The Head and Neck Cancers Program at Smilow Cancer Hospital provides total care for patients diagnosed with cancers of the head and neck. Our team sets the tone nationally and internationally for clinical trials and state-of-the-art care of patients. Our patients are offered the latest treatment options available and are given access to the some of the most highly trained specialty support staff in the region. The multidisciplinary team that will care for you includes head and neck surgeons, radiation oncologists, medical oncologists, pathologists, physical therapists, speech-language pathologists, nutritionists, a smoking cessation specialist, dentists, a physical/ lymphedema therapist, advanced practice nurses, and social workers. Functional outcome is an important element in deciding which treatment approach we recommend for you.
A team approach is critical to attain the highest cure rates while preserving your function when you are done with treatment. Our doctors are leaders in clinical trials internationally, which creates access for our patients to newer therapies not yet available elsewhere. Each patient is treated on an individual basis according to their specific diagnosis and needs. There are many options available including minimally invasive surgical approaches as well as those that don’t require surgery, and our team is dedicated to finding the option that best suits you by carefully balancing treatment effectiveness with quality of life. Our team regularly handles both difficult and routine cases involving the neck, larynx (voice box), pharynx (throat), oral cavity (mouth), ear, sinuses, tonsils, and salivary glands, as well as cervical (neck) lymph nodes or neck structures, and meets in a weekly Tumor Board Conference to review cases and offer patients the best treatment plans. Optimal care plans are based on the most up-to-date research performed at Yale and elsewhere.
Our team of surgeons specialize in taking care of head and neck cancer patients and achieves some of the best outcomes in the region and nation. Whether a small and routine tumor or a rare and complex one, having a team of experienced and expert specialist surgeons can make all the difference in terms of outcome. In addition to tumor removal, our surgeons achieve exceptional functional and cosmetic outcomes through the use of reconstructive surgery after a tumor has been removed. If reconstructive surgery is needed, it is usually performed at the same time as tumor removal. The success rate for reconstructive surgery with our team is very high in part because of the high volume of cases performed at Yale, and the skill and experience of our fellowship-trained surgeons, who focus entirely on head and neck cancer surgery.
Some tumors can be treated with minimally invasive surgery, and our team of surgeons are nationally known for their abilities with several of these techniques. Transoral robotic surgery (TORS) can be used to remove certain throat cancers while avoiding some skin and bone incisions. This approach speeds healing and shortens a patient’s recovery. Likewise, patients with certain laryngeal cancers, who a few years ago would have lost their vocal cords and their voices, can often be treated with less invasive surgeries using lasers. Patients who undergo these treatments maintain their ability to speak, although occasionally they may need to alter their diet or learn new swallowing techniques, particularly while recovering. At Yale, rehabilitative specialists work with patients to help them adjust to and overcome any swallowing problems. In terms of neck surgery, our team only rarely needs to perform radical neck dissections, which have been replaced by less invasive surgeries that preserve the nerves, arteries, and muscles in the neck. Patients continue to move, speak, breathe, and eat more normally after these newer and less radical surgeries, but without sacrificing cure rates. Following surgery, patients are moved to a special inpatient unit dedicated to the care of head and neck cancer patients. The unit focuses solely on the recovery process that head and neck cancer patients face, while avoiding a stay in the ICU which can prolong recovery. Every person on the floor is aware of all complications that may arise.
Our medical oncologists have unique expertise in head and neck cancers and dedicate their practice entirely to cancers of the head and neck. The integration of chemotherapy with radiation has become very important for patients with head and neck cancers that involve the lymph nodes or is locally extensive, and this approach can lead to organ preservation and increase the chance of cure for many patients. Breakthroughs in targeted therapy and biomarkers allow a personalized approach that can avoid the toxicities of conventional chemotherapy in some cases, and new treatments to prevent recurrence in high-risk situations are also being studied. For patients with recurrent disease, new anti-cancer drugs and immunotherapies are also available.
