Our experienced and nationally recognized surgeons perform a range of procedures for successfully treating cancers of the face, head, nose, ears, jaws, mouth, and throat. While your health and safety is always our top concern, in some cases we offer a minimally invasive approach using robotic-assisted, endoscopic or laser surgery. And while we always try to minimize the impact of our surgeries, we do provide top options for reconstruction and special monitoring to protect nerves. We take a team approach for the best results, with a number of specialists working together:
- Otolaryngologist - Head and Neck Surgeon (ear, nose and throat surgeon, or ENT)
- Plastic surgeon
While successful treatment is always our goal, we also try to minimize the impact on your talking, breathing, eating and appearance as much as possible. Our surgeries include:
- Hemilaryngectomy: remove half the larynx (voice box) and saves the voice
- Partial Laryngectomy: removes part of the larynx (voice box) and helps preserve the ability to speak
- Total Laryngectomy: removes the whole larynx (voice box)
- Supraglottic Laryngectomy: removes the supraglottis, i.e., the upper voice box, or larynx
- Total Laryngopharyngectomy: removes the larynx (voice box) and part of the pharynx (throat)
- Partial Laryngopharyngectomy: removes part of the larynx and part of the pharynx, to preserve the voice
- Laser Surgery: uses a laser beam to make bloodless cuts or remove a surface lesion
- Lobectomy: removes one of the two thyroid gland lobes
- Lymphadenectomy: removes cancerous lymph nodes in the neck
- Neck Dissection: removes lymph nodes and other neck tissue
- Near-Total Thyroidectomy: removes almost all the thyroid gland
- Total Thyroidectomy: removes the whole thyroid gland
Robot and Minimally Invasive Head and Neck Surgery
We offer a number of minimally invasive surgeries of procedures, which mean a smaller incision (or none at all) and a faster and easier recovery. These options include:
- Robot-Assisted Surgery: We have experience with the da Vinci Surgical System and regularly use it for cancer on the back of the tongue (oral cancer) or on the tonsils (oropharyngeal cancer).
- Endoscopic, Skull Base Surgery: A highly specialized technique and low-profile instruments help our surgeons—an ENT and neurosurgeon working together—remove some nasal cavity and paranasal sinus cancers through the nose, avoiding the facial incision of the conventional, open approach.
- Laser Surgery: We can treat some vocal cord tumors (laryngeal cancer) bloodlessly, with a laser—still leaving regular surgery as a later option, if needed.
While it’s not critical for most head and neck surgeries, we can monitor vital nerves when needed:
- Facial muscle electrodes to tell when we’re coming close to facial nerves—useful during surgery around the ear and the parotid gland (part of the salivary gland)
- Special equipment to assess the vocal cords—useful in some thyroid surgeries, since the voice box (larynx) nerve passes under the gland
Plastic Surgery and Reconstruction
We work closely with plastic surgeons to determine—when possible—which approaches will leave you with the best function and cosmetic appearance. They also help with any reconstruction during and after surgery to remove tumors. Examples include:
- Replacing removed or damaged teeth with dental implants
- Restoring the tongue with forearm skin and blood vessels
- Rebuilding the jaw with a section of fibula from the leg
- Taking a nerve graft from elsewhere in the body for the face
- Performing a tracheoesophageal Puncture (TEP) after the voice box (larynx) is removed, to create a pathway between the windpipe and esophagus with a special tube and make speaking possible again
Radiation therapy uses high-energy X-rays or other particles to destroy cancer cells. Our experienced radiation oncologists offer the most proven techniques and systems and are exploring new, promising approaches. We use radiation either as a primary head and neck cancer treatment, or after surgery to make sure no cancer remains. We also take special measures to avoid or minimize side effects.
We offer several types of radiation to treat head and neck cancers:
- External-Beam Radiation Therapy: Given by a machine outside the body and includes:
- CyberKnife: Radiation is delivered with laser-like precision, providing a newer option for patients who have already undergone radiation treatment for a head or neck cancer. Learn more about our CyberKnife treatment.
- Intensity-Modulated Radiation Therapy (IMRT): Our radiation oncologists can change treatment intensity as they go based on tissue type, delivering specific doses to different parts of a tumor and sparing healthy tissue.
- Image-Guided Radiation Therapy (IGRT): Your radiation oncology team uses high-quality imaging to carefully adjust radiation beams and doses to best fit the size, shape and location of the tumor, sparing healthy tissue.
- ZAP-X Machine: Enables your neurologist and/or Radiation Oncologist to streamline the treatment of brain tumors and conditions of the head and neck.
- Internal Radiation Therapy (Brachytherapy): Internal radiation is delivered through implants, like seeds. One example is radioactive iodine (RAI) for thyroid cancer.
Rehab for Head and Neck Radiation
At MedStar Georgetown Cancer Institute, rehab for radiation therapy side effects begins before treatment and continues until you are healed. Our program features:
- The active participation of therapists in our weekly tumor boards, an unusual partnership that helps the team plan for possible mouth and throat irritation radiation, ensure safe and effective swallowing and prevent long-term harm
- Speech therapists to respond to swelling and scarring
- Dentists to fix any problems with the teeth, gums or mouth before treatment starts, and to minimize or prevent tooth decay from radiation
- Evaluations to check the impact of radiation on the thyroid gland
- Nutritionists to help with diet and loss of appetite from changes to sense of taste
Our experienced medical oncologists use the latest chemotherapy drugs and regimens to destroy cancer cells, usually partnering with other colleagues who perform surgery or deliver radiation. One newer approach, chemoradiation, treats cancer with radiation and chemotherapy at the same time.
When appropriate, we provide patients the opportunity to join clinical trials—studies looking at promising new drugs and combinations, chemotherapy delivered at different times and in different ways and chemotherapy used to stop cancer from advancing.
Head and neck chemotherapy is typically given systemically, entering the bloodstream and targeting cancerous cells throughout the body. The drugs are given by:
- IV line
Targeted therapy represents a new front in attacking cancer—drugs and other substances aimed at specific molecules that help tumors grow, progress and spread. The idea is to target a tumor’s unique characteristics, including genes, proteins, supporting blood vessels or host tissue, while limiting damage to healthy cells.
While just one targeted therapy is approved for regular use on head and neck cancers so far, we are involved with a wide range of clinical trials and provide patients the opportunity to participate whenever appropriate. Our medical oncologists have the experience needed to know when to turn to this promising option.
Immunotherapy is a type of targeted therapy that mimics or boosts the body’s natural defenses, with head and neck cancers a particular promising target for this new line of treatment.
While we study a wide range of targeted therapies, we are particularly known for our immunotherapy clinical trials—in fact, patients travel to us from all over the country for them because of the limited opportunity elsewhere. A few examples of our trials include:
- Cetuximab: Cetuximab is an injectable, laboratory-made solution that mimics a natural antibody and targets a specific protein. While it’s the only head and neck targeted therapy approved so far, it’s only marginally effective by itself. So we’re studying ways to combine it with other drugs.
- Checkpoint Inhibitors: Checkpoint inhibitors fully release the body’s immune system so it can fight cancer, with drugs aimed at the normally restrictive PD-1 and PD-L1 proteins.
Some cancers are treated by stopping the production of certain hormones or blocking their effect, so that tumors no longer get the help they need to grow. For the head and neck, some thyroid cancer patients may receive drugs that prevent their bodies from making the thyroid-stimulating hormone (TSH) that can otherwise cause tumor growth or return.
Other thyroid patients may receive thyroid hormone replacement pills, because cancer treatment can kill needed thyroid cells.