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Akina Tamaki, MD Although standard treatment modalities for head and neck cancers—namely surgery, radiation, and chemotherapy—remained largely effective and unchanged, their application can vary across distinct subtypes according to distinct tumor characteristics and patient factors, according to Akina Tamaki, MD. “There are also new chemotherapies, immunotherapies, and systemic therapies, that are coming down the pipeline,” said Tamaki during an interview with OncLive ® for National Oral, Head, and Neck Cancer Awareness Month, observed annually in April. “That's probably where we're going to see the most change in the next 10 to 20 years.
[Head and neck cancer] is an exceptional field with many exciting things going on.” In the interview, Tamaki highlighted differences in the presentation and management of various head and neck cancer subtypes, surgical advances that have improved patient care, and the importance of multidisciplinary approaches for preserving patients’ functional abilities during aggressive treatment. Tamaki is an associate professor in the Department of Otolaryngology-Head and Neck Surgery at the Lewis Katz School of Medicine at Temple University and Fox Chase Cancer Center in Philadelphia, Pennsylvania.
Tamaki: Head and neck cancer is stated to be about the 8th most common cancer in the United States. It's not one of those top 3 that we always hear about, like lung, colorectal, and breast cancers. Of course, those are incredibly important, but I think there is a lack of knowledge and awareness of the prevalence of these cancers.
There are also very well-known risk factors like smoking and alcohol use but also factors that are probably much less known to the average population. Like all cancers, catching these cancers early is extremely important. It is directly related to the overall survival of these patients.
The more awareness [that is spread to] patients and providers, the earlier we will catch these cancers. In general, when they're caught early, many of these cancers are very treatable. The type of head and neck cancers that we traditionally think of are more of the mucosal cancers.
The most common sites where patients might develop mucosal cancers are in the oral cavity, larynx, and hypopharynx, which includes the back part of the larynx and nasal cavity. All those sites are part of the realm [of head and neck cancers]. As head and neck surgeons, we do see tumors that aren't traditionally considered classical head and neck cancers, including endocrine cancer.
These could include a lot of thyroid parathyroid carcinomas, which are less common, but then also a tremendous amount of skin and cutaneous cancers that occur in the head and neck region. [The SOC treatment approach] varies based on the histology and pathology [of the disease subtype]. In general, I tell my patients that there are 3 main ways that we typically manage their cancer: surgery, radiation, chemotherapy, or any combination of those 3 things.
It depends on the site and the histopathology that we're considering, but those are generally the treatments that we would recommend as a starting point. Regarding surgery, the things we offered in the 1980s and 1990s were quite morbid. Whenever somebody came in with a very large tongue cancer or throat cancer, the mainstay of treatment at the time was essentially to take out as much as we could and try to get negative margins on that cancer.
That paradigm still exists today, but we are less aggressive at certain things. Additionally, there are better ways to access tumors in difficult-to-approach places. For instance, there is a technology called transoral robotic surgery for cancers in the tonsils, base of the tongue, and oropharynx cancers.
This technique has changed the whole way that head and neck cancer care is delivered for that patient population. We can do a lot of things endoscopically now; [for example,] we can use scopes rather than making large incisions on the face. Outside of surgery, there's been a ton of development in the radiation realm.
There are many better ways to deliver radiation, which is much more focal, so there's significantly less toxicity associated with it. In the chemotherapy world, there are the same types of developments. Certain viral entities may be related to certain types of cancers, such as oropharynx cancers, which are certainly on the rise.
There are human papillomavirus [HPV]-related cancers that are specifically related to oropharynx cancers. People may have heard about its association with cervical cancer in women; the same subtypes seem to be linked to oropharynx cancer, and they tend to happen more in men in their 40s and 50s. We treat them differently because of the etiology of those types of cancers.
Considering mutations that [may be present in] certain cancers is an exciting development that we're looking at in the chemotherapy world. There's a lot of new research on different types of targeted therapies that are [expanding] treatment options for people with certain mutations in their cancer that they may personalize in terms of being candidates for those types of chemotherapy. [The management of HPV-related head and neck cancers] has probably undergone the most development in our head and neck surgery and cancer world in the past 15 to 20 years or so.
It was [historically] not an entity that was widely known and not widely tested for, even as early as 20 years ago. Nowadays, when people come in with cancers in a certain area, like the tonsil in the back of the tongue, we routinely test to see whether it's associated with this virus. Generally, those patients tend to do very well in terms of overall prognosis.
There are different ongoing trials [evaluating the feasibility of] de-escalating treatment, [which involve] giving a patient less treatment than we would for a non-HPV–related cancer. We know that people do so well on the treatment, which still includes surgery, radiation, and chemotherapy. Therefore, the SOC hasn't changed dramatically in terms of the arsenal that we have to treat these cancers.
However, we approach them as a completely different disease entity whenever we see them. Head and neck cancers are likely one of the most consequential areas of the body to treat. There are so many aspects intimately involved in care when people are diagnosed with any type of head and neck cancer, such as the ability to eat, speak, talk, and express themselves in terms of facial movements.
As surgeons and oncologists, we try to preserve those areas as much as possible. Whenever patients go to a cancer treatment center, or wherever they may be going for cancer treatment, a multidisciplinary approach in terms of seeing surgeons, radiation oncologists, medical oncologists, speech therapists, physical therapists, and occupational therapists, is so important. This harps on the importance of going to a center that can provide this type of multidisciplinary care whenever somebody is diagnosed with one of these types of head and neck cancers.
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