marcel Decker Publisher, 2007.
Arnaud F. Bewley, M.D.
Assistant Professor of Otolaryngology
Head and Neck Oncology and Microvascular Surgery
D. Gregory Farwell, M.D.
Professor of Otolaryngology
Director of Head and Neck Oncology and Microvascular Surgery
Jonathan Riess, M.D., M.S.
Assistant Professor of Internal Medicine, Hematology and Oncology
Megan Daly, M.D.
Shyam Rao, M.D., Ph.D.