Head and neck cancer

Treatment

Today, people facing head and neck cancers have more options for treatment than ever before, and many can be cured.

Fred Hutchinson Cancer Center offers comprehensive care for head and neck cancers, including advanced treatments — like transoral robot-assisted surgery, proton therapy, fast neutron therapy and targeted immunotherapy — as well as new options available only through clinical studies open at Fred Hutch. 

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies.

At our Head and Neck Multidisciplinary Care Clinic, all of the specialists who will be involved in your care will meet to design treatment tailored to you. You will receive an individualized, multidisciplinary treatment plan from an integrated team of experts. Throughout your treatment, our head and neck specialists meet at least weekly to ensure each patient receives the best possible care.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Head and neck cancer expertise at Fred Hutch

Everything you need is here

Fred Hutch head and neck surgeons, reconstructive surgeons, radiation oncologists, oral surgeons, medical oncologists, neuroradiologists and pathologists are nationally and internationally known experts in head and neck cancers. Together, they offer the most advanced diagnosis and treatment. Research shows that survival rates are better for patients treated at high-volume centers, like ours, with recognized head and neck cancer expertise.

Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation oncologist A physician who has special training in using radiation to treat cancer.
Head and neck cancer treatment tailored to you

Your Fred Hutch doctors will explain all your options in clear terms and recommend an individualized treatment plan to get you the best results based on the type, stage, location and size of your cancer. We view treatment as a collaborative effort, and we empower you to participate in decisions about your care in a supportive environment as part of the healing process.

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Innovative head and neck cancer therapies

Fred Hutch patients have access to advanced therapies being explored in clinical studies for head and neck cancers conducted here and at UW Medicine. Because our doctors conduct leading-edge research as well as treat patients, you can be sure you will be offered the most promising new treatments available.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease.
Team-based approach

Your personal team includes more than your head and neck cancer doctors. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like specially trained and certified dentists, speech and swallowing pathologists, dietitians, physical therapists, occupational therapists or social workers. 

Learn More About Fred Hutch Specialty Services

Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope.
Ongoing care and support

During and after treatment, your team continues to provide follow-up care on a schedule tailored to you. The Fred Hutch Survivorship Clinic is also here to help you live your healthiest life as a cancer survivor.

Learn More About Fred Hutch Survivorship Clinic

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at SCCA. 

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Chemotherapy

Your doctors may recommend chemotherapy in combination with radiation therapy if your cancer has spread to nearby tissues or lymph nodes. This may be your main treatment or you might have chemo and radiation after surgery.

Usually chemotherapy medicines are given by infusion into a vein. Some are taken by mouth in pill form. 

Your Fred Hutch team will talk with you about the specific drugs we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout Fred Hutch.

You may have the option of receiving the standard chemotherapy medicines for your disease or participating in a clinical study that explores an innovative approach. Fred Hutch researchers are studying new combinations of chemotherapy medicines to determine which are most effective.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Infusion An injection of medications or fluids into a vein over a period of time. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body.
Chemotherapy

Your doctors may recommend chemotherapy in combination with radiation therapy if your cancer has spread to nearby tissues or lymph nodes. This may be your main treatment or you might have chemo and radiation after surgery.

Proton therapy

Protons can be controlled with greater precision than X-rays. This means that more energy goes into destroying the tumor and less radiation is delivered to surrounding healthy tissue. For this reason, proton therapy is particularly good for treating tumors near healthy organs, including head and neck tumors.

More than 60,000 Americans are diagnosed annually with head and neck cancer. When treating head and neck tumors it’s critical to protect the delicate organs that surround the tumor. Proton therapy can potentially reduce damage to eyes, optic nerves, salivary glands, and other organs near head and neck tumors, thereby reducing the likelihood of side effects such as blindness, hearing deterioration, and dry mouth. Secondary malignancies are also less likely with proton therapy.

