Providence Head and Neck Cancer Program
Providence Head and Neck Cancer Program
At Providence, we see more than a patient with a head or neck cancer diagnosis. We see the life you’re fighting for — and we have for nearly 100 years. That’s how long we’ve been providing world-class cancer care in Oregon. Today, our commitment continues with nationally accredited cancer programs in Portland with a multidisciplinary patient focused approach.
Our team of certified oncology nurse navigators and patient navigators provide individual support and education, compassion and treatment coordination through every step of your cancer care.
Access to the most advanced technology and treatment options, including research, precision medicine, genetic counseling and clinical trials.
Your personalized treatment plan will depend on factors that are unique to you, from your specific diagnosis to your personal health and preferences. One thing that most patients can count on is that it will take a multidisciplinary team. That’s where Providence shines.
Your care team may include multiple experts who specialize in very specific aspects of cancer care. This collaborative team includes fellowship-trained head and neck surgeons, microvascular reconstructive surgeons, radiation and medical oncologists. Many other specialists such as nurses, dietitians, speech therapists, and dentists may also be collaborating on your care. Through regular multidisciplinary tumor conferences (tumor boards), members of your team gather to review your case as well as others. They share clinical opinions and give recommend treatments or strategies. If available, they may suggest opportunities for clinical trials and optimize care coordination.
To help guide you through the whole process, we will team you up with an oncology nurse navigator. Your nurse navigator helps you with understanding your treatment and answering your questions. They will monitor your treatment and coordinate your care. They can also refer you to helpful support services such as oncology social workers, financial coordinators and more. Treatment options and services may differ based on location. For more information, please contact the Patient Engagement Center or select a location from the list below.
Head and neck cancer includes several types of cancer that begin in the head, neck or throat.
Oral Cavity: Oral cavity cancer, also called oral cancer or mouth cancer, starts in the mouth. It includes the lips, the cheeks, or the front of the tongue. These tumors can involve the mandible and can affect speech and swallowing.
Oropharynx: Oropharyngeal cancer starts in the middle part of the throat. It includes the base of the tongue, soft palate and tonsils. There are many types of cancer of the oropharynx. Most of these cancers are squamous cell carcinomas. The incidence of these tumors is on the rise.
Nasal Cavity and Paranasal Sinuses: Nasal cavity cancers start inside the nose. Paranasal sinus cancers most often start in the maxillary sinuses in the cheeks and below the eyes on either side of the nose. These tumors can also involve the skull base, the orbit, or nerves that given sensation to the face. A number of different cancers originate in this area, including squamous cell carcinoma, olfactory neuroblastoma, or adenoid cystic carcinoma.
Larynx: Laryngeal cancer begins in the larynx, or voice box. Almost all laryngeal cancers develop from squamous cells, which are thin, flat cells in the inner lining of the tissue. A tumor in this area can affect the voice, swallowing, or the airway.
Hypopharynx: Hypopharyngeal cancer affects the lower part of the throat. Like laryngeal cancer, it most often develops from squamous cells lining the throat.
Nasopharynx: Nasopharyngeal cancer begins in the nasopharynx, a box-like chamber. It is the upper part of the throat behind the nose and near the base of the skull. It is very rare in the United States.
Salivary Gland: Salivary gland cancer affects the glands that rest on the sides of the face (parotid), below the jaw (submandibular), and inside the mouth and nose (minor salivary glands) that produce saliva. Salivary gland cancer is rare in the United States.
Neck: Many types of head and neck cancers can spread to the lymph nodes in the neck. In some cases, a mass in the neck can be the earliest sign of a problem. Cancers rarely originate in the soft tissues, nerves, or blood vessels in the neck.
Head and neck cancer most commonly affects people over the age of 50 and develops more often in men than women.
