Head & Neck Cancer Surgeon Oxford

Head and neck cancer is the eighth most common cancer in the UK. It accounts for approximately 3% of all new cases of cancer. There are approximately 12,000 new cases annually.

Head and neck cancer comprises a heterogeneous group of tumours. These anatomical sub-sites include the oral cavity, pharynx, paranasal sinuses, nasal cavity, larynx and salivary glands. More than 90% of the cancers are squamous cell in origin. 40% of head and neck cancers occur in the oral cavity(mouth), 15% in the pharynx (back of the throat), 25% in the larynx (voicebox) and the rest in the remaining sites.

Functionally the head and neck region performs a myriad of essential roles in terms of respiratory function, swallowing and mastication and also in communication through voice production. Psychologically the role facial appearance is of great significance as this is the first area of contact that is encountered in daily life.

Mr Silva has a subspecialist interest in Head and Neck Cancer and is involved in the Surgical and Medical management of all types of Head and Neck cancer, including Anterior and Lateral Skullbase cancers. Experienced in Robotic Surgery, he is Chair of the Thames Valley Cancer Alliance Group and sits on both the Head & Neck and Skullbase MDTs. He is also able to provide a second opinion on a National & International basis.

Diagnosis poses a challenge, as whilst a proportion of patients may present with a neck lump, other symptoms may be less obvious and may be vague. Following these may include a persistent sore throat, change in the voice or swallowing difficulties. In reality is that in the average working career of a GP, they may encounter one or two new diagnoses of Head and Neck cancer. This is further reflective of the incidence. This can make the diagnosis of such cases a challenge. Additionally cancers of the oropharynx (back of the throat) by virtue of their anatomical placement may reach a significant size before they present with symptoms. The first presentation may be a neck lump, representing metastasis from the primary.

Investigations carried out by the GP such as blood tests or ultrasound scans may only be of limited benefit and may even serve to delay the diagnosis.

In the presence of red flag symptoms, following a careful history and examination, expedient referral on a 2WW pathway is often the best process for the patient.  Symptoms of concern may include the presence of a persistent unexplained sore throat, difficulty swallowing, pain on swallowing, unexplained earache (otalgia) along with risk factors including being an ex-smoker or heavy alcohol drinker (Appendix I).

If you are concerned about any of the above symptoms, then an early referral to an ENT specialist either through the NHS or privately should hopefully allow you to obtain the reassurance that is required. Rarely if this is something more sinister, it’s essential to ensure that the specialist you are seeing has the experience and skillset to provide you with the optimum treatment. Early diagnosis is the key to ensure the best possible outcome. If you’re concerned about symptoms you may be experiencing, please contact your GP to arrange a referral. Alternatively please feel free to contact the team here, we will be happy to arrange an appointment for you.

Experience in dealing with Head and neck Cancer management is indeed the key. The author works as part of an experienced team and is able to offer advice and information in the management head and neck tumours from the benign through to the malignant.

Risk factors for Head and Neck cancer have evolved. The traditional risks factors of smoking and alcohol are still recognised. However as behaviours have changed, we have seen a decline in smoking related head and neck cancers. Instead we have seen an emergence of Human Papilloma Virus (HPV) related head and neck cancers.  This is related to orogenital contact and is linked to number of sexual partners and oral sexual practises. In the long term the role of the HPV vaccine will aid to reduce this rising trend of HPV related cancers. You may wish to speak to your specialist about the role of vaccinations.

HPV has resulted in a paradigm shift in the type of patient who present with a head and neck cancer. Therefore it’s worth noting that increasingly we are seeing patients who are non smokers and non drinkers presenting with head and neck cancers. The age of presentation may also be typically at a younger age. These patients occasionally present with cystic neck lumps, which may be mistaken for a benign neck cyst.

Treatment for head and neck cancers is most successful if they are diagnosed and treated early. Management is varied, and dependent on several factors, including the site, the stage at diagnosis, any associated medical problems and the patient preferences. Early stage tumours may be treated with single modality treatment such as surgery or radiotherapy. Locally advanced tumours may be treated with chemoradiotherapy or surgery and radiotherapy.

