Head and Neck Cancer Program

Meet Our Specialists

		Chenthilmurugan Rathnasabapathy, MD Head and Neck Oncology
		Alessandro G. Cusano, MD, DDS, FACS Head and Neck Oncology

Services We Provide

The services provided in the Head and Neck Cancer Program at the Dignity Health –  Cancer Institute at St. Joseph’s Hospital and Medical Center include diagnosis and treatment of malignant and high-risk diseases of the oral cavity, throat, salivary glands, thyroid and parathyroid, sinuses, ear and temporal bone and the eye. Head and neck cancers do not include brain or spinal cord cancers; these are separate and distinct cancers. Treatments for head and neck include surgery, radiation, chemotherapy, either as single or combination modalities, as well as symptom management and survivor services. 

Below are brief descriptions about the types of head and neck cancers treated at Dignity Health – Cancer Institute at St. Joseph’s. To schedule an appointment, please call 888.670.6341. 

• Oral Cavity Cancer
• Throat Cancer (cancer of the pharynx or larynx)
• Larynx Cancer
• Salivary Gland Cancer
• Thyroid and Parathyroid Cancer
• Sinus Cancer
• Ear and Temporal Bone Cancer

Oral Cavity Cancer

Oral cavity cancer The oral cavity includes the lips, the inside lining of the lips and cheeks (buccal mucosa), the teeth, gums (gingiva), the front two-thirds of the tongue, the floor of the mouth below the tongue, and the bony roof of the mouth (hard palate). The small area behind the wisdom teeth (retromolar trigone) can be included as a part of the oral cavity, although it is often considered part of the oropharynx. 

According to the National Cancer Institute (NCI) most oral cavity cancers begin as squamous cells (the thin, flat cells that line the lips and oral cavity) and eventually spread into deeper tissue as the cancer grows. Using tobacco products, heavy alcohol use, exposure to natural or artificial sunlight and being male increase the risk of oral cavity cancer. Signs of lip and oral cavity cancer may include a sore or lump on the lips or in the mouth. 

For more information about signs, symptoms and treatment for oral cavity cancer, visit the National Cancer Institute for more information at http://www.cancer.gov/types/head-and-neck/patient/lip-mouth-treatment-pdq.

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Throat Cancer

Throat Cancer The term “throat cancer” refers to either cancer of the pharynx (the part of the oral cavity beyond the mouth) or the larynx (voice box).

• Pharyngeal (Pharynx) Cancer
• Larynx Cancer

Pharyngeal (pharynx) cancer

The pharynx is divided into three parts:

• The nasopharynx is located behind the nasal cavity and above the soft palate.  
• The oropharynx is the part of the throat most easily seen without magnification or special instruments. It’s the part of the pharynx that connects to the esophagus (the tube that carries food to the stomach). It includes the base of the tongue (the back third of the tongue), the soft palate (the back part of the roof of the mouth), the tonsils, and the side and back wall of the throat.
• The hypopharynx is the lowest part of the throat located next to the larynx and makes swallowing easier.

The oropharynx can be particularly vulnerable to human papillomavirus (HPV) infection and can be associated with HPV-linked cancer. In fact, the Centers for Disease Control point out, 72 percent of all cancers of this part of the oral cavity are thought to be caused by HPV. The CDC estimates that more than 12,000 women and men in the U.S. are diagnosed with oropharyngeal cancer every year.

Oropharyngeal cancer is the most common pharyngeal cancer. In addition to HPV, other risk factors include a history of smoking, heavy alcohol use, and a diet low in fruits and vegetables.

Patients with HPV-associated cancer respond better to treatment compared to patients with tobacco-associated cancers of the head and neck.

These are the symptoms of oropharyngeal cancer:

• a sore throat that does not go away
• trouble swallowing
• difficulty opening the mouth fully
• difficulty moving the tongue
• weight loss for no known reason.
• ear pain.
• a lump in the back of the mouth, throat, or neck.
• a change in voice.
• coughing up blood.

 These are the symptoms of nasopharyngeal cancer:

• a lump in the nose or neck
• sore throat
• difficulty breathing or speaking
• nosebleeds
• trouble hearing
• pain or ringing in the ears
• headaches 

And these are the symptoms of hypopharyngeal cancer:

• a sore throat that does not go away
• ear pain
• a lump in the neck
• painful or difficult swallowing
• a change in the sound of your voice.

If any of these last longer than two weeks, seek a physician’s advice.

Preventing oropharyngeal cancer

Many people have heard of the HPV vaccine and mistakenly believe it only protects against cervical cancer. If administered to both males and females between the ages of 9 and 26, the HPV vaccine will guard against cervical and anal cancers and will significantly reduce the risk of other genital cancers as well as oropharyngeal cancer.

Larynx Cancer

This cancer affects the part of the throat that contains the vocal cords, which vibrate and make sound when air is directed against them. Smoking and consuming too much alcohol are the greatest risk factors for cancer of the larynx. Symptoms include a sore throat or cough that does not go away; difficulty or pain when swallowing; ear pain; a lump in the neck or throat; and a change or hoarseness in the voice.

