Multidisciplinary Head & Neck Cancer Care

Head & Neck Surgery

 

We are the pioneers of major scientific breakthroughs

  • Organ preservation approaches to head and neck cancer.
  • New drugs for head and neck squamous cell carcinoma (HNSCC) and extending uses of existing drugs to HNSCC and nasopharyngeal carcinoma (NPC).
  • Advanced radiation therapy techniques that limit toxicity and improve outcomes.
  • Minimally Invasive and Robotic Surgery
  • Stem cell work that extends the findings of the first paper, demonstrating the existence of “cancer stem cells” in HNSCC by researchers from Stanford and Michigan in 2007; and a 2009 Stanford study establishing that stem cell properties of patients’ malignancies correlate with prognosis. This work led to subsequent stem cell papers in 2011 and 2012.
  • Normal tissue stem cell studies to identify salivary gland stem cells and to manipulate them for preservation and/or restoration of salivary gland function from radiation damage.
  • HNOP’s breadth of research studies and protocols including treatment of intermediate and advanced disease as well as hypoxia imaging.

Our Innovations

  • Creation of the first head and neck multidisciplinary tumor patient conference (tumor board; 1976) in the U.S.
  • Introduction of the first use of chemotherapy with irradiation for head and neck squamous cell carcinoma (HNSCC), which is the basis of organ-preservation chemoradiation in the U.S.
  • Close working relationships with:
    • Neurosurgery, Interventional Radiology, and Neuroradiology,which are critical for complex open and endonasal endoscopic skull base surgery.
    • Endocrinology in the treatment of thyroid cancer.
    • Dermatology in the treatment of advanced skin cancers.
  • Innovative research by physicians now at Stanford that demonstrates the utility of the FDA-approved Mobetron for intraoperative radiation therapy.
  • Contributing research in a Phase II trial of immunotherapy in intermediate and advanced surgically-treated HNSCC. A Phase III trial is now planned.
  • Leadership in the head and neck disease site committee of the Radiation Therapy Oncology Group to develop new nation-wide clinical trials in head and neck cancer.
  • Biomarker studies to identify novel circulating biomarkers for prognostication and post-treatment surveillance in head and neck cancer.
  • Strong links to developmental therapeutics such as the advancement of new drugs to treat cancer.
  • Provision of a full range of treatment options that include minimally invasive surgery, robotic surgery, stereotactic radiosurgery such as CyberKnife, microvascular reconstruction, intraoperative radiation therapy (IORT), and new chemotherapy trials.

 

 

What is Head & Neck Cancer?

Head and neck cancer is a term that can include the broad array of tumors which may arise in this anatomically diverse region of the human body. Most often, the term head and neck cancer refers to tumors that arise from “squamous” cells that line the moist, mucosal surfaces of the mouth and throat. In fact, 95% of head and neck tumors are squamous cell carcinoma.

Tumors of the thyroid, salivary, and parathyroid glands, as well as cancers of the brain, nose and paranasal sinuses, esophagus, and eye, are not usually categorized as head and neck cancer. Furthermore, tumors of the skin, muscle and bone arising in the head and neck are also typically not included in this term.

Head and neck cancer is then further classified by its location within the mouth and throat:

Oral cavity

The lips, the oral tongue” (the forward two-thirds or front part of the tongue), the gums lining the upper and lower jaws, as well as the lining inside the cheek.  The area known as the floor of the mouth is a mobile area between the lower jaw and gum and the oral tongue.  The roof of the mouth or “hard palate” is also included as part of the oral cavity.  Finally, a small triangulated area of mucosa or gum lining the area behind the last wisdom tooth is called the“retromolar trigone” and is also part of the oral cavity.

Pharynx

In medical terminology, the throat is known as the pharynx.  In fact, the pharynx is supple tube or funnel that connects both the nose and mouth to the swallowing tube or esophagus.  The pharynx is composed of three parts: the nasopharynx (the area just behind the nose); the oropharynx (behind the oral cavity and in the back of the mouth], and the hypopharynx, which surrounds the voice box and leads into the esophagus.