Tobacco (including smokeless tobacco) and alcohol use are the most important risk factors for head and neck cancers. People who use both tobacco and alcohol are at greater risk for developing these cancers than people who use either tobacco or alcohol alone. Over the past decade, an increasing number of young, non- smokers have developed mouth and throat cancer associated with the human papilloma virus, or HPV.

Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
Tumors

The right-hand images above show proton beam treatment for head-and-neck cancer. The left-hand images shows typical treatment with conventional radiation, in this case VMAT.

Base-of-skull tumors

Base-of-skull tumors include chordomas and chondrosarcomas. Tumors in the base-of-skull region are difficult to treat because they are often close to critical structures such as the brainstem, brain, cranial nerves, and optic nerves. The location of these tumors often makes surgical removal difficult and limits the dose of radiation that can be delivered with standard X-ray radiation treatments. Proton therapy can be particularly appropriate for these tumors because it minimizes radiation exposure to surrounding healthy tissue. Since these tumors are found at a shallow depth, proton therapy is often able to deliver a high dose of radiation precisely to the tumor without affecting tissues of the brain and spinal cord. The more radiation delivered to the tumor the greater the chance of completely destroying it.

top of skull
base of skull

The greater precision of proton therapy (left, above) spares healthy organs, allowing a higher dose of radiation to be delivered to base-of-skull tumors. The higher the dose, the better tumor can be controlled.

Head and neck tract tumors most appropriate for proton therapy

  • Base of skull tumors (including, but not limited to, anterior, middle, and posterior cranial fossa, sphenoid and temporal bone-related tumors)
  • Sino – Nasal cancers (paranasal sinuses and nasal cavity)
  • Cancers located near the orbits/eyes
  • Nasopharynx cancers
  • Small/early oropharyngeal cancers (tonsils, tongue base)
  • Select salivary gland tumors (parotid, sub-mandibular and minor salivary glands of the upper aero-digestive tract) 
  • Complex skin cancers involving cranial nerves and/or lymph nodes of the neck (with a lateralized primary
  • Select patients who have received previous radiation
  • Unknown primary cancers (after a thorough surgical work up)

Three-field head and neck treatment technique

Our medical physics and dosimetry teams worked with our radiation oncologists to develop a 3-field treatment technique using pencil beam scanning. This new technique enables us to treat complicated head and neck cancers with multiple dose levels and bi-lateral neck involvement. 

Radiation oncologist A physician who has special training in using radiation to treat cancer.
Proton therapy

Protons can be controlled with greater precision than X-rays. This means that more energy goes into destroying the tumor and less radiation is delivered to surrounding healthy tissue. For this reason, proton therapy is particularly good for treating tumors near healthy organs, including head and neck tumors.

Radiation therapy

Most people with head and neck cancers receive radiation therapy, either on its own or in combination with surgery or chemotherapy.

  • Radiation therapy (also called radiotherapy) uses high-energy radiation in the form of photons (such as X-rays) or subatomic particles (such as electrons, protons or neutrons) to damage the DNA inside your cancer cells. 
  • When the DNA sustains enough damage, the cells cannot multiply, and they die. 
  • The goal of radiation therapy is to destroy as many cancer cells as possible with the least amount of damage to healthy cells.

As an SCCA patient, you will be cared for by radiation oncologists with specialized experience in treating head and neck cancers using state-of-the-art technology. Over the last decade there have been tremendous technical advances in head and neck radiotherapy, and clinical studies are testing newer strategies. 

Depending on the specifics of your cancer, your team may recommend one of several types of radiation therapy.

Intensity-Modulated Radiation Therapy (IMRT)

IMRT is designed so that the beam of X-ray radiation aimed at your tumor conforms closely to the tumor’s size, shape and contours. The beam can be split into smaller beamlets of different strengths to deliver a higher dose of radiation to the tumor and lower doses to nearby healthy tissue. By combining IMRT with image-guided radiation therapy (IGRT), we can deliver very precise radiation therapy to your cancer while sparing normal structures.

