One set of particularly difficult to treat carcinomas are those in the head and neck region. Head and neck cancers are any that occur in the oral cavity, pharynx or larynx. Not surprisingly, applying CRT to the head region comes with risks, as does surgery in this vital area. Of particular concern within this speciality are cancers of the lymph nodes, which are located under the jaw but also throughout the body. Tumours occurring in the organs associated with the lymph system tend to metastasise easily and can remain undetected after the original tumour has been cleared. Where it was once common for these cases to be immediately recommended for surgery, researchers are now working to develop new methods to non-invasively find and subsequently retreat these cancers. Head or neck cancer surgery is the last option because it is stressful for the patient and results in the loss of tissue. 'Currently, CRT serves as the foundation of organ preservation treatment for advanced laryngopharyngeal cancer and patients with neck tumours only receive surgical treatment if necessary,' says Dr Nobuhiro Hanai. Hanai has worked in the area of laryngopharyngeal cancer since 1996 and is currently Chief and Director of the Department of Head and Neck Surgery for the Aichi Cancer Centre Hospital in Japan. His work has focused largely on the prognosis and diagnoses of lymph node cancers and metastasis. By developing better criteria to determine when a neck dissection procedure to remove these cancers after CRT treatment is needed, he is better able to time the surgery for maximum effect or avoid it altogether. Avoiding surgery is great, but when it is ultimately required, timing is everything. 'The current way of thinking is to determine the need for neck dissection after CRT based on imaging examinations,' he says. The imaging examinations are mostly done using a PET-CT or CT scans. While PET is very accurate, it can be expensive and repeated exposure to PET is not recommended. CT scans have similar issues associated with them, so in cases where repeated scans are required, such as lymph node cancers, another option would be welcomed.