The larynx critical not only for the production of speech, but also breathing and swallowing. The “supraglottic” larynx has a valve called the epiglottis, which covers the larynx during swallowing to prevent “aspiration” of food into the lungs.

 

 

Treatments

HNOP offers multi-disciplinary, collaborative and integrated evaluation and care for patients with head and neck cancers.

Minimally invasive or endoscopic head and neck surgery (eHNS) is a dynamic new approach that allows surgeons to remove tumors with use of a specialized endocopes and cameras without external incisions and usually with little or no change in speech, appearance, and swallowing function.

An endoscope is a long, thin tube with special lighting and a narrow lens through which the surgeon can view organs and tissue inside of the body. For throat cancers, the surgeon inserts the endoscope through the patient’s mouth, and a microscope provides an excellent image of the tumor. Using very precise, state-of-the-art surgical instruments that are also inserted through the mouth, the surgeon can perform the operation without an external incision.

eHNS has several advantages in many cases. Some of these advantages are:

  • Reduced risk of blood loss
  • Lower pain levels
  • Fewer days spent in the hospital
  • Quicker return to a normal diet and faster recovery time
  • Less scarring, with improved cosmetic appearance


In some cases of throat cancer, eHNS may reduce or even eliminate the need for chemotherapy and radiation therapy.

At Stanford, your team of surgeons, oncologists, and radiologists will work together to determine the best course of action for you. The goal with eHNS is always the same: to eliminate the cancer while minimizing the risks and recovery time associated with traditional cancer care.

Chemotherapy or radiation therapy may still be necessary after eHNS. When chemotherapy and radiation therapy cannot be avoided through surgery, eHNS may still hold advantages for patients. Faster recovery after eHNS means patients can usually begin chemotherapy and radiation therapy earlier. And the smaller incisions with eHNS heal more quickly than larger incisions and are less likely to become infected.

Two types of eHNS, transoral robotic surgery (TORS) and transoral laser CO2microsurgery (TLM), have revolutionized the treatment for throat cancer.

Robotic surgery uses state-of-the-art technology that allows surgeons to safely remove certain thyroid tumors through discrete incisions several inches from the neck. Because no incision is made in the neck, the patient avoids a neck scar.

The da Vinci ® surgical system is a highly sophisticated computerized system that is used for robotic thyroid surgery. The surgeon cuts a 1-inch to 2-inch incision in the folds of skin under the patient’s arm and inserts the da Vinci ® system’s robotic arms, which have been customized to resemble standard surgical instruments. The surgeon guides the robotic arms underneath the skin toward the thyroid gland.

The surgeon views the surgical field on a 3-D high-definition screen, magnified up to 10 times. The skilled surgeons at Stanford Medicine control the da Vinci ® system’s robotic arms as one might control conventional surgery. The instruments on the robotic arms can move with seven degrees of movement and rotate 540 degrees, giving the surgeon the ability to manipulate delicate tissues with precision.

Robotic thyroidectomy is not available for all thyroid tumors. If your thyroid tumor is less than 3 cm in size and is likely to be benign (non-cancerous), then robotic surgery may be an option. Your surgeons will help you decide the best approach for you.

Clinical Trials

  • Study Evaluating Zr-Panitumumab for Assessment of Suspected Metastatic Lesions on 18F-FDG-PET/CT in Head and Neck Squamous Cell Carcinoma

    The purpose of this study is to determine the diagnostic utility of 89Zr-panitumumab to identify metastatic lesion(s) in subjects with head and neck squamous cell carcinoma (HNSCC).

    Not accepting patients at this time View Details
  • Post-operative Adjuvant Treatment for HPV-positive Tumours (PATHOS)

    The main objectives of the PATHOS study are:

    To assess whether swallowing function can be improved following transoral resection of HPV-positive OPSCC, by reducing the intensity of adjuvant treatment protocols. The aim is to personalise treatment, based on disease biology (HPV status and pathology findings), to optimise patient outcomes.

