April 15, 2022

Optimizing outcomes for head and neck cancer

Doctor checking patient's neck.

About four percent of cancers diagnosed in the U.S. each year (66,000 cases) are classified as head and neck cancer. Most are very treatable, especially when found in early stages.

However, the physical location of these tumors, and the potential surgical and radiation interventions required, can make head and neck cancer a frightening prospect for patients. The disease can not only affect a patient’s appearance but also their ability to speak, swallow and breathe normally.

“Of all cancer types, head and neck cancer can be among the most feared by patients, simply based on the critical location involving the mouth, throat, face and neck,” said Dr. Paul Harari, chair of the UW Department of Human Oncology and principal investigator for the Wisconsin Head and Neck Cancer Specialized Programs of Research Excellence (SPORE).

“In terms of cosmetic and functional impairment, these cancers can be exceptionally challenging, and the treatments require an experienced multi-disciplinary team of experts.”

What they are 

Head and neck cancer is a broad term that covers cancers that occur in the areas of the throat (pharynx), voice box (larynx), nose, sinuses, mouth, and skin.

Dr. Aaron Wieland, Associate Professor in the Division of Otolaryngology-Head and Neck Surgery in the UW Department of Surgery, said alcohol and tobacco use are major risk factors for developing these types of cancer. 

Certain types of human papillomavirus (HPV) also have become an increasingly common cause in recent years, though Wieland hopes the availability of HPV vaccines will eventually help curb those cases in the future.

Symptoms of head and neck cancer can include pain and functional issues with speech, swallowing and breathing. In the mouth, people may notice bleeding, loose teeth, jaw irregularities, and white or red patches along the gums, tongue or mouth lining.

“In the realm of HPV related-cancer, patients can often be minimally symptomatic and may present with a persistent neck mass,” Wieland said.

Dentists commonly perform oral health screenings as part of normal check-ups, and patients can also consult ear, nose and throat specialists about concerning symptoms and preventative screenings.

Treatments

Once a patient is diagnosed, they will meet with a multi-disciplinary oncology team to consider their treatment options. These options may include surgery, radiation, chemotherapy, immunotherapy, or some combination thereof. Surgery and/or radiation form the backbone of treatment for most head and neck cancers, while chemotherapy is often used concurrent with radiation to increase tumor control rates.

Radiation can be very effective against these types of tumors, however side effects may include mouth pain, sores, dry mouth, difficulty swallowing and jaw stiffness. Surgery can also be very effective for tumor control, although depending on the size and location of their tumor it is not necessary for all patients.

“The head and neck region is essential to the important functions of life that make you who you are,” said Dr. Tiffany Glazer, Assistant Professor in the UW Department of Surgery’s Division of Otolaryngology-Head and Neck Surgery.

Both Glazer and Wieland make a point of bringing up impacts to physical appearance because some patients can be too embarrassed to ask.

“They feel like they need to be focused on being cancer-free and not their appearance,” Wieland said.

Reconstruction is an important aspect of cancer removal surgery, and Glazer said surgeons prioritize using tissue from similar areas to match color and texture as much as possible.

Glazer and Wieland agreed it can be valuable for patients to consult with major health care centers like UW Health that perform a high volume of complex head and neck cancer surgery and reconstruction to ensure the best possible cancer and aesthetic outcome.

Head and neck cancer patients meet with their oncologists during the next five years after successful treatments, to monitor for any evidence of recurrence. As patients heal, there can be additional work done to address scars and improve functional needs.

“Survivorship means a lot more than just the cancer not coming back,” Wieland said.

Research

Dozens of researchers in UW’s Head and Neck Cancer SPORE have been working since 2016 to advance treatments and patient outcomes in head and neck cancer.

SPORE grants were created by the National Cancer Institute in 1992 to fund research of new and multifaceted methods to prevent, detect, diagnose, and treat cancer. SPOREs are designed as five-year projects specific to a certain organ or system of the body, and the grants are extremely competitive. 

The UW Head and Neck SPORE is the first SPORE grant ever received in Wisconsin. Their work includes investigating how these cancers develop, advancing targeted therapeutic treatments and determining biomarkers that may predict severity and treatment response. 

The team also has explored new radiation therapy techniques that would reduce side effects that impact patients’ quality of life, examining why patients become resistant to a certain molecular treatment, and trying to stimulate a patient’s immune response to fight recurrent cancer.

“The Head and Neck SPORE effort is broad and inspires us to develop even better treatments for the future” Harari said.

Patient tissue donations are a key resource for researchers, and Harari is proud of the vast increase in patient donation agreements over the past several years. When the SPORE was first established, less than 10 percent of patients gave consent to donate research samples. Now, the program has 85-90 percent participation among patients. 

Harari praised the efforts of the SPORE’s collaborators to increase patient outreach and forge more of those donor relationships.

“It’s a testament to how much people believe in and support this research,” Harari said. 

Glazer and Wieland also praised the work of the SPORE to not only seek highly-effective treatments but also prioritizing patient experience and quality of life as part of those treatments.

“Those studies are so important to finesse treatments and have less long-term side effects,” Glazer said. “We want to give patients that same good oncologic outcome with less intensive treatment.”