Our Program

Head-and-Neck-Cancer-rev

The head and neck cancer team at Keck Medicine of USC in Los Angeles builds strong relationships with patients to meet both the physical and emotional demands of fighting head and neck cancers. We work with our patients every step of the way – from diagnosis to rehabilitation – in treating tumors of the mouth, nose, throat, larynx, sinuses, lymph nodes and salivary glands. Our surgeons are also leading experts in parathyroid and thyroid surgery, and we are able to offer the finest diagnostic tools and endoscopic and open surgery removal techniques.

The team, which includes head and neck surgeons, medical oncologists, radiologists and radiation oncologists, is involved through the entire cycle of care from pre-surgery to rehabilitation and can offer patients the full range of options from robotic surgery, open surgery with reconstruction and chemo-radiation.

The team also works very closely with speech and language pathologists who are essential to the patient’s post-surgery rehabilitation. Our therapists and pathologists help patients regain muscle strength and coordination, powers of speech and other functional necessities like swallowing.

 Our Approach

We offer a comprehensive, multidisciplinary approach to treating head and neck cancer. Understanding that no two cancers are alike, we are committed to developing a unique treatment plan based on an individual patient’s specific need. We collaborate closely with our patients by discussing all options, including non-surgical alternatives, and then tailor treatment plans to maximize both clinical outcomes and quality of life.

Keck Medical Center was the first center on the west coast to offer Transoral Robotic Surgery (TORS) following U.S. Food and Drug Administration approval in 2009. We offer this minimally invasive surgery, in which complicated procedures can be performed through the mouth with greater precision, dexterity and control and at a higher level of expertise than other centers in the area.

Unique to Keck Medicine of USC is our strong focus on rehabilitation after treatment or surgery where we help our patients heal physically. We are the only center in the country that gives patients the ability to do swallow therapy exercises in the comfort of their own home for the treatment of esophageal strictures following radiation. We also offer unique rehabilitation therapy to restore the voices of laryngectomy patients (those who have had their voice boxes removed). Laryngectomy patients are presented with a variety of new communication options including a voice prosthesis or electrolarynx, and taught to use them.

Just as important as physical healing, we address the psychological healing that needs to take place. Our Patient Survivorship Program is a support group actively involved in patient education and promoting awareness about head and neck cancer. The group meets once a month and provides an outlet for patients to share their stories while receiving mentorship and encouragement from their physicians and fellow survivors. We also offer a support group the second Saturday of every month for head and neck cancer patients who have undergone a laryngectomy.

Conditions

Head and neck cancer accounts for 3 percent of all malignancies in the United States. Ninety percent of head and neck cancers are squamous cell carcinomas. Head and neck squamous cell carcinoma develops in the mucous membranes of the mouth, nose and throat.

Head and neck cancers include cancer of the mouth, nose, throat, larynx, sinuses, lymph nodes and salivary glands.

Risk of oral cancer is linked to smoking and tobacco use, heavy alcohol use, chronic irritation, human papillomavirus, immunosuppressants, and poor dental and oral hygiene. Symptoms may include a lump or ulcer in the mouth, problems chewing, mouth sores or difficulty swallowing.

Smoking and drinking alcohol also increase the risk of developing throat and larynx cancer. Symptoms may include coughing, coughing up blood, difficulty swallowing, long term hoarseness, long term sore throat, and lumps or swelling in the neck.

The most common type of salivary gland tumor is noncancerous, but some salivary gland tumors may be cancerous. Symptoms of a tumor may include firm swelling in one of the salivary glands (in front of the ears, under the chin or on the floor of the mouth, and difficulty moving one side of the face).

Types of head and neck cancer include:

  • Hypopharyngeal cancer
  • Laryngeal cancer
  • Lip and oral cavity cancer
  • Nasopharyngeal cancer
  • Oropharyngeal cancer
  • Paranasal sinus and nasal cavity cancer
  • Salivary gland cancer
  • Squamous cell neck cancer
  • Soft tissue sarcoma
  • Thyroid cancer

Our surgeons also treat benign parathyroid tumors and hyperparathyroidism.

Treatments

We make it a top priority to build strong relationships with our patients to meet both the physical and emotional demands of cancer. Through a multidisciplinary approach, we’re there for our patients every step of the way – from diagnosis to rehabilitation. Your team of physicians meets regularly to discuss your diagnosis and treatment options.