Adaptive radiation therapy

Adaptive radiation therapy is the process of varying the radiation plan according to changes in tumor dimensions during treatment. The goal is to cure the cancer while minimizing side effects.

Proton therapy

Proton therapy is an advanced therapy and an important alternative to standard X-ray radiation for many types of cancer (and some noncancerous tumors). 

Head and neck cancers are frequently located close to critical structures, such as your optic nerves, eyes, brain stem and spinal cord. The advantage of using protons to treat these cancers is that doctors can target high doses of radiation at the cancer while sparing the sensitive structures nearby. This may reduce side effects. Our Proton Therapy facility is the first and only facility in the Northwest to offer this treatment. 

Fast neutron therapy

Neutron therapy has been shown to be very effective against cancers that are resistant to standard X-ray radiation, such as salivary gland tumors. There are two advantages to using neutrons instead of photons or protons. 

  • Neutron beams are much more powerful. They deposit about 20 to 100 times as much energy into the target tissue. 
  • Neutron beams are more likely to damage both strands of a cancer cell’s DNA, rather than only one strand, making it harder for the cells to repair themselves and survive. 

UWMC is the only place in the United States to offer neutron therapy, and doctors here are internationally recognized for their neutron therapy expertise. In addition to salivary gland cancer, we sometimes use neutron therapy to treat cancers that are resistant to conventional radiation therapy, such as sarcoma, melanoma and thyroid or other cancer, especially when surgery is not an option. Read more about fast neutron therapy on the UW Medicine website.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines. Radiation oncologist A physician who has special training in using radiation to treat cancer. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
Radiation therapy

Most people with head and neck cancers receive radiation therapy, either on its own or in combination with surgery or chemotherapy.

Surgery

Surgery is an important treatment for most head and neck cancers. We use the latest techniques to remove your tumors and restore your appearance and function.

Surgeons at the Otolaryngology–Head and Neck Surgery Center at University of Washington Medical Center (UWMC) treat Fred Hutch patients. They are national leaders in head and neck cancer surgery, performing a high volume of complex procedures every year. 

Depending on the specific features of your cancer, you might have:

  • Minimally invasive surgery
  • Traditional open surgery
  • Reconstructive surgery

Minimally invasive head and neck surgery

Minimally invasive procedures are usually used for upper-airway tumors. These procedures are done through your mouth or nose so you don’t need incisions in your face or neck. Whenever possible, our surgeons opt for this method. Patients typically return home in only a day or two.

Your surgeon may use a variety of tools and technologies to assist with your surgery. For example, they may use a thin tube with a light and a lens (endoscope) to reach a tumor through your mouth and remove it with a laser (transoral laser microsurgery). 

The newest technique for tumors at the back of the tongue or in the throat is transoral robot-assisted surgery (TORS), also called transoral robotic surgery. 

  • Removing these tumors used to require a large incision in the neck and lower jaw, and many patients had trouble swallowing or speaking afterward. 
  • Now, using the da Vinci Surgical System, or da Vinci robot, we can remove tumors in this area through your mouth. UWMC was the first to bring robot-assisted surgery using da Vinci to our region.
  • Your surgeon uses hand and foot controls to move robotic arms that hold a camera and surgical instruments. 
  • The system allows your surgeon to perform very precise, complex motions.

Traditional open surgery

If minimally invasive surgery is not an option for you because of your tumor’s location or size, your surgeon will use a traditional open approach, making an incision in your face or neck. This type of surgery may be more involved and take longer. Your recovery may take longer as well. 

With new open techniques, surgeons strive not only to remove the cancer (and lymph nodes, if needed) but also to avoid disturbing important nerves, muscles and blood vessels in your neck and shoulder area.

Reconstructive surgery

Not everyone who has surgery to remove head or neck cancer needs reconstructive surgery. But for those who do, UW Medicine reconstructive surgeons are experts in their field.

