AN OVERVIEW OF HEAD AND NECK CANCERS WITH DR DANIEL BOWLES
Presenter:
Daniel Bowles, MD, Rocky Mountain Regional VAMC
Conference:
2024 Meeting of the Oncology Nursing Society (ONS) Metro Denver Chapter
At the 2024 Meeting of the Oncology Nursing Society (ONS) Metro Denver Chapter, Dr Daniel Bowles' presentation provided an in-depth examination of head and neck cancers, primarily squamous cell carcinomas (HNSCC), which can affect various areas of the upper respiratory and digestive tracts, including the oral cavity, throat, and larynx. Dr. Bowles emphasized the critical role of a multidisciplinary approach in the diagnosis and treatment of these cancers, due to their considerable clinical complexity. He highlighted that the primary risk factors for HNSCC include tobacco use, alcohol consumption, and HPV infection, with HPV emerging as a leading cause. Notably, head and neck cancers now represent the most common HPV-associated malignancy worldwide, surpassing cervical cancer.
Patients with head and neck cancers typically present with symptoms such as a neck lump, throat discomfort, or unexplained pain. The diagnostic process generally begins with imaging and referral to an ear, nose, and throat (ENT) specialist, followed by biopsy and staging. For cancers of the tonsils or base of the tongue, HPV status testing using the p16 surrogate marker is essential, as HPV-positive tumors are associated with improved outcomes. Upon diagnosis, patients often require consultations with multiple specialists—including radiation oncologists, medical oncologists, and speech pathologists—and substantial nursing support is needed to help coordinate their care.
Dr. Bowles outlined that treatment strategies for head and neck cancers depend on both the cancer's anatomical location and HPV status. Early-stage cancers (HPV negative stage I-II, some stage I HPV-positive) are typically addressed with single-modality treatments, such as surgery or radiation. In contrast, advanced-stage tumors (HPV negative stage III-IVb and HPV positive stage II-III) require multimodal approaches, which combine surgery, radiation, and sometimes chemotherapy. He underscored that, for cancers of the oral cavity, surgery is essential as the primary treatment, in order to achieve optimal outcomes. Treatment protocols for HPV-positive tumors may vary slightly, with ongoing trials investigating the possibility of reducing treatment intensity due to the high cure rates and the long-term side effects of aggressive therapy.
Dr. Bowles also highlighted the long-term and acute side effects associated with treatment, which can be considerable. Radiation therapy, for example, can lead to dry mouth, swallowing difficulties, taste changes, and secondary cancers, while cisplatin—one of the primary chemotherapy agents used in head and neck cancers—can cause nausea, fatigue, hearing loss, and kidney damage. Oncology nurses play a vital role in managing these toxicities, through interventions such as hydration protocols and patient education. While it is essential in some cases, surgery can also result in disfigurement, lymphedema, chronic pain, and communication challenges, especially for patients who undergo a laryngectomy.
Post-treatment surveillance involves regular follow-up visits with ENT specialists and periodic imaging, often with PET/CT scans, at three months after treatment, in order to assess response. Dr. Bowles recommended that thyroid function should be monitored for life in patients who received neck radiation. Supportive care remains crucial after treatment completion, including ongoing dental care, speech therapy, nutritional management, and counseling for substance use. Smoking cessation is particularly emphasized, as continued smoking during treatment can significantly decrease the likelihood of cure.
In cases where cancer recurs or metastasizes, the prognosis becomes more complex. Most relapses occur locally within the head and neck region, although distant metastases are possible. Immunotherapy, particularly checkpoint inhibitors like pembrolizumab, has become a frontline treatment option for recurrent or metastatic disease, offering improved outcomes over traditional chemotherapy. While some patients achieve remarkable responses, however, most do not attain long-term remission, underscoring the need for continued research and clinical trials.
Dr. Bowles also discussed future directions in the treatment of head and neck cancers, noting several promising areas of investigation. Proton therapy, for example, is being explored as an alternative to traditional (photon-based) radiation in head and neck cancers, with the potential of reducing long-term side effects. For HPV-positive cancers, researchers are also working to identify ways to reduce treatment intensity (i.e., de-escalate treatment) without compromising patient outcomes, although rigorous study design is required to avoid the risk of under-treating patients. Other promising research avenues include novel immunotherapies, cellular therapies, and new medications to reduce toxicities such as radiation-induced mucositis.
While head and neck cancers remain complex to treat, Dr Bowles notes that the field has made notable advancements in recent years, particularly with the integration of immunotherapy. He emphasized the importance of a comprehensive, patient-centered approach, involving close collaboration among medical teams and robust nursing support. Despite the inherent challenges, Dr Bowles noted that many patients can achieve favorable outcomes, especially when treated at high-volume centers with access to specialized care.
Speaker Disclosure Information: Dr. Bowles reported no disclosures for this presentation.
You can see Dr Bowles’ full presentation from the 2024 Meeting of the Oncology Nursing Society (ONS) Metro Denver Chapter here.