Treatment Advances in Head and Neck Cancer Improve Patient Outcomes
Benjamin Judson, MD, the William H. Carmalt Professor of Surgery, chair of the Yale School of Medicine Department of Surgery, surgeon-in-chief of Yale New Haven Health, and chief of surgery at Yale New Haven Hospital, specializes in surgically treating head and neck cancers. Dr. Judson appeared on Yale Cancer Answers to discuss surgery for head and neck cancers, recent advances in treatment, and cancer “prehab”—the steps patients can take before surgery to build their strength.
What are the most common causes of head and neck cancers?
For a long time, the majority of head and neck cancers were thought to come from smoking and alcohol exposure. As smoking rates in the United States have decreased, we’ve also seen those types of cancers decrease. Unfortunately, we’re seeing a real increase in people with throat cancers that are thought to be caused by the human papillomavirus (HPV).
What are some recent advancements in the treatment of head and neck cancers?
The first advancement is in reconstruction, and now oftentimes when a person is having surgery to treat a head neck cancer, there’s also a reconstructive team—not just a single surgeon but multiple surgeons working together. Sometimes this team includes an oral surgeon, and the techniques and technologies that are used to reconstruct whatever is being treated surgically have come so far, and they continue to be new advancements.
We’re now using virtual surgical planning—basically using AI to design exactly what’s going to happen to a patient [during the surgery]. Before the surgery we create plates and models to guide and to support the reconstructive team. The other area where surgery has advanced is in minimally invasive techniques, and so a big one is the use of a robot to perform transoral robotic surgery. It sounds alarming, but when a patient’s asleep, we can actually introduce robotic arms through the patient’s mouth to access areas in their throat that we would not otherwise be able to get to, and it’s possible to do minimally invasive surgeries to remove tumors or growths from farther down in areas that we wouldn’t otherwise be able to see or get to.
And the visualization is phenomenal—it’s like the highest definition you can imagine. There’s actually binocular vision, so you have depth perception, and you’ve got these tiny little arms that can have wrists, and they can do almost everything and more than your own wrists can do.
We’re also using targeted therapies as a way to reduce or avoid surgery. So this is where I think the future is. We’re having all these advances in surgery and advances in types of radiation that can be given and advances in targeted therapy and figuring out how to integrate all of these is the next chapter for us in providing care for patients with head and neck cancer.
What is cancer “prehab”? What do you recommend for head and neck cancer prehab?
We know that when someone’s having a knee replacement, it’s understood that doing physical therapy before the surgery is really important to help them recover from that surgery. We don’t have the luxury in cancer care to spend a lot of time getting ready for the treatment. But patients also oftentimes will ask me what should they do in the weeks or months leading up to treatment. It’s reasonable to think that prehab helps.
Being active, getting swallowing exercises from a speech–language pathologist, working with a nutritionist, and making sure one’s diet is a healthy diet—these are all things that can come before treatment that can drive how people do in terms of getting through treatment and how they do afterwards.
This Q&A was adapted from Connecticut Public Radio’s “Yale Cancer Answers,” a weekly program that shares information on the latest cancer breakthroughs and treatments through conversations with experts from Yale Cancer Center.