Various factors are known to raise the risk of head and neck cancer, including:
- Tobacco use (smoking, chewing and secondhand smoke)
- Frequent and/or heavy alcohol use (more than one drink per day)
- Human papillomavirus (HPV – a common sexually transmitted virus) infection is linked to most cases of oropharyngeal cancer.
- Epstein-Barr virus (EBV) is associated with nasopharyngeal cancer
- Sun exposure – a major cause of cancer on the lips
- Poor nutrition
- Genetic syndromes
Having any of these risk factors does not mean you will develop cancer, but if you are concerned about your risk, talk to your doctor.
There are no routine screening tests for head and neck cancer. Talk to your doctor or dentist if you have any of the conditions that increase risk or notice any potential symptoms. Ask your doctor or dentist to perform a physical examination of your neck, mouth and throat at each routine visit. The sooner cancer is detected, the easier it may be to treat.
Consider the following guidelines to help lower your risk of head and neck cancer:
- Avoid tobacco use
- Eliminate or reduce alcoholic beverages
- Maintain a healthy body mass index and lose weight if you are overweight
- Get regular dental check-ups to look for early signs of oral cancer
- Under age 46, talk to your doctor about HPV vaccines
Cancers of the head and neck usually have no early signs, so most are not found until they begin to cause symptoms.
Having any of these symptoms does not mean you have head or neck cancer; in fact, most are likely to be caused by infections, non-cancerous tumors or other conditions. However, if any symptoms last more than two weeks, talk to your doctor about them.
Oral cavity and oropharyngeal cancer symptoms may include:
- A sore on the lip or in the mouth that doesn't heal
- Pain in the mouth that doesn’t go away
- A lump or thickening in the lips, mouth or cheek
- A white or red patch on the gums, tongue, tonsil, or lining of the mouth
- Persistent sore throat or a feeling that something is caught in your throat
- Trouble chewing or swallowing
- Trouble moving the jaw or tongue
- Numbness of the tongue, lip, or other area of the mouth
- Swelling or pain in the jaw
- Dentures that start to fit poorly or become uncomfortable
- Loosening of the teeth or pain around the teeth
- Voice changes
- A lump or mass in the neck or back of the throat
- Pain in the ear
Laryngeal and hypopharyngeal cancer symptoms may include:
- Hoarseness or voice changes that last more than two weeks
- Persistent sore throat
- Pain or difficulty when swallowing
- Ear pain
- Difficulty breathing
- Lump or mass in neck (as it spread to nearby lymph nodes)
Nasopharyngeal cancer symptoms often affect only one side of the neck and may include:
- A lump or mass in the neck
- Hearing loss or ringing in the ear
- Pain or feeling of fullness in the ear
- Ear infections that keep coming back (especially without an upper respiratory infection)
- Nasal blockage or stuffiness
- Facial pain or numbness
- Trouble opening the mouth
- Blurred or double vision
- Trouble breathing or talking
Salivary gland tumors can affect several important nerves and structures in the face and neck. Salivary gland cancer symptoms may include:
- A lump or swelling in your mouth, cheek, jaw, or neck
- Pain in your mouth, cheek, jaw, ear, or neck that does not go away
- A difference between the size and/or shape of the left and right sides of your face or neck
- Numbness or weakness in part of your face
- Trouble opening your mouth widely
- Fluid draining from your ear
- Trouble swallowing
Nasal cavity and paranasal cancer symptoms often affect only one side of the face and may include:
- Nasal congestion and stuffiness that doesn’t improve or worsens
- Pain above or below the eyes
- Blockage of one side of the nose
- Post-nasal drip (nasal drainage in the back of the nose and throat)
- Pus draining from the nose
- Problems with sense of smell
- Numbness or pain in parts of the face
- Loosening or numbness of teeth
- A lump or mass on the face, roof of the mouth or inside the nose
- Constant watery eyes or bulging of one eye
- Loss or change in vision
- Ear pain or pressure, or hearing loss
- Trouble opening the mouth
- Enlarged lymph nodes in the neck (seen or felt as lumps under the skin)
Your doctor will perform a physical examination and medical history. They may refer you to a head and neck cancer specialist, such as an ear, nose and throat (ENT) doctor (otolaryngologist) or an oral and maxillofacial surgeon.
