Head & Neck Cancer

In 2015, The American Cancer Society estimates that in the United States, approximately 3-5 percent of all cancers will be in the head and neck region. This year, an estimated 45,780 people (32,670 men and 13,110 women) will develop head and neck cancer. 8,650 deaths (6,010 men and 2,640 women) will occur this year as a result of this cancer diagnosis.

Treating Head and Neck Cancer

Treatment for head and neck cancers depends on several factors. These include the type of cancer, tumor size and stage, tumor location and the patient’s general health. Effective treatment for head and neck cancers requires a team approach. The team includes a surgeon, a radiation oncologist and a medical oncologist. Surgery and/or radiation therapy are the best options for cancer found in its early stages. For more advanced tumors, combination therapy including surgery, radiation therapy and/or chemotherapy may yield the best results.

Radiation Therapy

Radiation therapy is one of the best treatments available for head and neck cancer. It involves a radiation oncologist delivering focused radiation to kill cancer cells. Surrounding healthy tissue may also be affected. However, healthy normal cells are better able to heal from radiation injury. For head and neck cancer, new technologies in radiation treatment allow for preservation of important organs.

These new techniques can give patients equal cure rates with better swallowing and/or voice function when compared to surgically removing a tumor. In some cases, radiation will be combined with surgery, chemotherapy or both.

Surgery

Surgery is another important approach to head and neck cancer treatment.  From biopsy to evaluating the nose, mouth and throat with a flexible endoscopic camera, your surgeon can determine whether the tumor has spread. If surgery will be part of your treatment, your surgeon will aim to remove the tumor along with some surrounding healthy tissue. Depending on the tumor location and size, the surgeon may also remove lymph nodes in the neck. The lymph nodes are part of the normal immune system. Lymph nodes are a common path for spread in some tumors. Ask your doctors whether you need treatment for the lymph nodes in the neck.

In some cases, surgery is combined with radiation therapy. If radiation therapy is the main treatment, some surgery may be helpful afterwards. This is determined on a case-by-case basis. If surgery is the main treatment, radiation therapy may be helpful after surgery if more advanced disease is found.

Medical Therapy

Surgery and radiation therapy focus directly on treating the tumor. Medication is often recommended to improve cure rates. A medical oncologist will evaluate you and determine what medications may be most helpful.

There are two main categories of systemic therapy (treatment that is injected into the blood stream).

  • Chemotherapy can destroy cancer cells by different methods.  Often, one to three different types of drugs may be combined to get the best outcome. The dose and schedule for treatment varies. In some cases, chemotherapy may be helpful before radiation treatment. This type of treatment is called induction chemotherapy.
  • Targeted therapy involves focusing anti-cancer treatment on certain molecules.  An example is the epidermal growth factor receptor (EGFR). Targeted therapy can be used with radiation therapy as well.

Ask your medical oncologist whether these drugs may be helpful for you.

Dental Care

Dental care is an essential part of preparing for radiation treatment. Before you begin head and neck radiation therapy, you may need to be examined by a dentist or oral surgeon. Your mouth may become dry during and following the treatments. This puts you at increased risk for cavities. Your dentist may make fluoride carriers for your teeth to improve dental health.  If the dentist determines that you need any dental work like having bad teeth removed, this must to be done before beginning treatment. After radiation treatment your jaw bone may not heal as well. Dental work may delay starting radiation treatment for up to two weeks to allow time for healing. Ask your doctor whether you need to see your dentist before starting treatment.

External Beam Radiation Therapy

External beam radiation therapy involves a series of painless sessions.  Treatments are usually scheduled daily, Monday through Friday, for five to seven weeks. In some cases, your radiation oncologist may schedule your radiation treatments to be twice a day.

Before beginning treatment, you will be scheduled for a planning session.  Your radiation oncologist will map where to treat. This procedure, called simulation, involves having X-rays and/or a CT scan.

To help you stay in position during treatment, your doctor may use a plastic mask over your head and shoulders. You can see and breathe through this form-fitting mask. It is made to comfortably minimize movement during treatment. Other devices may be used to ensure that radiation to normal parts of the mouth are avoided. You may also receive tiny marks on your skin, like a permanent tattoo, to help precisely position you for daily treatment. Sometimes, these marks can be made on the plastic mask so there are no permanent marks on your skin. Different techniques can be used to give radiation for head and neck cancer:

  • Three-dimensional conformal radiotherapy (3-D CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the affected area.
  • Intensity modulated radiation therapy (IMRT) is a specialized form of 3-D CRT that varies the intensity of each radiation beam. IMRT can help lower the chance of having a dry mouth or other side effects.

Internal Radiation Therapy

Internal radiation therapy is also called brachytherapy. This treatment involves inserting radioactive material into a tumor or surrounding tissue to give a more focused dose of radiation. For head and neck cancers, brachytherapy is often used with external beam radiation therapy. It may also be used alone or after surgery.  During brachytherapy, your radiation oncologist places thin, hollow, plastic tubes into the tumor and surrounding tissue. These tubes are loaded with tiny radioactive seeds that remain in place for a short time to kill the cancer. The seeds and the tubes are then removed. With low-dose-rate brachytherapy, the seeds will be left in place for one to three days. For high-dose-rate brachytherapy, a single radioactive seed stops at various positions along the tubes for short intervals to deliver the dose. It is usually administered in a few sessions over two or more days.

Caring for Yourself During Treatment

Cancer treatment can be difficult. You have many issues to cope with. Your oncology team, along with family and friends, are available to help.

  • Get plenty of rest during treatment.
  • Follow your doctor’s orders. Ask if you are unsure about anything.
  • Tell your doctor about any medications, vitamins or supplements you are taking to make sure they are safe to use during radiation therapy.
  • Eat a balanced diet. If food tastes funny or if you’re having trouble eating, tell your doctor, nurse or dietitian.
  • Treat the skin exposed to radiation with special care. Stay out of the sun.  Avoid hot or cold packs. Only use lotions and ointments after checking with your doctor or nurse. Clean the area with warm water and mild soap.
  • Good dental care can lessen the risk of mouth infections and tooth decay.  Use fluoride toothpaste without abrasives. Floss gently between your teeth daily using a waxed, non-shredding dental floss. If needed, it may help to rinse daily with a salt and baking soda solution.

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