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April 20, 2014 - 1:13am | 60°F
   

Otolaryngology/Head and Neck Surgery

 

Prevention
Symptoms
Diagnosis
Treatment
Supportive Care
Advanced Science
Clinical Trials

Head and Neck Surgery Team
Appointments
Head & Neck Cancer Alliance
In the News

Otolaryngology/Head and Neck Surgery treats cancers of the head and neck region, including those in the oral cavity (tongue, lips, mouth), larynx (voice box), pharynx (eating passage behind the voice box extending from the nose to the trachea (windpipe) and to the top of the esophagus), nose and sinuses, salivary glands, thyroid, parathyroid gland, and skin cancers on the face, scalp and neck.

The most common type of head and neck cancer is squamous cell cancer. It arises from the thin membrane that covers areas of the mouth, throat, voice box and eating passage. This type of cancer occurs in a step-by-step manner, often causing precancerous lesions that later progress to cancer.

Risk Factors & Prevention

Most head and neck cancers can develop in anyone. However, people who smoke, drink alcohol excessively or chew tobacco are at a much higher risk. Also, skin cancers occur more frequently in people with excessive sun exposure.

There is a growing incidence of thyroid cancer, and the risk factors include family history and extensive exposure to radiation. Other risk factors for head and neck cancer now include exposure to viruses such as the Human Papilloma Virus (HPV) and the Epstein Barr Virus (EBV). Researchers in the Tumor Virology Program are internationally recognized for their work in HPV and EBV. In addition, gastro-esophageal reflux is also a risk factor for some head and neck cancers. Our team of speech and swallow pathologists use video stroboscopy and transnasal esophagoscopy to determine whether a patient has acid reflux.

Screening Opportunities

Otolaryngology/Head and Neck Surgery is committed to prevention of head and neck cancers through a FREE annual screening as part of Oral, Head and Neck Cancer Awareness Week. During this week, the LSU Health Shreveport Dept. of Otolaryngology/Head and Neck Surgery, directed by Cherie-Ann Nathan, MD, FACS and Feist-Weiller Cancer Center, partner with the Head and Neck Cancer Alliance to offer a free screening to everyone interested. Doctors look for signs of cancer affecting the mouth, lips, tongue, voice box or neck. Call 318.675.6262 for information.

Symptoms

Please note that many of the warning signs of head and neck cancer are non-cancerous. However, should any of these symptoms persist, one should seek help. Call 318.675.6262 for further information.

  • non-healing ulcer in the mouth or bleeding ulcer
  • red or whitish patch in the mouth that does not go away
  • persistent hoarse voice
  • persistent ear ache
  • persistent pain or difficulty swallowing
  • nose bleeds and obstruction, especially if one sided and not responding to treatment
  • lump in the neck
  • skin lesions or moles that change color or increase in size

Diagnosis

The Otolaryngology/Head and Neck Surgery clinic realizes that patients travel long distances for treatment at Feist-Weiller Cancer Center and the clinic is committed to streamlining the diagnostic process. This patient-tailored boutique service allows patients to have many diagnostic services performed on the same day. It makes for a long, but effective visit.

Thorough head and neck exam. Otolaryngology/Head and Neck Surgery examines your ears, nose, mouth, throat and looks for swelling in the neck. ENT oncology also may conduct simple neurological tests to see whether any nerves are affected by your illness. Patient cases are presented at the weekly multidisciplinary tumor board and treatment is initiated as soon as possible. 

The following procedures may be performed at your initial visit if not previously obtained by your referring physician.

  • Biopsy. Discontinue blood thinners if approved by your doctor, and to avoid non-steroidal, anti-inflammatory medications for a week prior to your biopsy, as these increase the risk of bleeding.
  • CT scan. If not already performed by the referring physician, Otolaryngology/Head and Neck Surgery will obtain a CT scan at the initial visit and perhaps schedule an MRI.

    For patients with advanced-stage head and neck cancer, the clinic will obtain CT/PET scans to look for additional lymph node metastases and distant metastasis.

    The Biomedical Research Foundation PET center has state-of-the-art facilities with nuclear medicine physicians who are specially trained to read CT/PETs and are present at our weekly tumor board conference. This center has the only cyclotron in the state, which allows us to make novel radioisotopes, resulting in the opportunity to participate in exciting clinical trials that enable diagnosis of the spread of your disease.
  • Rapid interpretation fine needle biopsy. This service is provided by the Department of Pathology, and allows a preliminary diagnosis on a lump in the neck to be made at the time of your initial visit.

    By inserting a tiny needle into the lump, the pathologist obtains sample cells for inspection under the microscope. If the needle biopsy favors lymphoma, more material is taken with the needle for flow cytometry and molecular pathology at our state-of-the-art laboratory in the LSU Health Shreveport Department of Pathology.
  • Flexible nasopharyngolaryngoscopy and Videostroboscopy. Videostroboscopy is a noninvasive procedure performed in the clinic with local decongestants and numbing agents. We record what we see on video and use these images to compare with your follow-up exams. We want to know how well you are responding to your treatment, and how well you are able to breath, swallow, and voice. We also watch you closely, because catching problems early makes them easier to treat. 