Depending on the type of cancer, you may have diagnostic tests including:
- Endoscopy: This test uses a long, thin tube inserted through the mouth into the throat to directly view the area. Various types of endoscopy examine different areas.
- Flexible laryngoscopy examines the larynx, pharynx, vocal cords and the back of the throat.
- A rigid endoscope examines the nasal passageways and allows for suctioning and manipulation.
- Magnetic resonance imaging (MRI): Using radio waves and strong magnets, MRI provides detailed images of any growths in the head or neck. MRI also can help determine if cancer has spread.
- Computed tomography (CT) scan: A CT imaging scan uses X-rays to provide information about the size, shape and location of growths. A CT scan can help determine if cancer has spread.
- Positron emission tomography (PET) scan: A PET scan uses a radioactive drug called a tracer to detect malignant disease, highlighting tissues that are metabolically active. The tracer may be injected, swallowed, or inhaled, depending on the area being examined.
- Fine needle biopsy: If the physician suspects a growth may be cancer, they may perform a biopsy. It is a procedure to remove a tissue sample from the growth for testing.
- Molecular Genomic Cancer Profiling: Genomic Cancer Profiling by the Providence Molecular Genomics Lab is available to Providence patients with advanced or aggressive malignant solid tumors, so that precision medicine can be used to personalize cancer treatments.
From the latest technology, such as transoral robotic surgery and virtual surgical planning, to immunotherapies and genomically targeted therapies and promising clinical trials, Providence leverages the full power of today’s most advanced, evidence-based therapies to treat head and neck cancer. Your personalized treatment plan will depend on the type and the stage of cancer you have. It includes your overall health and other factors.
Treatment for head and neck cancer may include any or all of the following:
Surgery removes the tumor and surrounding tissue, including diseased lymph nodes. Many types of head and neck cancer surgeries can be performed using minimally invasive surgical techniques. These include transoral robotic surgery (TORS), transoral laser microsurgery (TLM) and transnasal endoscopic surgery.
There are several types of surgery for head and neck cancer:
- Oral Cavity and Oropharynx surgical procedures include:
- Transoral robotic surgery for removal of tumors of the tonsils, base of tongue, oropharynx and supraglottic larynx
- Transoral laser surgery for precise tissue cutting
- Diagnostic endoscopy for biopsy
- Larynx surgical procedures include:
- Transoral laser microsurgery: Removes cancers of the vocal cord and surrounding tissues, with preservation of surrounding normal tissues
- Supracricoid partial laryngectomy: Open surgery with preservation of the breathing, speaking, and swallowing function of the larynx
- Partial laryngectomy: Removes part of the larynx and helps keep the ability to talk. This procedure is sometimes performed through a minimally invasive transoral approach with either robot or laser technologies
- Total laryngectomy: Removes the whole larynx and creates an opening in the front of the neck to allow the patient to breathe (tracheostomy)
- Voice rehabilitation, including tracheoesphageal voice prosthesis and electrolaryngeal voice devices.
- Nasal and Sinus surgical procedures include:
- Endoscopic approaches to the sinuses, skull base, and orbit
- Image-guided surgery
- Anterior skull base resection
- Salivary tumor surgical procedures include:
- Parotidectomy: Removal of all or part of the salivary gland on the side of the face
- Removal of submandibular gland
- Reconstruction procedures include:
- Free tissue transfer of bone or soft tissue from other sites in the body
- Local or regional flaps for aesthetic and functional reconstruction
- Immediate reconstruction and placement of dental implants (Jaw in a Day)
- Craniofacial implants and prosthetic rehabilitation
- Other head and neck surgical procedures include:
- Excision of skin cancers
- Lymph node dissections
- Glossectomy, or removal of part of the tongue.