Surgery can range from removal of a small lump on the front of the tongue or back of throat, to more complex surgery such as removal of part or all of the voicebox, and food pipe along with reconstruction of the area. Surgery may also involve removing multiple lymph nodes from the neck (Neck Dissection). Following this some patients may need plastic or reconstructive surgery for areas where the cancer has been removed from, or specialised dentistry after the tumour has been treated. Where tumours interface into other areas such as the skullbase, eye or brain, they may require combined neurosurgical/ENT procedures. 

Sinus cancers / Ear cancers involving the skullbase cancer

Malignant skullbase tumours represent a small subsection within head and neck accounting for approximately 2-3% of all head and neck cancers. Tumours of the skullbase, are those that are in close proximity to the bone of the bottom the skull. They may involve the brain, the covering of the brain or the eye. These are usually originating from cancers within the sinus or nose that have spread. Treatment of sinus tumours which extend towards the anterior skull base or eye are complex due to the significant anatomic detail of the region and the variety of cell types that occur in this area. Lateral malignant skullbase tumours encompass tumours of the ear and temporal bone, and include metastatic skin cancers.  The incidence is low accounting for less that 0.2% of all tumours of the head and neck with an annual incidence of 6 per million people.

There are only a few centres in the country that undertake this type of complex surgery and we pride ourselves in being able to offer treatment for this type of tumour.

Multimodal therapy through a team approach is the optimal management approach for these tumors. There are only a few centres nationally including ourselves that carry out significant volumes of malignant skullbase surgery. Our catchment population is approximately 2.5 million. All cases are discussed by the skullbase team which meet regularly. Decisions for treatment are reached in consensus.

Treatment for head and neck cancer, can impact significantly on function. Patients may have difficulty with eating, drinking and talking, and some may also need to cope changes in their appearance. In Oxford, Priy has worked as part of a highly experienced team which includes a reconstructive plastic surgeon and neurosurgeon. We have worked as a team for the past 7 years. A full range of head and neck cancers are treated. These include complex cancers of the skullbase and cancers within the neck, throat and voicebox and sinuses and ear. 

Successful surgical management of any cancer relies on the experience of the team. A key and crucial aspect with head and neck cancer surgery is the reconstruction. The better the reconstruction the better the function after head and neck surgery. As such, this will directly have an impact on speech, swallowing and appearance after the surgery. The results of our reconstructive team speak for themselves. The flap failure rates are well below the national rates placing us in the top 1% of the country.

There are some cancers where treatment may impact upon, or the cancer itself may involve the facial nerve. The facial nerve is the nerve which controls movement of the muscles of the face. Cancers involving the facial nerve, require management of the nerve itself and thought as to how best to achieve this. Where there is nerve involvement, treatment may require carefully following the nerve back towards the brain, with the aim of obtaining a clear margin beyond. This is something which only a few centres are able to offer. Here in Oxford, we are able to offer this level of complex surgery with good comparative outcomes.

Working as a team, we are able to provide solutions to cancers involving the nerve, including dynamic facial nerve reanimation. This is a move towards a more sophisticated way of reconstructing the nerve. This involves cutting edge surgery with the aim of trying to reproduce function of the face as best as possible. There is no subsitute to your normal functioning facial nerve, nevertheless this surgery aims to provide the best possible function. Where your tumour involves the nerve, it is important to be aware of your options. Including how the tumour will be removed and what reconstruction will be offered to you. It is important to talk to your specialist about how they can help you with this.

By working closely with a plastic surgeon who focuses on the reconstructive aspects of the surgery, we are able to ensure that the functional aspects of the surgery are as best managed as they can be. We regularly audit our complications, outcomes and constantly analyse ways of improving this

Head and Neck Cancer represents a heterogeneous term, involving multiple areas that cannot often be assessed or visualised easily. Symptoms may be innocuous and non specific and therefore it may be difficult to diagnose. GPs may only encounter 1 case of a head and neck cancer in their working career. Awareness of red flag symptoms is for this purpose important. Speak to your specialist if you are concerned about any symptoms of concern. This may result in earlier referral and subsequent diagnosis and therefore improved oncological outcome. 

If diagnosed with a head and neck cancer, it is important you are managed by a team that have the skill and experience to deal with your type of cancer. Surgery in this area is highly skilled and can impact on function. Our team, comprised of a plastic surgeon and neurosurgeon, we are able to offer you a tailored bespoke service.

If you have any concerns or you wish to seek an opinion, please contact us here.