Treatment may include surgery, radiation therapy, chemotherapy or a combination of treatments.

Surgery is customized to the size and site of the tumor with the goal of controlling the tumor locally and preventing it from spreading. Surgery involves removing the tumor and possibly the lymph nodes. If cancer begins to spread, often it will spread first to the nearest lymph nodes. Removal of lymph nodes may help prevent the tumor from spreading. Your surgeon will discuss the type of surgery and the risks and benefits of surgery.

Patients with large tumors or whose tumor has spread at time of diagnosis will require a combined treatment approach including surgery, radiation therapy and chemotherapy.

Types of surgery include transoral endoscopic surgery, neck dissection and transoral robotic surgery.

A laryngectomy is a procedure performed in certain hypopharyngeal and laryngeal cancer cases. The larynx (commonly referred to as the “voice box”) is surgically removed. The head and neck surgeon reconstructs a new opening in the neck for breathing called a “stoma.”

Keck Medicine of USC is the only medical center in Southern California that offers a comprehensive laryngectomy program, which encompasses pre-treatment counseling, psychosocial evaluation, surgery (robotic and non-robotic), chemotherapy and speech and swallowing rehabilitation. Our mission is total rehabilitation bringing the patient to as close to their pre-treatment functional level as possible. An experienced interdisciplinary team of health professionals works together to optimize the patient’s function and provide ways to enhance the patient’s quality of life.

In our pursuit of advancing cancer surgery, we became the first academic medical center on the west coast to offer Transoral Robotic Surgery (TORS) following U.S. Food and Drug Administration approval, which allows for a minimally invasive approach that gives the surgeon enhanced dexterity and greater precision in tumor removal. This results in reduced pain and discomfort, reduced risk of infection and minimal scarring.

TORS is most commonly used for patients with tumors at the base of the tongue or throat. The traditional surgery for cancer of this nature requires a large incision and has significant drawbacks, including a long recovery and risk of infection. TORS allows our physicians to perform delicate, complex procedures through the mouth. With the help of the daVinci® robot, physicians have 3-D imaging of the tumor and two-handed, wristed dexterity allowing them to easily maneuver within the contours of the mouth and throat. Usually chemotherapy can be avoided and lower doses of radiation are needed, which leads to shorter recovery times and improved functional outcomes, particularly the ability to swallow, post-treatment.

Very often our patients are able to avoid reconstructive surgery altogether.

Following removal of the tumor, your surgeon will reconstruct the area to provide the best function as well as cosmetic look. Even patients who undergo robotic surgery may need reconstructive surgery. The surgeon may reconstruct the area, if necessary, with tissue from another area of your body. The tissue, referred to as a flap, can be rotational or free. Rotational flaps are moved to the reconstruction area without disconnecting the tissue from the vessels. Free flaps are taken from another area of the body.

Our surgeons were among the first in the region to implement a reconstructive technique, the supraclavicular artery flap that requires less time in surgery and provides the patient with improved aesthetic and functional results.

Our surgeons expertly perform complex microvascular reconstructive surgery. Using this technique, they can rebuild tongues and jaws by transferring tissue from another part of the body and meticulously connecting tiny blood vessels in the neck using a microscope and sutures as fine as human hair. The result is not only a better cosmetic outcome, but also improved speech, swallowing and breathing.

Most importantly, microvascular techniques have allowed surgeons to operate on many patients who might have been considered inoperable in the past because they didn’t have the ability to reconstruct certain parts of the head, such as the throat, which patients need to survive.

Radiation therapy is the treatment of disease using penetrating beams of high-energy waves of particles called radiation. The radiation is given at high doses to treat cancer and other illnesses. Radiation in high doses kills cells or keeps them from growing and dividing. Radiation may sometimes be used before surgery to shrink a tumor to perform less invasive surgery.

Patient Information

Head and Neck Cancer FAQs

How do I prepare for surgery?
Alcohol and smoking cessation is the most important thing that the patient can do. This will help healing and overall outcome.

Before surgery, the anesthesiologist will check your blood, chest X-ray and EKG to make sure you are healthy enough for surgery.

What about pain?
Pain is often a concern of many patients. Head and neck tumors can cause severe physical pain, and many patients are relieved of that pain with surgery. Surgical pain in the immediate postoperative period is to be expected, but is thought by most to be milder than the previous tumor pain. Every effort will be made by your head and neck team to control your pain during the entire treatment process.