- Treatment of osteoradionecrosis following radiation therapy
Radiation therapy uses high-energy x-rays or other types of radiation to destroy cancer cells. It can be used to shrink the tumors and keep them from growing.
We offer specialized radiation therapy technologies that are important in treating head and neck cancer:
- MR-Linac: Precision Radiation Therapy: Standard radiation cancer care treats anywhere the tumor might move to during treatment, including the surrounding healthy tissue and organs. Unlike standard radiation care, the MR-Linac allows your doctor to track and target your tumor in real time. This greatly decreases the amount of radiation to healthy tissue and organs. This means your tumor can receive a stronger cancer destroying radiation treatment with decreasing the negative side effects.
- 3-D conformal radiation therapy (3D-CRT): A procedure that creates a precise three-dimensional scan of tumors. This is used to deliver more focused and accurate high-dose radiation to the precise size, shape and depth of cancerous tumors.
- Intensity-modulated radiation therapy (IMRT): IMRT allows physicians to deliver a highly precise form of radiation therapy by simultaneously directing different intensities of radiation to the same region of the body. IMRT is important in treating head and neck cancer, as there are many critical structures in the head and neck immediately adjacent to the treatment region which must be protected from excess radiation.
Immunotherapy uses medicines that help your own immune system identify and destroy cancer cells. The immune system turns proteins on immune cells (known as checkpoints) on or off to trigger an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immunotherapy drugs called “checkpoint inhibitors” target these checkpoints to keep cancer cells from using them.
Targeted therapies destroy cancer cells or stop their growth by targeting metabolic defects in cancer cells. They are sometimes taken in pill form.
Chemotherapy uses drugs to destroy cancer cells. Chemotherapy may be used to shrink the tumors and keep them from growing, dividing, and making more cells.
It is now technically possible to characterize the biology of a patient’s cancer and immune system to provide oncologists with the data necessary to develop a personalized treatment program. This could involve combinations of immunotherapy and genomically targeted therapy, as well as next generation biotherapeutics such as CAR-T cell therapy and gene engineered cellular therapies.
Our services are provided by a cancer care team that not only understands the importance of comprehensive support, but also values each patient’s needs.
Genetics play an important role in your medical health and that of your family members, as they help you understand the influence of inherited gene changes linked to cancer. Genetic counseling and testing are available for all cancer types that may be linked to a familial pattern. Our genetic counselors combine genetic test results, personal factors, family history, and counseling to generate a personalized genetic risk assessment, They can provided estimates of future cancer risks for both individuals and family members. The process of genetic counseling creates risk estimates and improves patient and physician understanding, which leads to individualized medical management, empowered cancer prevention, and appropriate risk reduction strategies. See if genetics counseling is right for you.
Clinical trials are research studies that test the safety and effectiveness of new medical treatments. Patients who volunteer for clinical trials often gain access to the newest advancements and investigational therapies. At Providence, our physicians work closely with our world-class research team to make appropriate clinical trials a regular part of our patients’ care options.
To learn more visit the Earle A. Chiles Research Institute website.
Head and neck cancers can have ripple effects that extend beyond your physical health. At Providence, we believe in treating the whole person, not just the cancer. We believe in empowering our patients, and their families, in mind, body and spirit. We foster a partnership with you and your loved ones. We are here for you every step of your journey. Our multidisciplinary approach and commitment include a variety of helpful and supportive services to keep you and your family informed and healthy, such as these:
- Patient navigation
- Social work services
- Financial counseling
- Support groups and wellness groups
- Inpatient and outpatient rehabilitation (physical, speech and swallowing therapy)
- Integrative medicine (e.g., acupuncture, reiki, massage)
- Oncology nutrition services
- Speech and language pathology
- Oral oncology and oral medicine
- Home health care
- Palliative care
*Treatment options and services may differ based on location