Head and Neck Surgery for Cancer

Treating squamous cell carcinoma

by Robert Strominger, M.D.

People who smoke are generally aware that they run the risk of developing lung cancer as a result of their habit. However, fewer smokers fully understand their increased risk of developing a particularly aggressive form of cancer in their nose, mouth, throat, or esophagus, called squamous cell carcinoma.

The majority of people with this type of cancer develop it because they smoke, and the risk is compounded if they regularly consume alcohol, as well. The cancer develops as a result of progressive changes in the lining of the nose, mouth, and throat due to chronic irritation from smoke and alcohol. The most common tumor site is in the mouth, followed by the larynx (voice box).

Squamous cell carcinoma has a propensity to spread relatively quickly, and carries with it a high rate of mortality. If it is caught in the early stages, however, there is a cure rate of 85 to 95 percent. As the tumors grow larger, and if the cancer spreads into the neck, the cure rate drops significantly. This means it is imperative to detect and treat these cancers swiftly.

Depending on the specific site of the tumor, the symptoms for head and neck cancer vary somewhat. Generally speaking, if you smoke (or smoke and drink) and you experience any of the following warning signs, you should be evaluated by your doctor, dentist, otolaryngologist or other health-care provider immediately:

• pain in a specific area
• a lump that develops in your neck
• blood in your spit
• a sore in your mouth or on your tongue that won't heal
• progressive hoarseness
• difficulty breathing or swallowing that grows worse
• unexplained weight loss

Early cancers can be treated successfully by either surgery or radiation therapy. Depending on where the lesion is located, one modality will be recommended over another.As the tumor becomes larger, whether or not the cancer has spread to other sites, a multidimensional therapy is required and usually includes surgical removal of the tumor, followed by radiation therapy.

Enhanced local care

The biggest challenges with head and neck surgery for cancer are preserving the function of the affected area (voice, tongue, etc.) while effectively treating the tumor and leaving the patient cosmetically intact. Patients being treated locally are now able to benefit from new surgical procedures aimed at conserving tissue and function while optimizing the chances for cure. Laser surgery, endoscopic removal of selected cancers, and conservation laryngeal (voice box) surgery are performed at Cayuga Medical Center.

Other advances in cancer care

There are three recent advances in cancer research that will have significant impacts on diagnosis and treatment. The first of these advances is research to determine the genetic markers that indicate if an individual's cancer is more aggressive, requiring more aggressive treatment. Eventually, we might be able to determine a person's predisposition to developing cancer, which will be enormously helpful in the area of disease prevention.

The second important advance is the development of conservation surgical procedures and reconstructive techniques that leave patients with head and neck cancer functionally and cosmetically intact. And finally, for more advanced cancer, a treatment approach utilizing both chemotherapy and radiation therapy is yielding promising results.

People who stop smoking reduce their risk for cancer to that of the nonsmoking population within ten years of quitting cigarettes. Simply stated, stopping smoking can help you avoid cancer. And just for the record, do not switch from tobacco cigarettes to clove cigarettes or chewing tobacco with the idea that this move will reduce your risks. They will promote the development of cancer.

Dr. Strominger trained at Washington University in St. Louis, and did a one-year fellowship at the National Institutes of Health. He is board certified in otolaryngology and head and neck surgery, and serves on the medical staff of Cayuga Medical Center at Ithaca. He is in practice with Dr. Jonathan Cryer at Cayuga Ear, Nose, Throat -- Head and Neck Surgery Associates. He can be reached at (607) 266-0772.