Management of Head and Neck Cancers With Multidisciplinary Teams at Morristown Medical Center

Tom Thomas, MD, MPH

Otolaryngologist, Director

Head and Neck Reconstructive Surgery and Transoral Robotic Surgery (TORS)

Leonard B. Kahn Head and Neck Cancer Institute

Morristown Medical Center of Atlantic Health System

Morristown, NJ

Management of head and neck cancers requires a robust multidisciplinary team to manage the complex surgical and nonsurgical (radiation, chemo/immunotherapy) treatment aspects of the disease process.

At the Leonard B. Kahn Institute for Head & Neck Cancer at Carol G. Simon Cancer Center at Morristown Medical Center, patients presenting with cancers of the head and neck can expect world-class treatment from initial consultation all the way through post-treatment management and long-term follow-up.

“Head and neck cancers are treated and cured with surgery, but sometimes when the patient is unable to undergo surgery or they will benefit from non-surgical treatment, we work together in a multidisciplinary fashion. This involves radiation oncology and medical oncology,” Tom Thomas, MD, MPH, otolaryngologist and director of Head and Neck Reconstructive Surgery and Transoral Robotic Surgery (TORS) at the Leonard B. Kahn Head and Neck Cancer Institute at Morristown Medical Center of Atlantic Health System in New Jersey, said in an interview with CancerNetwork®. “We have an entire village of people taking care of head and neck cancer because it affects patient’s identity and function, let it be breathing, speech, swallow, or overall well-being.”

Patients presenting to the center are usually referred through primary care or an otolaryngologist in the community with symptoms such as sore throat or a lump in the neck that was found incidentally. Typical diagnostic work-up includes full physical examination, history taking, endoscopy, and biopsy for confirmation of disease.

“We have a multidisciplinary tumor board, where the surgeons, radiation oncologists, medical oncologists, pathologists, and radiologists sit together to have a discussion/debate about what is the best treatment for that particular patient,” Dr. Thomas said. “We follow national treatment guidelines on all of our patients, and we get the entire multidisciplinary team involved in caring for that patient from that point forward.”

Surgical Management at Atlantic Health System

With clinical interests focused on surgical management of both benign and malignant head and neck tumors, Dr. Thomas detailed standard treatment of patients with head and neck cancer who present at Morristown Medical Center.

The difficult to access oropharynx region, including the palatine tonsils and base of tongue, represents the most common area for cancers originating from human papillomavirus (HPV), with the Centers for Disease Control and Prevention (CDC) estimating up to 70% of all oropharyngeal cancers stemming from HPV-related causes.1 Overall, about 10% of men and 3.6% of women have oral HPV, with prevalence of infection growing over the last few decades.

“Because these are sensitive areas in terms of speech and swallow, we try to use transoral robotic or minimally invasive techniques to resect the tumor,” Dr. Thomas said. “We also use guided CO2 laser to perform transoral laser microsurgery.”

Dr. Thomas stated that even larger lesions can usually be resected, using the tried-and-true traditional open surgery followed by microvascular, plastic, and reconstructive surgery.These patients usually require adjuvant radiation with or without chemotherapy.

When asked about areas of specialty, Thomas said there are no areas of the head and neck that they do not treat at Morristown Medical Center. “We treat everything from the top of the skull/scalp to the clavicle,” he said, or more aptly, “from dura to pleura.” We can surgically manage, all types of skin cancers, thyroid and parathyroid pathologies, parotid, paraganglioma, carotid body tumors, skull base tumors, oral cavity, oropharynx, and the larynx benign and malignant tumors.

Available Clinical Trials

Along with surgical management, patients who require systemic therapy to treat more advanced disease are treated by medical oncologists. Additionally, the Atlantic Health System has several open clinical trials for the treatment of patients with advanced-stage head and neck cancers.

Moving Care Forward

In general, Dr. Thomas says he maintains follow-up care with his patients for at least 5 years, which includes closer follow-ups early in the cancer surveillance per national guidelines.Follow-up includes full head and neck physical examination and endoscopy. After this time, they are considered cured and can choose to follow up with me once a year or not.

Atlantic Health System has a team of professionals besides our physicians and mid-level providers such as head and neck nurse navigator, nutritionist, speech and swallow therapist, prosthodontist, physical therapist,who are dedicated to caring for our head and neck cancer patients.

“Patients should always follow up with their primary treatment physician,” Dr. Thomas said. “I’m available to my patients for the rest of their life.”

Reference

HPV and Oropharyngeal Cancer. Centers for Disease Control and Prevention. December 13, 2021. Accessed May 17, 2022. https://bit.ly/3PtMYbS