A study led by Yale Cancer Center revealed that the checkpoint inhibitor pembrolizumab (Keytruda) offers patients with advanced head and neck cancers longer survival time; this led to FDA approval of immunotherapy as first-line treatment in head and neck cancer that has recurred or spread.
Radiation treatment is critical for cure of almost all advanced head and neck cancers. Radiation therapy can be delivered alone or combined with chemotherapy as a primary therapy or after surgery. Our radiation oncologists specialize in the use of intensity-modulated radiation therapy (IMRT) to effectively target head and neck tumors. IMRT allows for more precise delivery of therapeutic x-rays with the goal of eradicating tumor while simultaneously minimizing damage to surrounding normal critical tissues and organs. Our doctors work in close coordination with ENT surgeons, medical oncologists, radiologists, and pathologists to design a precise radiation plan after extensive multidisciplinary review. Furthermore, by receiving radiation treatment through a high-volume center such as ours, it is proven that outcomes for patients with head and neck cancer are improved.
During the course of radiation treatment, patients are carefully evaluated by their physician and support team weekly. The team works to address any symptom management, nutritional needs, or social support needs. After treatment is completed, your radiation oncologist will continue to follow you to help with cancer surveillance, and also symptom management.
Many of the head and neck physicians at Yale are also cancer researchers who study how to prevent or treat head and neck cancers in their laboratories, who lead clinical trials, or who analyze information from national databases to compare the effectiveness of different treatment approaches. We are committed to not only providing you with the very best care today, but are dedicated to cutting-edge research and innovative therapies that will advance the standard of care tomorrow. Our radiation oncologists actively participate in clinical trials that explore novel agents to sensitize cancer cells to radiation, as well as new therapies that may help maintain treatment response. Through this active participation, they have access to the most up to date information and are involved in influencing the direction of head and neck cancer research in the future.
Our medical oncologists are engaged in research and trials looking at HPV-directed vaccines and more tolerable chemotherapy regimens. Although immunotherapy is effective for patients with head and neck cancer when other options haven’t worked, it too can stop working. When this happens, our physicians are ready to offer targeted therapies. Recently a trial led by one of our doctors led to FDA approval of a new treatment option for head and neck cancer, and there are currently studies underway looking at how to best treat human papillomavirus (HPV)-positive head and neck cancers.
Yale Cancer Center was recently awarded grants from the National Institutes of Health (NIH) to fund the Yale Head and Neck Cancer Specialized Program of Research Excellence (SPORE) to address critical barriers to treatment of head and neck squamous cell carcinoma due to resistance to immune, DNA damaging, and targeted therapy. Yale researchers also hold grants from the National Cancer Institute and the Department of Defense to study new treatments in head and neck cancer.
Our staff is specially trained to care for your needs following treatment. They are experts in the care of patients with head and neck cancers and extend to a myriad of essential services including pastoral support, complementary therapy, pain management, speech-language pathology, nutrition, smoking cessation, dentists, a physical/lymphedema therapist, advanced practice nurses, and social workers. Smilow Cancer Hospital also offers a state-of-the-art Survivorship Clinic that employs a multidisciplinary team approach designed to address patients’ needs after treatment ends. All of the pieces come together to provide you with the best care possible in all areas of diagnosis, treatment, and follow-up care.
Smilow Cancer Hospital at Yale New Haven offers cancer support groups.
Despite having spent 40 years in the research laboratories at Yale in the Department of Orthopaedics & Rehabilitation and well versed in the inner workings of the human body, Dr. Mark Horowitz was shocked to learn that his diagnosis of head and neck cancer was caused by a virus known as the human papillomavirus (HPV). Dr. Horowitz was having trouble breathing and sought the advice of an urgent care doctor, who recommended he get a neck ultrasound. The ultrasound revealed a neck mass and a biopsy later confirmed that it was HPV-positive squamous cell carcinoma.