What is a flap?
Along with removal of the tumor, your surgeon will reconstruct the area to provide the best functional and cosmetic result possible. To reconstruct the area, your surgeon may plan to use tissue from other parts of your body. The tissue from the other part of your body is then called a flap. The tissue flap can consist of skin, muscle and/or bone. The flap can come from your chest, back, abdomen, arm or leg. It is either moved to the reconstruction area without disconnecting it from the vessels (rotational flap) or by disconnecting from its original site (free flap).

What about the cosmetic result?
Cosmetic result is important to your surgeons who will try to hide all incision lines in creases and wrinkle lines. One of the goals of reconstruction will be aimed at achieving a good cosmetic result.

Will I still be able to eat and talk?
The other goal of reconstruction is good function, such as chewing, swallowing and speaking to maintain a good quality of life during and after treatment. After surgery, a speech pathologist will help you regain speech and swallowing skills.

Laryngectomy FAQs

What happens to my breathing after surgery?
The new opening in the neck, called the “stoma” becomes the “new nose.”

How do I care for my stoma (hole/opening in the neck)?
The stoma should be cared for daily. Your healthcare team will train you in how to keep the area clean and what types of devices help with humidification and moisture to that area. You will be given a special tube called a LaryTube following surgery that helps with the protection of the stoma and assists with keeping the stoma area open.

What happens to my ability to speak/have voice?
When the larynx (voice box) is removed, you will no longer use your vocal cords to speak. You can learn other ways to verbally communicate.

Is there anything to help me speak again?

There are currently 3 options for voice restoration (verbal communication):
Non-surgical options

  1. Artificial larynx or electrolarynx – a battery-operated device that uses a vibrating drum. The sound can be generated by using a neck placement or an intraoral placement.
  2. Esophageal speech – this speech utilizes production of sound by trapping air in the esophagus and releasing it back in the mouth, similar to “burping.” This method does not require any equipment but is often more difficult to acquire.
  3. Surgical options
    Tracheoesophageal Puncture (TEP) – during this procedure, the head and neck surgeon creates an opening from the back wall of the trachea through the front wall of the esophagus. The voice prosthesis is made out of medical silicone and is placed in this opening. This is a more natural method of producing sound/voice.

Will I need radiation and/or chemotherapy?
If radiation/chemotherapy were given prior to surgery, then usually it will not be given again. The options of surgery and the need for radiation therapy and/or chemotherapy will be based on the stage of the disease. This decision will be made in discussion with your surgeon. The goal of treatment will always be to maximize the quality of life.

When can I start eating again?
For the first one to two weeks after your surgery, you will use a feeding tube for all nutrition and hydration needs. Following that time period, you will be evaluated for appropriateness to advance to an oral diet usually beginning with liquids. Most patients, following a total laryngectomy, are able to eat most foods without much difficulty.

What happens if I have some difficulty with swallowing?
You will be evaluated to determine the reason behind your difficulty with swallowing. Most of the time, this evaluation is done via a radiographic swallowing study called a modified barium swallow. You will be referred for dysphagia treatment (swallowing treatment) this should also be bold to allow the patient to click for a description of swallowing treatment) or other options may be recommended.

After surgery, when can I take a shower?
Usually you will be cleared to shower one week following your surgery. You should prevent water and soap from entering your stoma. You may use a shower cover or shower collar to protect this area or you may also use a damp but dry cloth. There are various options. Ask your surgeon which may be best for you.

When can I start shaving?
You can usually start shaving 2 weeks after surgery. You should be careful with any sprays or cream getting in the stoma because this is irritating to the airway. The neck will be numb after surgery, so you need to take extra care when shaving.

When can I spend time outdoors – in the sun?
Always use sunscreen on the incisions and clothing that protects your skin. Wear a hat and protect your stoma against outdoor irritants by using a stoma cover, or heat and moisture exchanger (HME), a device, which facilitates improved breathing function due to improved humidification and moisture as well as reduced mucus and coughing.

Am I allowed to go swimming or take a bath?
No. Not without special devices that are rarely used.

When should I follow-up with my doctor after surgery?
One week after you are discharged from the hospital.

Common supplies used following surgery:

Medical Bracelet-This can be ordered through several companies. It should be worn around the wrist. The words NECK BREATHER inform people that you do not breathe through the nose.

