Head and neck cancer includes a diverse group of cancers involving the mouth, throat, voice box, salivary glands, nasal cavity and sinuses, as well as cancers that present as lymph nodes in the neck.
The appropriate treatment depends on where the cancer has started, its stage and type, as well as the individual patient.
Treatment may involve surgery, radiation therapy, systemic treatment such as chemotherapy or immunotherapy, or a combination of these approaches.
Dr Julia Crawford is an ENT and Head & Neck Surgeon with advanced fellowship training in head and neck cancer surgery and Transoral Robotic Surgery (TORS). Her practice is focused predominantly on the assessment and surgical management of benign and malignant head and neck disease.
She works as part of multidisciplinary head and neck cancer teams at St Vincent's Hospital and Chris O'Brien Lifehouse.
Head and neck cancer is an umbrella term covering cancers arising from several different anatomical areas.
Head and neck cancer can present in many different ways.
Symptoms that warrant assessment include the following.
Human Papillomavirus, particularly HPV-16, is now an important cause of oropharyngeal cancer involving the tonsils and base of tongue.
HPV-related oropharyngeal cancer frequently occurs in patients who do not have the traditional risk factors of heavy smoking or alcohol consumption.
It may first present as a painless lump in the neck, sometimes with very few throat symptoms.
HPV-related cancers behave differently from many smoking-related head and neck cancers and generally have a more favourable prognosis. Treatment still needs to be tailored carefully to the individual tumour and patient.
The investigation depends on the symptoms and where the suspected abnormality is located."
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Assessment usually includes examination of the mouth and neck.
Flexible nasendoscopy and laryngoscopy will usually be performed during the consultation to help identify abnormalities within the nose, throat or around the voice box. This involves passing a fine flexible telescope through the nose to examine these areas. Although it can be a little uncomfortable, the examination only takes a few minutes and is an important part of the assessment for a suspected head and neck cancer.
Head and neck cancer treatment is rarely decided by one doctor alone.
Dr Crawford works across multidisciplinary head and neck cancer teams at St Vincent's Hospital and Chris O'Brien Lifehouse.
These meetings bring together head and neck surgeons, radiation oncologists, medical oncologists, radiologists, pathologists, speech pathologists, dietitians, specialist nurses and other clinicians involved in head and neck cancer care.
The purpose of the multidisciplinary team is to review the diagnosis and staging and consider the available treatment options before recommending an individual treatment plan.
For some cancers, surgery is the preferred treatment. For others, radiation therapy or chemoradiotherapy may be more appropriate. In some circumstances there may be more than one reasonable treatment option.
The aim is to recommend the treatment that offers the best balance between cancer control, function, treatment burden and the individual patient's priorities.
Surgery varies considerably depending on the site and extent of the cancer.
It may include the following.
Dr Crawford completed advanced fellowship training in Transoral Robotic Surgery and is one of a relatively small number of Australian head and neck surgeons with specific fellowship training in this technique.
TORS allows selected tumours of the oropharynx, particularly the tonsil and base of tongue, to be approached through the mouth using a robotic surgical system.
The system provides three-dimensional visualisation and allows the surgeon to work within areas of the throat that can otherwise be difficult to access.
TORS avoids an external incision for removal of the primary throat tumour, although many patients will also require a neck dissection, which involves an incision on the outside of the neck.
Robotic surgery is not appropriate for every throat cancer. The suitability of TORS depends on the location and size of the tumour, its relationship to surrounding structures, whether lymph nodes are involved and the likely need for additional treatment after surgery.
The decision to recommend TORS should therefore be made as part of the overall cancer treatment plan rather than simply on the basis that a tumour is technically accessible robotically.
Surgery is only one component of head and neck cancer treatment.
Depending on the cancer, treatment may include one or more of the following.
Treatment for head and neck cancer can affect swallowing, speech, voice and nutrition.
Speech pathologists and dietitians are therefore important members of the head and neck cancer team.
Some patients require assessment and support before treatment begins, while others require rehabilitation during or after treatment.
The type and degree of support required depends on the cancer and the treatment being undertaken.
Some head and neck cancer operations result in a defect that requires reconstruction.
Depending on the size and location of the defect, reconstruction may range from relatively simple techniques to complex microvascular free-flap reconstruction.
Where complex reconstruction is required, Dr Crawford works with appropriately trained reconstructive surgeons as part of the multidisciplinary surgical team.
The aim is not simply to remove the cancer, but to achieve the best possible functional outcome while maintaining appropriate cancer control.
Recovery varies considerably depending on the operation.
A relatively small salivary gland procedure, for example, has a very different recovery from major oral cancer surgery or TORS.
Before surgery, Dr Crawford will discuss the following.
Patients with suspected or confirmed head and neck cancer can be seen at Sydney ENT Clinic in Darlinghurst or Kogarah, or through Chris O'Brien Lifehouse.
If you already have imaging, biopsy results, pathology reports or previous correspondence, providing these before your appointment allows Dr Crawford to review the available information in advance.
Additional imaging or biopsy may sometimes be arranged before or after your consultation depending on what has already been performed.
The aim is to obtain the information required to establish the diagnosis and treatment options while minimising unnecessary appointments and delays.
If you have a persistent neck lump, concerning head and neck symptoms or a confirmed diagnosis of head and neck cancer, specialist assessment can help establish the diagnosis and appropriate treatment options.
Appointments are available at Sydney ENT Clinic Darlinghurst and Kogarah and through Chris O'Brien Lifehouse.
Our team can assist with appointment enquiries and help arrange a consultation with Dr Julia Crawford at one of her three Sydney consulting locations:
Dr Julia Crawford consults for head and neck conditions, head and neck cancer, thyroid and salivary gland disease, obstructive sleep apnoea, paediatric ENT and selected general ENT problems.
Her team can assist with arranging an appointment at Darlinghurst, Kogarah or Chris O'Brien Lifehouse, and will help ensure the appropriate information and investigations are available before your consultation.