More than 13,000 Americans are expected to be diagnosed with larynx cancer in 2015. For information about survival rates for this cancer, visit http://seer.cancer.gov/statfacts/html/laryn.html.
For more information about treatment for throat cancer, cancer.gov/types/head-and-neck/patient/oropharyngeal-treatment-pdq#link/_80_toc

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Salivary Gland Cancer

Salivary gland cancer is a rare disease in which malignant cells form in the tissues of the saliva glands. Being exposed to certain types of therapeutic radiation may increase the risk of salivary cancer. The American Cancer Society estimates that fewer than 2,300 cases per year are diagnosed in the U.S. (based on an estimate of 1 in 100,000 adults developing the disease).

Signs of salivary gland cancer include trouble swallowing or opening the mouth widely; a typically painless lump near the ear, cheek, jaw, lip or inside the mouth; numbness or weakness in the face; fluid draining from the ear; pain in the face that doesn’t go away.

For information about treatment for salivary gland cancer, visit cancer.gov/types/head-and-neck/patient/salivary-gland-treatment-pdq.

Thyroid and Parathyroid Cancers

Thyroid

The thyroid is a gland at the base of the throat near the windpipe. Shaped like a butterfly, it has a right lobe and a left lobe and a thin strip of tissue connects the two lobes. The thyroid manufactures hormones that help control weight, blood pressure, heart rate, and body temperature.

Of the four types of thyroid cancer, what’s called “papillary” is the most common type. The other three are called “follicular,” “medullary,” and “anaplastic.” Anaplastic thyroid cancer is hard to cure with current treatment. Other types of thyroid cancer can usually be cured.

According to the American Cancer Society, symptoms of thyroid cancer can include a lump in the neck that sometimes grows quickly or a swelling in the neck; pain in the front of the neck, sometimes going up to the ears; hoarseness or other voice changes that don’t go away; difficulty swallowing; difficulty breathing.

Exposure to radiation of the head and neck as a child increases the risk of thyroid cancer. Having certain genetic conditions also can increase the risk of thyroid cancer. The National Cancer Institute estimates that more than 62,000 cases of thyroid cancer will be diagnosed in the U.S. this year. For more general information about thyroid cancer, take a look at this page developed by the National Cancer Institute: cancer.gov/types/thyroid. For more information about survival rates, review this page developed by the National Cancer Institute: http://seer.cancer.gov/statfacts/html/thyro.html.

Parathyroid

There are four parathyroid glands, organs the size of a pea found in the neck near the thyroid gland. These glands produce parathyroid hormone to help the body keep calcium in the blood at normal levels.

Symptoms of parathyroid cancer, which is extremely rare, include feeling very tired; nausea and vomiting; weakness; loss of appetite; weight loss that’s not intended; excessive thirst; frequent urination; constipation; difficulty thinking clearly.

For information about parathyroid cancer treatment, visit cancer.gov/types/parathyroid/patient/parathyroid-treatment-pdq.

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Sinus Cancer

This is a very rare cancer, estimated to affect only about 2,000 Americans each year. For more information, visit this page created by the National Cancer Institute: cancer.gov/types/head-and-neck/hp/paranasal-sinus-treatment-pdq.

Ear and Temporal Bone Cancer

The temporal bone is more commonly known as the ear canal. Because of sun exposure, cancer of the outer ear is not uncommon, but cancer of the ear canal is very rare. Ear canal cancer, when it does occur, usually is either basal cell carcinoma or squamous cell carcinoma. This cancer, because of its location and proximity to adjacent areas like the parotid gland (saliva gland anterior to the ear canal), the neck (inferior to the ear canal), the middle ear (deep/medial to the ear canal) or the mastoid (posterior to the ear canal), can spread quickly. Treatment, therefore, is needed right away.

If you have lingering pain in the ear canal, occasional bleeding, a discharge, sudden hearing loss, dizziness or facial paralysis, consult a dermatologist or your primary care provider right away.

For more information about head and neck cancer, visit this page put together by the National Cancer Institute: cancer.gov/types/head-and-neck.

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Treatment you may receive

There are three ways to treat head and neck cancers: surgery, radiation, and medications (chemotherapy). Your oncologist at the Dignity Health – Cancer Institute at St. Joseph’s will help you understand which treatment is most appropriate for you.

Questions to ask your oncologist

1. What is my diagnosis and prognosis?
2. What is your experience in treating the cancer I have?
3. How will you determine the best treatment for me?
4. How long does each treatment option typically last, both individually and as a series of treatments?
5. How will you know if the treatment is making progress?

For more information about various types of cancer, cancer staging and treatment options, click on this link from the National Comprehensive Cancer Network (NCCN): NCCN Guidelines for Patients® - nccn.org/patients/default.aspx.

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For more information about scheduling an appointment at the Dignity Health – Cancer Institute at St. Joseph’s, please call 888.670.6341.