The Head and Neck Cancers Program at Smilow Cancer Hospital provides total care, as well as innovative and organ-sparing treatment options to patients with cancers of the head and neck. Our team sets the tone nationally and internationally for clinical trials and state-of-the-art cancer care. By carefully balancing treatment efficacy with quality-of-life, our collaborative approach to care personalizes treatment for tumors affecting the neck, larynx (voice box), pharynx (throat), oral cavity (mouth), ear, sinuses, tonsils, and salivary glands, as well as cervical (neck) lymph nodes or neck structures.
Our multidisciplinary team includes head and neck surgeons, radiation oncologists, medical oncologists, pathologists, physical therapists, speech-language pathologists, nutritionists, a smoking cessation specialist, dentists, a physical/lymphedema therapist, advanced practice nurses, and social workers. Functional outcome is an important element in deciding which treatment approach is recommended.
Our program offers a promising new surgical technique, transoral robotic surgery (TORS), that can be used to remove certain throat cancers while avoiding skin and bone incisions. This approach speeds healing and shortens a patient’s hospital stay. Likewise, patients with certain laryngeal cancers, who a few years ago would have lost their vocal cords and their voices, can often be treated with less invasive surgeries.
Patients who undergo these treatments maintain their ability to speak, although they may need to alter their diet or learn new swallowing techniques. At Yale, rehabilitative specialists work with patients to help them adjust to and overcome some of these swallowing impairments.
In many cases, radical neck dissections have been replaced by less radical surgeries that preserve the nerves, arteries, and muscles in the neck. Patients continue to move, speak, breathe, and eat normally after less radical surgeries, without sacrificing cure rates. Additionally, in recent years, the field of reconstructive surgery has achieved many breakthroughs, yielding previously unattainable cosmetic and functional outcomes.
Our medical oncologists have unique expertise in head and neck cancers and dedicate their practice entirely to cancers of the head and neck. The integration of chemotherapy with radiation has become very important for patients with head and neck cancers that involve the lymph nodes or is locally extensive, and this approach can lead to organ preservation and increase the chance of cure for many patients. Breakthroughs in targeted therapy and biomarkers allow a personalized approach that can avoid the toxicities of conventional chemotherapy in some cases, and new treatments to prevent recurrence in high-risk situations are also being studied. For patients with recurrent disease, new anti-cancer drugs and immunotherapies are also available.
A study led by Yale Cancer Center revealed that the checkpoint inhibitor pembrolizumab (Keytruda) offers patients with advanced head and neck cancers longer survival time; this led to FDA approval of immunotherapy as first-line treatment in head and neck cancer that has recurred or spread.
Radiation treatment is critical for almost all advanced head and neck cancers. Radiation therapy can be delivered alone or combined with chemotherapy as a primary therapy or after surgery. Our radiation oncologists specialize in the use of intensity-modulated radiation therapy (IMRT) to effectively and more precisely target head and neck tumors.
Our doctors work in close coordination with ENT surgeons, medical oncologists, radiologists, and pathologists to design a specific radiation plan after extensive multidisciplinary review.
During the course of radiation treatment, patients are carefully evaluated by their physician and support team weekly. The team works to address any symptom management, nutritional needs, or social support needs. After treatment is completed, the radiation oncologist will help with cancer surveillance and symptom management.
Clinical Trials and Research
Many of the head and neck physicians at Yale are also cancer researchers who study head and neck cancers in their laboratories, lead clinical trials, or analyze information from national databases to compare the effectiveness of different treatment approaches. Our radiation oncologists actively participate in clinical trials that explore novel agents to sensitize cancer cells to radiation, as well as new therapies that may help maintain treatment response. Through this active participation, they have access to the most up-to-date information and are involved in influencing the direction of head and neck cancer research in the future.
Our medical oncologists are engaged in research and trials looking at human papillomavirus (HPV)-directed vaccines and more tolerable chemotherapy regimens. Although immunotherapy is effective for patients with head and neck cancer when other options haven’t worked, it too can stop working. When this happens, our physicians are ready to offer targeted therapies. Recently, a trial led by one of our doctors led to FDA approval of a new treatment option for head and neck cancer, and there are studies underway looking at how to best treat HPV-positive head and neck cancers.
Yale Cancer Center was recently awarded grants from the National Institutes of Health (NIH) to fund the Yale Head and Neck Cancer Specialized Program of Research Excellence (SPORE) to address critical barriers to the treatment of head and neck squamous cell carcinoma due to resistance to immune, DNA damaging, and targeted therapy. Yale researchers also hold grants from the National Cancer Institute and the Department of Defense to study new treatments in head and neck cancer.
Our staff is specially trained to care for our patients’ needs following treatment. We provide essential services including pastoral support, complementary therapy, pain management, speech-language pathology, nutrition, and smoking cessation, as well as access to dentists, a physical/lymphedema therapist, advanced practice nurses, and social workers.
Smilow Cancer Hospital also offers a Survivorship Clinic that employs a multidisciplinary team approach designed to address patients’ needs after treatment ends.