A Noninvasive Treatment for Painful Mets from Head/Neck Cancers

While the term head and neck cancers refers to a group of cancers located in or above the neck, each type has a separate name based on its location:

• Nasopharyngeal cancer (starts in the upper part of the throat behind the nose)
• Hypopharyngeal cancer (starts in the lower part of the throat)
• Laryngeal cancer (most common type of throat cancer)
• Tonsil cancer (starts in the cells of the tonsils)
• Nasal cavity and paranasal sinus cancer (very rare, forms in the space behind the nose or the adjacent air cavities)
• Salivary glands
• Oral cancer (may affect the lips, lining of lips/cheeks, teeth, gums, tongue, and floor or roof of the mouth)
• Oropharyngeal cancer (the part of the throat just behind the mouth

Note that thyroid cancer and brain cancer are treated as separate cancers not part of head and neck cancers.

Stages of head and neck cancers

Head and neck cancers are staged by how localized or spread (metastasized) they are, abbreviated as T, N, or M:

• Tumor (Stage T) – refers to the primary tumor and which adjacent tissues are involved. This is considered localized disease because it has not yet spread beyond the immediate area.
• Node (Stage N) – refers to cancer having spread into the lymph nodes closest to the tumor. The lymph nodes are small structures that are part of the immune system. Since the lymph system has interconnected locations throughout the body, Stage N is often a precursor to more widespread disease.
• Metastasis (Stage M) – refers to the cancer cells having spread to distant organs (e.g. lungs or liver) and bone. Once there, they can form tumors, often called “mets.”

Treating head and neck cancers is based on stage, and according to the National Cancer Institute, may include “surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments.”

Bone mets

Although the lungs are the site of most metastatic head and neck cancers, each type can invade one or more bones – though this is quite rare. A 2013 journal article reports that the most common skeletal sites are the “parietal bone of skull, shaft of humerus and femur, sacrum, and ribs.”

The first symptom of bone mets is usually severe bone pain, though fractures, spinal compression and elevated blood levels of calcium may also indicate bone mets from a head or neck cancer. Although the length of survival is shortened once bone mets are diagnosed, it is essential to preserve quality of life by treating the bone pain. This easing of pain is called palliative care. Medication may not be sufficient for palliation of bone pain. Surgery may not be indicated depending on the location of the lesion(s), and radiation is not immediately effective and not always durable. In addition, patients who have already been treated with radiation of the primary tumor may not be candidates for more radiation, depending on the location.

MRgFUS for painful bone mets

Fortunately, there is an innovative new treatment called MR-guided Focused Ultrasound (MRgFUS). Magnetic resonance imaging is a preferred method to detect and help diagnose bone mets. Once the lesion is confirmed by an MRI scan, doctors can plan the MRgFUS treatment. The treatment consists of noninvasive targeted delivery of ultrasound (sound waves) to the bone mets lesion. When the soundwaves are directed from several different directions to the lesion, they generate lethal heat at the point where they meet. This heat destroys (ablates) the metastatic bone tumor, and deadens the nerves that send pain messages to the brain.

With 3-7 days after treatment, most patients have significant pain reduction – in some cases, almost zero pain.

Advantages of MRgFUS

Patients who are candidates for palliative surgery or radiation for their bone mets are also candidates for MRgFUS, which offers the following advantages:

• Noninvasive procedure done inside the MRI equipment
• No surgery, no risk of infection

No exposure to radiation

• Outpatient procedure
• Return to normal activity in a few days
• Pain control results in a week or less
• Competitive, if not better, results when compared with surgery and radiation
• Significant pain relief that is as durable, if not more so, than radiation

If you or a loved one has been diagnosed with metastatic head or neck cancer, the Sperling Medical Group offers state-of-the-art magnetic resonance imaging to scan for bone mets. If the presence of bone mets becomes painful, our Center offers the Exablate MRgFUS to relieve pain that does not respond to medication. For more information, contact our Center, or visit our website.