Multidisciplinary Treatment in Head and Neck Cancer: Why One Surgeon Is Not Enough
The treatment of head and neck cancer is the work of a brain tumour board, not a single surgeon. Studies show that the treatment plan changes by 30-40% in patients evaluated by the tumour board. This guide explains how the multidisciplinary approach works, which specialists are involved and what to expect at each stage of treatment.
Published: 2026-07-05 · Updated: 2026-07-05
What is a multidisciplinary tumour board in head and neck cancer and why is it important?
The head and neck cancer tumour board (multidisciplinary oncology meeting) is a team of experts that meets weekly to determine the treatment plan for each patient. This team typically consists of a head-neck surgeon (ENT), radiation oncologist, medical oncologist, pathologist, radiologist, plastic and reconstructive surgeon, speech-swallowing therapist and psychologist/social work specialist. Research shows that the tumour board changes the treatment plan in thirty to forty percent of patients compared with single surgeon assessment. Organ-preserving surgical options, concurrent radiochemotherapy indications and functional outcomes (swallowing, voice, facial appearance) are better optimised with this multidisciplinary approach.
- By world standards, every patient diagnosed with head and neck cancer should be presented in a tumour board — a 30-40% change in treatment plan is a clinical reality.
- Organ-preserving approaches (transoral robotic surgery, laser microsurgery) cannot be evaluated without a tumour board; multidisciplinary discussion is essential for the correct indication.
- Radiochemotherapy alone can be as effective as surgery; which route is better is determined in the tumour board according to the stage and localisation of each tumour.
- Swallowing rehabilitation (dysphagia therapist) and psychosocial support are an integral part of the multidisciplinary team as they improve measurable quality of life outcomes.
- In Turkey, reference centres are at university hospitals such as Cerrahpaşa, Hacettepe and Marmara and experienced private oncology centres; getting a second opinion is always the patient's right.
Who is in the multidisciplinary tumour board and what is discussed?
The head and neck cancer tumour board typically meets once a week and covers all newly diagnosed or recurrent cases. The core of the meeting is formed by the head-neck surgeon (ENT or head-neck surgery specialist), radiation oncologist and medical oncologist. Pathologist, radiologist presenting CT and MRI reports, plastic surgeon for cases requiring reconstruction planning, speech-swallowing therapist (pathologist speech therapist) and psycho-oncologist complete the meeting.
For each case, the following questions are answered in the tumour board: Is the staging correct (does clinical staging match radiological findings)? Is the biopsy material adequate, has immunohistochemistry been completed? Primary surgery or radiochemotherapy first? Is an organ-preserving approach applicable? If surgery is to be performed, will neck dissection be added? Is reconstruction needed? The answers to these questions determine the treatment path and differ from a single surgeon's opinion by 30-40% in daily practice.
Organ-preserving surgery and robotic approaches
One of the most important developments in modern head and neck oncology is the replacement of aggressive open surgery with organ-preserving approaches in selected cases. With transoral laser microsurgery (TLM), precise resection at vocal cord level has become possible in early-stage laryngeal cancers instead of total laryngectomy. Transoral robotic surgery (TORS) allows removal of oropharyngeal (especially tongue base and tonsil fossa) cancers inaccessible through the mouth without facial incisions.
Patient selection is critical for the correct application of these approaches: tumour size, location, presence of cartilage and vascular invasion are carefully evaluated in the tumour board. Organ-preserving surgery applied with incorrect indication can predispose to recurrence due to inadequate margin clearance. Therefore, organ-preserving options should only be applied in centres experienced in these techniques and with an active tumour board.
Frequently Asked Questions
- Does the tumour board give a recommendation only, or does it make the treatment decision?
- The tumour board produces a multidisciplinary consensus recommendation, not a binding decision. The final decision is made by the responsible physician together with the patient's informed consent. However, studies show that adherence to board recommendations significantly improves survival.
- Where are centres with tumour boards in Turkey?
- Istanbul University Cerrahpaşa, Marmara, Hacettepe and Gazi university hospitals and major private oncology centres hold weekly head and neck tumour boards. International JCI accreditation also mandates multidisciplinary management.
- My treatment plan was made without a tumour board — what should I do?
- This situation justifies applying for a second opinion to a centre with an active tumour board. If possible, refer to a multidisciplinary centre before treatment begins; this is even more critical if bone or vascular invasion is anticipated.
- Is there a difference in treatment for HPV-positive oropharyngeal cancer?
- Yes. HPV-positive oropharyngeal cancers have a better prognosis than HPV-negative tumours and similar results can be achieved with less intensive treatment. De-escalation protocols (reduced radiotherapy dose) should be evaluated in the tumour board.
- Can organ-preserving surgery be applied to every patient?
- No. Transoral robotic surgery or laser microsurgery can only be applied in tumours of certain stage and localisation. Cartilage invasion, proximity to major vessels or insufficient mouth opening may constitute contraindications.
- Is concurrent radiochemotherapy as effective as surgery?
- In selected cases, concurrent radiochemotherapy (CCRT) is as effective as surgery but carries a different side-effect profile regarding long-term effects on swallowing, voice and mouth opening. Which approach is better should be individualised in the tumour board.
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Every patient's anatomy, expectations and clinical picture is different. Reach us on WhatsApp or via the contact form — Prof. Dr. Hasan Ahmet Özdoğan will get back with a personalised assessment.
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