    To demonstrate the non-inferiority of reducing the intensity of adjuvant treatment protocols in terms of overall survival in the reduced intensity treatment arms.

    Now accepting new patients View Details
  • Study Evaluating 111In-Panitumumab for Nodal Staging in Head and Neck Cancer

    The primary purpose of the study is to assess the safety of 111In-panitumumab as a molecular imaging agent in patients with Head and Neck Squamous Cell Carcinoma.

    The secondary objective is to compare sensitivity and specificity of identifying sentinel lymph nodes by systemic injection of 111In-panitumumab prior to Day of Surgery versus conventional local injection with an optical dye at the time of surgery.

    Investigator

    Now accepting new patients View Details
  • Comparing Sentinel Lymph Node (SLN) Biopsy With Standard Neck Dissection for Patients With Early-Stage Oral Cavity Cancer

    This phase II/III trial studies how well sentinel lymph node biopsy works and compares sentinel lymph node biopsy surgery to standard neck dissection as part of the treatment for early-stage oral cavity cancer. Sentinel lymph node biopsy surgery is a procedure that removes a smaller number of lymph nodes from your neck because it uses an imaging agent to see which lymph nodes are most likely to have cancer. Standard neck dissection, such as elective neck dissection, removes many of the lymph nodes in your neck. Using sentinel lymph node biopsy surgery may work better in treating patients with early-stage oral cavity cancer compared to standard elective neck dissection.

    Investigator

    Now accepting new patients View Details
  • Neoadjuvant Atezolizumab in Surgically Resectable Advanced Cutaneous Squamous Cell Carcinoma

    The purpose of this research is to evaluate whether the administration of atezolizumab before surgical resection of your tumor is feasible and to evaluate the treatment response, safety, and tolerability of atezolizumab.

    Investigator

    Now accepting new patients View Details
  • Study of Cemiplimab in Patients With Type of Skin Cancer Stage II to IV Cutaneous Squamous Cell Carcinoma

    The primary objective of the study is to evaluate the efficacy of neoadjuvant cemiplimab as measured by Pathologic complete response (pCR) rate per independent central pathology review.

    The secondary objectives of the study are:

    - To evaluate the efficacy of neoadjuvant cemiplimab on measures of disease response, including:

    - Major pathologic response (mPR) rate per independent central pathology review

    - pCR rate and mPR rate per local pathology review

    - ORR prior to surgery, according to local assessment using RECIST 1.1

    - To evaluate the efficacy of neoadjuvant cemiplimab on event free survival (EFS), disease free survival (DFS), and overall survival (OS)

    - To evaluate the safety profile of neoadjuvant cemiplimab

    - To assess change in surgical plan (ablative and reconstructive procedures) from the screening period to definitive surgery, both according to investigator review and independent surgical expert review

    - To assess change in post-surgical management plan (radiation, chemoradiation, or observation) from the screening period to post-surgery pathology review, both according to investigator review and independent surgical expert review

    Investigator

    Not accepting patients at this time View Details
  • TOGETHER: Track Outcomes and Guidance, Technology for Health and Effective Resources

    The goal of this project is to iteratively develop and test a TOGETHER pilot mobile app product in preparation for commercialization. TOGETHER is a mobile application on a smart software system that informal caregivers can use to develop and implement home-based care for cancer patients/survivors.

    The Technical Objectives are to:

    1. Establish the project team and obtain stakeholder feedback on what to include in the product.

    2. Evaluate IT customization requirements and HIPAA compliance security, and privacy protocols.

    3. Develop a prototype to show NCI and then a pilot version for beta and usability testing among stakeholders.

    4. Enhance interoperability and test integration into health system(s) - if feasible.

    5. Develop user support documentation for stakeholders.

    Investigator

    Now accepting new patients View Details
  • Investigation of Two Swallowing Therapy Models During Radiation Therapy for Head and Neck Cancer

    Vibrent Health is partnering with Stanford Cancer Center to conduct a randomized control trial (RCT) using mobile health technology to enhance adherence and improve swallowing outcomes in patients undergoing radiation therapy for head and neck cancer.

