Head and Neck Cancer Multi-Disciplinary Team (MDT)
Our multi-disciplinary team (MDT) of specialists work together to decide the best way to proceed with your treatment.
Members of your MDT will include experts such as surgeons, doctors, nurses, speech and language therapists, dieticians, dentists, and physiotherapists who all have specialist training and experience in diagnosing, treating and supporting patients with head and neck cancers. You will be assigned a clinical nurse specialist who will be responsible for co-ordinating your care (your ‘key worker’).
The MDT meets every week to discuss the diagnosis and treatment plan of individual patients. They ensure that each patient is given the same high standard of care and has the most appropriate investigations and treatment.
The main aim of treating head and neck cancer is to provide a cure and make sure all of the cancer is removed or destroyed. Other considerations such as reducing the long term effects of treatment are equally important. Maintaining quality of life is an important consideration to us when planning your treatment. This means we will aim to preserve your appearance and ensure your ability to speak, chew, taste and swallow are affected as little as possible.
Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
Diagnosis and staging
If you have concerns regarding head and neck symptoms you should consult with your doctor or dentist. They may feel that you should be referred urgently to see a head and neck specialist.
All suspected cancer referrals will be seen within two weeks of the referral being sent. Thankfully, the majority of patients we investigate do not have a cancer. It is much safer for us to diagnose patients with suspected cancer as soon as possible as the outcomes are much better for early-stage cancers.
You will be sent an appointment to be seen at the University College Hospital Macmillan Cancer Centre. At this initial consultation, you will be seen by a head and neck specialist. During this visit they will speak to you about your symptoms and carry out an examination. It is important that you bring with you a list of any medications, if any, that you take.
We aim for you to be seen on time and it may be necessary that other investigations are carried out the same day. This may mean that you attend for several hours.
The following tests may be carried out. Sometimes it is necessary for you to return at other times for these investigations.
A nasendoscope is a thin, flexible tube with a fibreoptic light at the end that can be used to examine the throat and back of the mouth. The doctor will pass the tube through your nostril to the back of the mouth. This test usually takes about a minute. Sometimes a local anaesthetic spray is used to numb the nose and throat. If this is used it is important not to eat and drink anything afterwards until the numbness has worn off.
Ultrasound examination is a painless test which takes only a few minutes. It is undertaken by a specialist radiology doctor. The doctor will apply some gel to your neck and then a small device is used which is moved over the neck. The device generates sound waves which produces a picture on the screen. This test is very useful for looking at lymph nodes in the neck.
This simple test allows the doctor to take a sample of cells from a lump. A fine needle is passed into the lump and you may feel slight discomfort while this is being done. More often than not, this test is undertaken at the same time as an ultrasound scan as this helps to guide the needle into the correct area.
This test is done after numbing the area with local anaesthetic. A thin slice of tissue is removed. It may be necessary to have some stitches put in to help the area heal. You can expect the area biopsied to be uncomfortable for a few days afterwards.
You may have x-rays taken of your jaws and teeth. This procedure is painless and takes only a few minutes.
This scan takes a series of x-rays which builds up a three dimensional picture of the area scanned. Modern CT scanners mean that this examination is quick and often takes only a few minutes. Sometimes an injection of a dye is given into a vein in the arm which allows particular areas to be seen more clearly.
This scan uses powerful magnets to build up a detailed three-dimensional picture of areas of the body. Before this scan you will be asked to remove any metal objects such as jewellery and will be asked about any metal implants you may have such as a pacemaker or surgical clips. You may be given an injection of a dye into a vein in the arm which allows particular areas to be seen more clearly.
The scan is painless and you will be required to lie still on a couch inside a tube. Some people find this a bit claustrophobic and it can be noisy. The scan lasts for about 30 to 45 minutes.
A PET (positron emission tomography) scan uses low-dose radiation to measure activity of cells in different parts of the body. A mildly radioactive substance is injected into a vein in the arm and after a wait of around an hour the scan is undertaken. A CT scan is undertaken at the same time which helps to build up a detailed three-dimensional picture. The scan takes around 30 minutes.
Sometimes it is necessary to undertake a biopsy or examination whilst you are asleep under a general anaesthetic. If this is required, it will not be done the same day as your initial consultation. In the majority of cases this is done as day surgery and you will be able to go home the same day.
The stage of the cancer is a term is used to describe the size and extent of the cancer and whether it has spread beyond its original site. The stage is determined by a combination of clinical and radiological examinations. Staging of different types of head and neck cancers vary slightly. Your specialist will be able to explain in more detail.
The most common staging system for head and neck cancer is known as the TNM classification.
- T describes the size of the tumour and what structures are involved where it has arisen
- N describes whether the cancer has spread to affect lymph nodes and which nodes are involved.
- M describes whether the cancer has spread (metastasised) to any other part of the body.
There are many treatment options available at UCLH for patients with head and neck cancers. The type of treatment you are offered will depend on many things and will include important factors such as; the type and size of the cancer, and stage (how big it is and how far it has spread), as well as your general health. Your doctors will discuss with you the best treatment options for you in detail and will give you time to make these important decisions.