LaryTube– A LaryTube is a flexible yet rigid tube that helps with protection of the stoma and assists with keeping it open. You will be fitted with a LaryTube following your surgery. You will usually use this tube with the use of a HME (see description below). Please direct any questions regarding use and care of your tube to your surgeon and speech-language pathologist.

Heat and Moisture Exchanger (HME)-A HME comes in the form of a cassette that fits over an adhesive baseplate or LaryTube which facilitates improved breathing function resulting in improved humidification and moisture as well as reduced mucus and coughing which improves speech and hygiene.

Baseplate/Adhesive housing-This adhesive comes in a variety of shapes and sizes and provides the housing to hold the HME cassette in place.

Stoma covers-There are a variety of “covers” for the stoma ranging from cloth, knitted material to foam. Discuss your options with your physician and speech-language pathologist.

Shower covers-There are a variety of ways to cover your stoma when you take a shower. Discuss your options with your physician and speech-language pathologist.

Voice prosthesis FAQs

What should I do if I am unable to talk?
First, clean your voice prosthesis with the brush and flush (specially designed devices used to clean the voice prosthesis). If you have just finished eating/drinking, you may find it more difficult to talk or you may find that your voice sounds “gurgly.” If you continue to have difficulty with talking or find that you require increased effort to talk, please contact your physician’s office.

What should I do if I am “leaking” through and/or around my voice prosthesis?
First, clean your voice prosthesis with the brush and flush to see if that stops the leakage. If the leakage continues, use the plug (a specially designed device to allow temporary blockage of fluids) while you are eating/drinking if you are leaking through the center of your voice prosthesis. You will be unable to talk with the plug in. Contact your physician’s office and obtain an appointment as soon as possible for replacement of the voice prosthesis. You may also try drinking thicker liquids during this time to prevent leakage through the center of the prosthesis.

What should I do if my voice prosthesis comes out?
Don’t panic! Take your red rubber catheter and place it in the opening. Take the end of the catheter and fold it over. Use a rubber band or tape to keep it together. Contact your physician’s office. It is important that you place the catheter in the opening (TEP) to prevent the opening from closing.

What should I do if I am unable to eat?
Contact your physician’s office immediately.

What should I do if I am having difficulty cleaning my voice prosthesis?
Contact your physician’s office so that the voice prosthesis and stoma may be evaluated.

I will be traveling out of town, what do I do if I have problems with my voice prosthesis?
It is recommended that you always have an extra voice prosthesis with you when you travel. If you are planning to travel, let your physician and speech-language pathologist know ahead of time so they can recommend a facility that can assist you when you are away.

Common supplies used for voice prosthesis:

Brush-A specially designed brush is used to clean and care for the voice prosthesis. This is done on a daily basis usually 2-3 times per day.

Flush-A specially designed device that is used to “flush” any particles that remain on the voice prosthesis to clean the voice prosthesis following meals. This is used regularly after meals.

Plug-for the prosthesis-This specially designed “plug” is placed in the middle opening of the voice prosthesis to allow temporary blockage of fluids leaking through the prosthesis. An appointment with the physician and speech-language pathologist should be made as soon as consistent (e.g.,happening during every meal) leaking is observed through the opening(center) of the voice prosthesis.

How do I obtain more supplies:

All additional supplies need to be ordered by the patient. The insurance may cover some items. Please check with your insurance regarding DME (Durable Medical Equipment) and what is covered for your specific plan. Most items require a physician’s prescription prior to ordering. Discuss the prescriptions with your surgeon and speech-language pathologist.

Resources

American Cancer Society
www.cancer.org

National Cancer Institute
www.cancer.gov

Support Groups
HNC Support International
www.hncsupport.org
First Saturday of every month
10 a.m. to 12 p.m.

1450 San Pablo St., Suite 5100
Los Angeles, CA 90033

Laryngectomy Support Program
The Laryngectomy Support Program at USC provides patients and their families an opportunity to receive support and information. The program meets the 2nd Saturday of every month in the lobby of the Otolaryngology Department). For more information regarding our program, please contact 323.442.7432.

Keck Hospital of USC
1500 San Pablo St., Silver Room
Los Angeles, CA 90033

Our Physicians

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Keck Hospital of USC
Keck Medicine of USC - Downtown Los Angeles
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Keck Hospital of USC
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USC Norris Comprehensive Cancer Center and Hospital
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Children's Hospital Los Angeles
Keck Hospital of USC
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Keck Hospital of USC
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USC Outpatient Surgery Center
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