Many head and neck cancers can be cured if found early. Physicians use the results of diagnostic tests to determine the site of the cancer and to stage it—or tell how far it has spread. This helps determine the outlook for recovery and the best course of treatment. It is important to understand that treatments to this area of the body can affect eating, breathing, talking or appearance. They may also require rehabilitation and/or reconstructive surgery. Patients should work together with their physician to choose the best treatment options, and understand the risks and benefits of each.
While it is not usually the first treatment choice for head and neck cancer, surgery may be used to remove the primary tumor. This is typically followed by radiation therapy or chemotherapy to kill any remaining cancer cells. The type of surgery performed depends on the location of the cancer. For instance, surgeries in the nasal cavity are often performed with an endoscope (a thin, flexible lighted tube inserted into the nasal cavity or sinus) to see and remove the tumor, rather than cutting through the bone to open up the whole cavity. If the cancer has spread to the lymph nodes in the neck, these may be removed as well.
Chemotherapy (also called “chemo”) employs oral or injected drugs to kill cancer cells. These drugs enter the bloodstream and travel throughout the body, making the treatment useful for cancers that have spread to distant organs. It is also used to shrink head and neck tumors prior to surgery.
Because chemo kills some normal cells in addition to malignant ones, it can cause side effects that vary depending on the type of drug used. These include, but are not limited to, fatigue, nausea, vomiting, loss of appetite, hair loss, mouth sores, changes in menstrual cycle and infertility. It can also cause low white blood cell and platelet counts resulting in higher risk of infection and easy bruising/bleeding. Chemotherapy is often used concurrently with radiation therapy.
With head and neck cancers, preserving vital organs in the area is extremely important. For this reason, radiation is often the first treatment approach with the goal of eliminating, or at least shrinking, the tumor prior to surgery. Surgical removal of the lymph nodes may be necessary if the cancer has spread and not all of the disease is eliminated by radiation. Radiation can be delivered internally or externally. Side effects of radiation are usually limited to irritation around the radiation site, although many patients also report fatigue.
Brachytherapy With brachytherapy, radioactive seeds (pellets) are placed into the head and neck tissue, next to the cancer. The seeds give off small amounts of radiation over several weeks. For head and neck cancers, brachytherapy is often used with external-beam radiation therapy. This radiation method carries small risks associated with seed migration within the body.
External-Beam Radiation Therapy External-beam radiation is much like getting a regular x-ray, but with a much higher dose of radiation. Precisely-focused beams of radiation are focused on the affected area from outside the body. Therapy is administered five days a week for a defined number of weeks, depending on the size, location and type of tumor. This schedule allows enough radiation to get into the body while giving healthy cells time each day to recover. The treatment itself takes only minutes and is usually painless, but since nearby healthy tissue can be damaged, radiation that reaches vital organs in the head and neck area can pose a risk. In addition, radiation therapy to the head and neck area may increase the risk of mouth infections and tooth decay. Due to the complicated structures involved in this area of the body, external-beam radiation is used primarily for palliative treatment in the case of head and neck cancers.
Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) IMRT/IGRT is rapidly replacing traditional external-beam radiation therapy for treating certain cancers. These methods deliver higher radiation doses more precisely to cancerous tumors while avoiding healthy tissue. With IMRT/IGRT, physicians can more effectively treat tumors in the head and neck while reducing the chance of side effects caused by damage to important surrounding tissue and structures. IGRT can also potentially shorten the duration of therapy and enable physicians to treat some head and neck cancers for which traditional radiation therapy was not an option.