    Not accepting patients at this time View Details
  • Radiation Therapy and Cisplatin With or Without Cetuximab in Treating Patients With Stage III or Stage IV Head and Neck Cancer

    RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Cisplatin may also make tumor cells more sensitive to radiation therapy. Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving radiation therapy and cisplatin together with cetuximab may kill more tumor cells. It is not yet known whether radiation therapy and cisplatin are more effective with or without cetuximab in treating head and neck cancer.

    PURPOSE: This randomized phase III trial is studying radiation therapy, cisplatin, and cetuximab to see how well they work compared to radiation therapy and cisplatin in treating patients with stage III or stage IV head and neck cancer.

    Not accepting patients at this time View Details
  • Cetuximab IRDye800 Study as an Optical Imaging Agent to Detect Cancer During Surgical Procedures

    This study is an open label, single institution, Phase 1 dose-escalation study to determine the safety profile of cetuximab-IRDye800 used in subjects with head and neck squamous cell carcinoma (HNSCC) that undergo surgery with curative intent. Participants will be given a dose of an approved head and neck cancer drug (Cetuximab) along with an investigational study drug called Cetuximab-IRDye800. Cetuximab-IRDye800 is a drug that is given prior to surgery that attaches to cancer cells and appears to make them visible to the doctor when he uses a special camera during the operation. The investigators are evaluating whether or not the use of the study drug along with the special camera will better identify the cancer while patients are in the operating room.

    Not accepting patients at this time View Details
  • Clinical Validation of ThyroidPrint: A Gene Expression Signature for Diagnosis of Indeterminate Thyroid Nodules

    A clinical trial is proposed, to clinically validate, in a US population, the diagnostic performance of a new genetic test (ThyroidPrint). It will determine the nature of thyroid nodules that have been informed as indeterminate by cytology through a fine needle aspiration (FNA). The Genetic Classifier for Indeterminate Thyroid Nodules is a test that determines the expression of a panel of 10 biomarkers (CXCR3, CCR3, CXCl10, CK19, TIMP1, CLDN1, CAR, XB130, HO-1 and CCR7). Gene expression data is analyzed through an algorithm that generates a composite score that predicts the risk of malignancy. It´s intended use is for patients with thyroid cytology as indeterminate (Bethesda III and IV, according to The Bethesda System for Reporting Thyroid Cytopathology). This test uses a fine needle aspiration (FNA) sample.

    Now accepting new patients View Details
  • Panitumumab-IRDye800 Compared to Sentinel Node Biopsy and (Selective) Neck Dissection in Identifying Metastatic Lymph Nodes in Patients With Head&Neck Cancer

    This phase II trial studies how well panitumumab-IRDye800 works in identifying head and neck cancer that has spread to the lymph nodes in patients with head and neck cancer. Panitumumab-IRDye800 may help surgeons to identify metastatic lymph nodes during surgical removal of the primary tumor and/or lymph nodes of the neck with equal or better accuracy than the current methods.

    Investigator

    Not accepting patients at this time View Details
  • Identification of Secreted Markers for Tumor Hypoxia in Patients With Head and Neck or Lung Cancers

    The purpose of this study is to identify and confirm new blood and tissue markers for prognosis and tumor hypoxia. Tumor hypoxia, or the condition of low oxygen in the tumor, has been shown to increase the risk of tumor spread and enhance tumor resistance to the standard treatment of radiation and chemotherapy in head and neck and lung cancers. We have recently identified several proteins or markers in the blood and in tumors (including osteopontin, lysyl oxidase, macrophage inhibiting factor and proteomic technology) in the laboratory that may be able to identify tumors with low oxygen levels or more aggressive behaving tumors.