    This is a routine office procedure that involves examining the nose, mouth, top part of the eating passages, and the voice box, including vibratory movement of your vocal cords, with a slender scope or a rigid scope depending on the type of tumor. This helps with the diagnosis and allows the patient to see the tumor so they understand the need for further treatment. The video helps when we present your case at our weekly multidisciplinary tumor board meetings. This service is provided by the Department of Pathology, and allows a preliminary diagnosis on a lump in the neck to be made at the time of your initial visit. .

Lab Analysis

Pathologists visit the Head and Neck Surgery clinic to examine the tissue biopsies under the microscope while you wait! Oftentimes this gives us a head start and indicates how to proceed with your diagnosis and treatment.

Treatment

Once your work up is complete, your case is presented at our tumor board. The multidisciplinary head and neck tumor board is composed of medical oncologists, radiation oncologists, head and neck surgeons, and other specialists who combine their knowledge to create a comprehensive treatment plan. This collaboration by physicians at Feist-Weiller Cancer Center and others throughout the community creates the best individualized treatment plan for each patient. We find this to be very important for head and neck cancers, as there are a variety of ways to treat this disease that involve many potential combinations of surgery, radiation, and chemotherapy.

Plans for subsequent testing and treatment may include:

  • preoperative workup including labwork, chest X-ray, EKG, preoperative teaching
  • scheduling of other radiological studies (MRI, ultrasounds, PET scans)
  • scheduling of medical clearance for surgery (cardiac/pulmonary). Patients can facilitate this by obtaining this from their own doctor prior to the scheduled appointment
  • appointments with ancillary specialists such as pulmonary medicine, endocrinology, or neurosurgery

Appropriate treatment is determined by multiple surgeons, radiation therapists and chemotherapists. Treatment depends on the site, type and stage of your cancer. Very often it includes combined treatment modalities, or a combination of surgery, chemotherapy and/or radiation to improve your chances of cure. Feist-Weiller Cancer Center physicians consider the chance of cure with our treatment recommendations, and strive to give you the best functional and cosmetic outcome to enhance your quality-of-life following treatment.

Surgical Options

The surgeons in the Department of Otolaryngology/Head and Neck Surgery at Feist-Weiller Cancer Center believe in a team approach to treating this disease. If a patient has cancer of the larynx and must lose any part of the larynx, a speech therapist will evaluate the patient before surgery. Patients learn they can still communicate effectively by using a voice prosthesis after surgery. Continuous advances in treatment could allow surgeons to perform partial laryngectomies and sometimes endoscopic laser laryngectomies.

If the cancer has spread to lymph nodes in the neck, surgeons remove the lymph nodes and spare major nerves and vessels such as the nerve that moves the shoulder. Some patients may need sampling of lymph nodes in the neck for certain cancers even if there is no obvious evidence of spread to the neck.

This patient has had extensive surgery having lost his voice box and also had a large incision to remove all the lymph nodes in his neck. He can now speak and has returned to work as a result of his voice prosthesis.

   

Reconstructive Surgery

Immediate reconstruction after extensive surgeries allows for the best functional results. For example, if the jaw bone is removed, it can be reconstructed by transplanting part of the leg bone to create a new jaw. If part of  the tongue is removed, it can be reconstructed with tissue from the forearm. Reconstructive surgeries are performed by Timothy Lian, MD, FACS, a microvascular reconstructive surgeon at LSU Health Shreveport and affiliated with Feist-Weiller Cancer Center.

Radiation and Chemotherapy

Chemotherapy is frequently used to increase the response of cancer cells to radiation. Dr. Nathanís research team is working on novel radiosensitizing agents with possibly fewer side effects.

Chemoprevention

Cigarette smoke causes precancerous changes in the mucosa exposed to the cigarette smoke, which increases the risk of developing cancer in the head and neck region, esophagus, or lungs. The head and neck surgery research team is studying the effects of a bioactive food compound curcumin to prevent precancers from becoming malignant. The most important preventive effort is smoking cessation.

Dr. Timothy Lian holds an exact replica of a patientís jaw bone made using 3D imaging. Taking a portion of the patientís own bone, the model will be used to fashion the bone and plates of a replacement jaw to match that removed because of cancer.

 

Supportive Care - Rehabilitation & Therapy

Head and Neck Cancer is treated by one or all of the following methods: surgery, chemotherapy and/or radiation therapy. Treatment is determined by several factors, including location and stage of disease, prior treatment and general medical health. After treatment, follow-up appointments may focus on any or all of the following:

  • evaluation of wound healing
  • postsurgical teaching
  • postoperative speech, swallowing and facial nerve rehabilitation
  • referrals to other specialists as indicated
  • discussion of test findings
  • evaluation of response to disease by physical exam, video, X-ray, scans  and/or labs
  • some patients will require a second look operative scope surgery with biopsies to confirm a response to therapy

Voice Prosthesis

Speech pathologists change out a voice prosthesis, known as TEP, in a patient who had a laryngectomy. The patient achieved excellent communication and was able to return to a normal life. The New Voice Club is a support group at Feist-Weiller Cancer Center that meets monthly to discuss technology updates, solve problems related to a prosthesis and more. For information contact Kelley Babcock, MS, CCC-SLP at 318.813.1328.

