New Options for Head and Neck Cancers
By Tara Hulen
It’s the first question a cancer patient wants to ask after surgery: “Did you get it all?” Unfortunately, physicians usually can’t be absolutely certain, especially in the case of head and neck cancer, when removing even an extra fraction of an inch of healthy tissue can instantly take away a patient’s ability to speak and eat normally. Head and neck cancers can appear in the mouth, nose, sinuses, salivary glands, throat, and larynx, and in the lymph nodes in the neck. Most can be cured if caught early, but advanced cases often require complex treatment with the possibility of lasting side effects.
That is changing. Improved minimally invasive surgical techniques, targeted therapy that zeroes in on tumors, and a method to literally light up cancer cells are extending the prospect of easier, more successful treatments for head and neck cancers.
Doing More with Less
Minimally invasive surgical approaches for head and neck cancers aren’t new, says UAB Comprehensive Cancer Center otolaryngology surgeon and researcher William Carroll, M.D. For example, endoscopic surgery via the nose, mouth, or ear has been used for decades to remove early-stage head and neck tumors.
“What’s really changed is that larger and more involved tumors in the head and neck are now being treated by these approaches as well,” Carroll says. “We’re learning to get to places and take things out without destroying or damaging normal structures. The patients’ recovery time is faster, and the time it takes to begin swallowing and talking again, rejoining their families, and going back to work is all potentially improved by less-invasive approaches.”
Stay on Target
Another intriguing development in head and neck cancer treatment is targeted therapy, says otolaryngology surgeon and researcher Eben Rosenthal, M.D. Using advanced imaging techniques, physicians can precisely identify the location of tumors, then target treatment to those areas alone. One type of targeted therapy employs lab-created molecules known as monoclonal antibodies to seek out and latch onto specific types of cancer cells. Among other properties, monoclonal antibodies can boost the effectiveness of radiation and chemotherapy. Rosenthal and other researchers at UAB are testing a novel technique: pairing a fluorescent agent with a monoclonal antibody to essentially paint a glowing bullseye on head and neck cancer cells. When the cells are viewed through advanced optical imaging equipment during surgery, physicians can easily distinguish tumor cells from normal tissue.
Although human trials are five to 10 years away, the potential benefits are exciting. The new fluorescent technique “will improve our ability to take out the cancer, minimize normal tissue damage, determine margins, and establish if lymph nodes have cancer in them,” says Rosenthal, who believes that FDA approval is bound to follow successful trials. And when that happens, he says, “UAB will probably be one of the first places in the country that does anything like this for head and neck cancer.”