State-of-the-art reconstruction can help to minimize changes in your appearance caused by your cancer or your treatment.

  • Using a team approach, your oncology surgeon and a reconstructive surgeon will work together during one operation to both remove your cancer and complete any reconstruction you need. 
  • The combined operation means you’ll be under anesthesia and in surgery for significantly less time that you would be for two separate operations. 
  • After surgery, a team of nurses, speech pathologists and social workers will help you recover and rehabilitate.

One reconstructive technique is free-flap surgery, in which surgeons remove skin, bone or other tissue from one part of your body to reconstruct another part. For example, if you need part of your jaw removed, UW Medicine surgeons may reconstruct your jaw using bone from your leg, hip or shoulder blade. Even your tongue can be reconstructed with tissue from another part of your body.

Great advances have been made in using prosthetics to restore parts of the body that need to be altered or removed. 

  • For patients who have their larynx removed, doctors can implant a tracheoesophageal puncture prosthesis (TEP) in a small hole made between your windpipe (trachea) and esophagus. A TEP restores your ability to deliver air from your lungs into your throat to produce speech. 
  • Another option for restoring vocal ability is an electrolarynx — a device placed against your neck to help produce sound that comes out through your mouth.

Learn More About Reconstructive Surgery 

After surgery

We will do everything we can to prevent or minimize side effects you might experience from surgery and will provide care to help you heal well and deal with any side effects that do occur. 

If surgeons cannot save or restore certain important structures while also removing your cancer, or if you have trouble with chewing, swallowing, speaking or other functions after surgery, we have specialists to help. They include speech and swallowing pathologists, physical therapists, occupational therapists, dietitians and lymphedema specialists (who perform specialized massage and compression to manage chronic swelling called lymphedema). Your team will talk with you in detail about your unique situation, what to expect and what treatments or services might help you.

Your pathology report, which provides details about the tissue that was removed, will be available when you return in a week for a follow-up visit with your surgeon. Decisions about any further cancer treatment, such as radiation therapy or chemotherapy, will be based on the findings in your report, including:

  • What kind of tumor you had
  • How large it was
  • Whether all of the cancer was removed 
  • Whether cancer had spread to lymph nodes in your neck
Anesthesia Drugs or other substances that cause a loss of feeling or awareness. This keeps patients from feeling pain during surgery or other procedures. A loss of feeling or awareness caused by drugs or other substances. Anesthesia keeps patients from feeling pain during surgery or other procedures. Local anesthesia is a loss of feeling in one small area of the body, such as the mouth. Regional anesthesia is a loss of feeling in a part of the body, such as an arm or leg. General anesthesia is a loss of feeling and a complete loss of awareness that feels like a very deep sleep. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Lymphedema A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged or removed by surgery. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
Surgery

Surgery is an important treatment for most head and neck cancers. We use the latest techniques to remove your tumors and restore your appearance and function.

Targeted therapy and immunotherapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells, or they prompt your immune system to attack particular cells (also called immunotherapy).

The landscape of treatment for head and neck cancers is evolving rapidly, with immunotherapies approved for some people with these cancers and additional options available through clinical trials. Your Fred Hutch team will advise you about any targeted therapies, including immunotherapies, that may be effective in your particular situation.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
Targeted therapy and immunotherapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells, or they prompt your immune system to attack particular cells (also called immunotherapy).

Palliative care for head and neck cancers

If your cancer is too advanced or your health is too compromised for you to undergo intensive treatments, your Fred Hutch team will offer you the best care options to match your needs and wishes. Your cancer doctors work closely with palliative care professionals to provide supportive, compassionate care that’s right for you. 

Palliative care is for anyone with a cancer diagnosis. It can improve your quality of life, regardless of the stage of your disease, and may help you live longer, even with advanced cancer.

Learn More About Palliative Care

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.