 

 

Swallow Therapy  

Speech pathologists can provide video modified barium swallow studies and FEES to determine the extent of swallowing problems and whether there is any possibility of aspiration.

Advanced Science and Research

 

 

 

 

 

Here, Dr Nathan obtains consents for research on one of her biomarker trials. Dr Nathan's award-winning discoveries in the molecular genetics of head and neck cancer inspire us to look for better prevention and treatment.

 

Gene Therapy Approches to Head and Neck Cancer

We intend to decrease the recurrence rate in this group of patients with eIF4E positive margins using gene therapy with a eIF4E antisense adenovirus vector thus decreasing the potential conversion of these occult cells into the malignant phenotype.

Goals:

  • establish eIF4E antisense adenoviral vectors
  • demonstrate that this vector suppresses the growth of established tumors of the head and neck in cell culture and in animal models
  • develop a microscopic residual model which mimics the postsurgical environment of head and neck cancer patients

Clinical Trials

Feist-Weiller Cancer Center actively participates in clinical trials and research for our cancer patients. Newly developed treatments or investigational drugs may reduce tumor size and eliminate symptoms better than treatments currently available.

Patients are asked if they would like to participate in clinical trials to evaluate new cancer prevention and treatment choices. Participation is completely voluntary. Ask your doctor about clinical trials at your visit.

Head and Neck Cancer Clinical Trials at Feist-Weiller Cancer Center. For information about ongoing clinical trials at Feist-Weiller Cancer Center, call toll-free 1.866.LSU.FWCC (578.3922) or 318.813.1410.

Dr. Nathanís laboratory is at the forefront of research in molecular targeted therapy for head and neck cancer. Often patients with the same stage disease for the same site will have dramatically different responses. It is believed that the biology of the tumor or the molecular signature of the tumor is equally important in predicting response to therapy. Patients may be asked at diagnosis to have a small piece of tumor kept for research purposes so that Dr. Nathanís laboratory can study the genetic make up of your tumor. The laboratory team consists of PhDs, research associates, clinical research nurses and students in training.

Otolaryngology/Head and Neck Surgery  Team

Head and Neck Surgery

Director of Head and Neck Surgery
Cherie-Ann Nathan, MD, FACS

Head and Neck Surgeons
Timothy Lian, MD, FACS
Robert Aarstad, MD, FACS
Cherie-Ann Nathan, MD, FACS 

Microvascular Reconstructive Surgeons
Timothy Lian, MD, FACS 

ENT Oncology
Ellen Lewis, FNP-BC
Teresa Harris, RN, ENT

Medical Oncology
Jay Marion, MD
Glenn Mills, MD, FACP
Syed Jafri, MD
Cheryl Duncan, PA-C

Speech Therapy
Kelley Babcock, MS, CCC-SLP
Ashley Mickelson, MS, CCC-SLP
Matt Morgan, M.Ed., CCC-SLP

We are a dedicated team of treating physicians, bringing novel molecular targeted therapeutics, chemopreventive agents and state-of-the-art rehabilitative techniques to our head and neck cancer patients at Feist-Weiller Cancer Center through a multidisciplinary, comprehensive team approach.

The Otolaryngology/Head and Neck Surgery program, under the leadership of Cherie-Ann Nathan, MD, FACS at LSU Health Shreveport's Feist-Weiller Cancer Center, is committed to providing excellence in patient care, teaching and most importantly, bringing novel treatments to our patients. Many head and neck cancer patients are diagnosed with a disease that causes facial disfigurement and affects major organ functions such as speech, swallowing and breathing. Specially-trained Feist-Weiller Cancer Center physicians often arrest the progression from precancer to cancer by using bioactive food compounds such as curcumin, as well as encouraging healthy eating and lifestyles. When necessary, head and neck surgeons perform ablative surgery for indicated lesions using the state-of-the-art flexible CO2 laser that is available in the clinic.

Appointments

Call 318.675.6262 to schedule an appointment and obtain medical records.

Referral Form for ENT Oncology/Head and Neck Surgery

The patient's insurance is verified and pre-authorization or physician referral is obtained (patients welcome to facilitate this process). Out-of-state patients without insurance are referred to UTMB due to self-pay status, or are informed and agree to make required deposits. Louisiana residents without insurance must apply for free care through financial counseling.

What to Bring

Bring outside films, records and slides if the patient has been biopsied. Out pathologist will review all prior workshops. Patient needs to bring a list of all medications.

Don't forget your state ID, insurance cards and co-pay, if any.

Directions & Parking 

What to Expect on Your First Appointment

Full registration completed on the first floor at Feist-Weiller Cancer Center.

The patient then will check in at the third floor Otolaryngology/Head and Neck Surgery Clinic. Nurses will assess the patient, take vital signs, weigh the patient and record medications. Please bring your list of current medications.

Soon the patient will be called to an exam room for a series of tests.

Feist-Weiller Cancer Center ē 1501 Kings Highway ē Shreveport, LA 71103
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