The treatment required is different for every patient and may be just surgery or radiotherapy alone. For many patients it will be a combination of treatments and can include surgery, radiotherapy and chemotherapy.
When possible your team will aim to remove your cancer completely, but preserving quality of life is always an important consideration. We offer reconstructive surgery to give you the best possible chance of normal speech and swallowing, and to ensure the best cosmetic results. We also provide a number of non-surgical therapies, such as speech and language therapy and physiotherapy, to aid you in your recovery and preserve your quality of life.
Surgery is one of the main treatments used for cancers of the head and neck. Using modern surgical techniques the surgeons will aim to remove the tumour while preserving nearby structures involved in sensory and physical functioning.
Some patients may require their surgeon to remove the lymph nodes in their neck to see if any cancer cells have spread beyond the original location. Surgeons are often able to remove these lymph nodes while sparing nearby important structures such as blood vessels, nerves and muscles to maintain normal function.
Minimally invasive surgery is used when possible to remove tumours that are located near important areas for sensory and physical functioning. This allows patients to recover more quickly than they would with traditional, open surgery. Wherever possible we use cutting edge technology such as laser assisted surgery.
UCLH is a specialist centre for reconstructive surgery and reconstructive surgeons are involved in care of patients when required. The aim of reconstruction is to rebuild or replace damaged or removed structures to restore function and appearance.
Often microvascular head and neck reconstruction is used. This technique is one of the most advanced surgical options available and involves taking flaps of healthy tissue from other sites in the body. The tissue is then used to reconstruct the affected area of the head and neck. A microscope is used to suture (stitch) the blood vessels of the flap to blood vessels in the neck. This allows the tissue to live as if it were back in its original location.
The surgical team at UCLH are involved in research and innovation to constantly improve the outcomes for patients and adopt new technology and techniques such as sentinel node biopsy technique and robotic surgery.
The surgical team work closely with a specialist team of anaesthetists who have particular skills in managing patients with complex airway problems. We have a large critical care unit where patients may be initially cared for after complex surgery. There is a dedicated head and neck ward (T6 North) staffed with highly skilled nursing staff and allied health professionals such as speech & language therapists, dietitians, & physiotherapists who will all work toward getting you home as soon as possible.
Radiotherapy uses controlled doses of high-energy radiation to destroy cancerous cells. It can be used as a treatment on its own for early-stage cancer. This is referred to as primary radiotherapy. It is often used after surgery to stop cancerous cells returning and in this situation it is referred to as adjuvant radiotherapy. It's sometimes combined with chemotherapy when it is known as chemoradiotherapy.
As well as killing cancerous cells, radiotherapy can affect healthy tissue and unfortunately this has a number of side effects, including sore, red skin (similar to sunburn), mouth ulcers and dry mouth. Your radiotherapy team will monitor any side effects and treat them when possible. For example, protective gels can be used to treat mouth ulcers, and medicines are available for a dry mouth.
Most side effects should pass within a few weeks of treatment finishing.
The type of radiotherapy you have and the length of treatment depends on the size and type of cancer, and where it is. The radiotherapy team will explain all of this to you.
External-beam radiation therapy
Most radiotherapy treatment usually involves using a machine called a linear accelerator which focuses high-energy radiation beams onto the area requiring treatment. The administration of the radiation itself is completely painless. For the treatment of head and neck cancer most patients are treated using a technique call intensity modulated radiotherapy. These cutting edge machines allow the radiation to be focused very precisely to the required area whilst avoiding damage to sensitive structure close by.
Chemotherapy uses powerful cancer-killing medicines to damage the DNA of the cancerous cells and stop them reproducing. It may be used to shrink a tumour before surgery or radiotherapy, or in combination with radiotherapy to make the radiotherapy more effective.
It can also be used to treat cancer that is advanced or has come back after treatment. In this situation, it can relieve symptoms and may slow the cancer's growth.
Chemotherapy medication is usually given as an injection into a vein (intravenously). You may need to stay in hospital for a few days during each treatment or you may just come in for a short visit each time.
Chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. This, unfortunately, means side effects are common, such as hair loss and loss of appetite.
Chemotherapy can also weaken your immune system, making you more vulnerable to infection and illness.
It's therefore important to report any symptoms of a potential infection to your MDT, such as a high temperature, chills or a persistent cough. You should also avoid close contact with people known to have an infection.
The side effects of chemotherapy should improve after your treatment has finished.
PBT is a particularly effective form of radiotherapy used to treat certain types of cancers. It uses a high energy beam of protons rather than high energy X-rays to deliver a dose of radiotherapy. It directs the radiation treatment to precisely where it is needed with minimal damage to surrounding tissue. The treatment is particularly suitable to complex childhood cancers and other hard to treat cancers.
A new clinical facility is being built that will make UCLH one of only two PBT centres in the UK.
The UCLH PBT centre is expected to treat patients in 2020.