Tongue Base Cancer
Deciding on a Treatment Plan
Before starting treatment, your doctor will make sure that the following steps are completed.
Pretreatment Evaluation
- A full history and physical examination, including a complete head and neck exam (mirror and fiberoptic exam, if needed)
- An evaluation by the members of a head and neck cancer team
- A biopsy of the primary site or FNA of the neck to confirm a diagnosis of cancer
- Imaging of the lungs to check for spread, if needed
- Imaging of the primary tumor and the neck with CT and/or MRI
- Maybe a PET-CT for advanced cancers
- Testing for HPV
- EUA with endoscopy as needed
- A dental evaluation with or without jaw x-rays
- Nutrition, speech and swallowing evaluation and maybe even a hearing evaluation
- Pretreatment medical clearance and evaluation of medical conditions
Then your doctor will recommend a course of treatment for you, depending on a number of factors. As with all cancers in the head and neck, there are three general options to consider:
- Surgical removal (with or without reconstruction)
- Radiation (a few different types)
- Medications (chemotherapy and biologic medications)
For oropharyngeal cancer, there is not one clear treatment method. You should have an extensive discussion with your cancer team to decide upon the best treatment course for you personally.
T1-2, N0-1 | For small primary tumors, with at most one lymph node on the same side as the primary tumor (T1-2, N0-1), the options for treatment are as follows:
If treatment without surgery is chosen and there appears to be cancer left after treatment, then surgery should be performed to remove everything (see Pharyngectomy and Neck Dissection). If the first treatment that you and your doctor decide upon is surgical removal of the cancer, then the cancer has to be analyzed under the microscope to determine if additional treatment is needed. Your doctors will be on the lookout for any adverse features, which include:
For example:
|
T3-4a, N0-1 | These are locally advanced cancers, which means that the primary tumor is quite large. In this case, there are a few treatment options that your doctors will consider:
Again, if treatment without surgery is chosen and there appears to be cancer left after treatment, then surgery should be performed to remove everything (see Pharyngectomy and Neck Dissection). If the first treatment that you and your doctor decide upon is surgical removal of the cancer, then the cancer has to be analyzed under the microscope to determine if additional treatment is needed. Your doctors will be on the lookout for any adverse features:
Then,
|
Any T, N2-3 | This is a cancer involving either many lymph nodes in the neck, large lymph nodes in the neck, and/or lymph nodes on both sides of the neck and/or lymph nodes on the side of the neck opposite to the main tumor mass.There are a few options for the initial treatment:
If a non-surgical treatment is chosen as the first line, your doctor will determine whether the cancer is gone:
If the first treatment that you and your doctor decide upon is surgical removal of the cancer, then the cancer has to be analyzed under the microscope to determine if additional treatment is needed. Your doctors will be on the lookout for any adverse features such as:
Then,
|
T4b, any N Unresectable neck disease Unfit for surgery |
In cases that are very advanced, or in patients who are extremely sick, an extensive discussion with your doctors should be undertaken. |