    Now accepting new patients View Details
  • A Phase 2 Clinical Trial of the Safety and Effects of IRX-2 in Treating Patients With Operable Head and Neck Cancer

    This was a Phase 2a trial to investigate the safety and biological activity of the RIX-2 Regimen in patients with untreated, resectable squamous cell cancer of the head and neck (HNSCC).

    Not accepting patients at this time View Details
  • Cervical Nodal Mets in Squamous Cell Carcinoma of H&N - MRI, FDG-PET, & Histopathologic Correlation

    The purpose of this study is to determine the value of novel non-invasive medical imaging methods for detecting the spread of head and neck squamous cell carcinoma to the lymph nodes in the neck by comparing their results to findings at the time of surgery.

    Not accepting patients at this time View Details
  • Biopsy of Human Tumors for Cancer Stem Cell Characterization: a Feasibility Study

    To see if a limited sampling of tumor tissue from human subjects is a feasible way to gather adequate tissue for cancer stem cell quantification.

    Not accepting patients at this time View Details
  • Radiation Therapy With or Without Cetuximab in Treating Patients Who Have Undergone Surgery for Locally Advanced Head and Neck Cancer

    RATIONALE: Giving radiation therapy that uses a 3-dimensional (3-D) image of the tumor to help focus thin beams of radiation directly on the tumor, and giving radiation therapy in higher doses over a shorter period of time, may kill more tumor cells and have fewer side effects. Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. It is not yet known whether radiation therapy is more effective when given alone or together with cetuximab in treating patients with head and neck cancer that has been removed by surgery.

    PURPOSE: This randomized phase III trial is studying radiation therapy to see how well it works compared with radiation therapy given together with cetuximab in treating patients who have undergone surgery for locally advanced head and neck cancer.

    Not accepting patients at this time View Details
  • Perioperative Oral Steroids for Chronic Rhinosinusitis Without Polyps (CRSsNP)

    While oral steroids have been shown to be effective in the management of patients with chronic rhinosinusitis with polyps, its role in treating chronic rhinosinusitis without polyps (CRSsNP) is ambiguous. Despite a lack of strong clinical evidence to suggest a benefit in this disease state, steroids are often prescribed as a component of post-operative care after sinus surgery for patients without polyps. Oral steroids carry with them significant adverse effects, and should be prescribed thoughtfully. The aims of this study are to determine if oral steroids in the peri-operative period improves patient outcomes in CRS without polyps.

    Investigator

    Not accepting patients at this time View Details
  • Study to Evaluate Immunological Response to PD-1 Inhibition in Squamous Cell Carcinoma of the Head and Neck (SCCHN)

    This is a single-center cross-sectional imaging and correlative biomarker study in patients with Squamous Cell Carcinoma of the Head and Neck (SCCHN). Cohort 1 will be patients with unresectable or metastatic SCCHN cancer receiving standard of care (SOC) anti-PD-1 treatment and Cohort 2 will be neoadjuvant study participants who will receive one dose of anti-PD-1 treatment prior to tumor resection or radiation. Blood sampling and tissue biopsies will be collected from both cohorts and both cohorts will undergo two whole body PET(Positron Emission Tomography)/CT(Computed Tomography) imaging with [18F]F-AraG. First scan prior to initiating anti-PD-1 treatment and second scan post initiation of anti-PD-1 treatment in Cohort 1 and prior to tumor resection or radiation in Cohort 2

    Not accepting patients at this time View Details
  • Identification and Characterization of Novel Proteins and Genes in Head and Neck Cancer

    Through this study, we hope to learn more about the mechanisms, which may contribute to development and progression of head and neck cancer. The long-term goal of this study will be to develop new strategies and drugs for the diagnosis and treatment of head and neck cancer.

    Now accepting new patients View Details

 

 

Head & Neck Surgery