The American Cancer Society estimates that in the United States, approximately three to five percent of all cancers will be in the head and neck region. Treatment options are based on where a head and neck cancer starts (e.g. tongue vs. throat) because each tumor site responds to treatment type in different ways. The main two forms of treatment that can cure head and neck cancers are either radiation therapy or surgery. Sometimes, chemotherapy and/or targeted systemic therapy will be used together with radiation therapy to improve the chance that the cancer will not come back or spread to other parts of the body.
Treatment for head and neck cancers depends on several factors, including the type of cancer, its size and stage, its location and your overall health. For many head and neck cancers, combining two or three types of treatment may be most effective. Treatment for head and neck cancers requires a multidisciplinary approach, including a surgeon, a radiation oncologist and a medical oncologist. Often, organ preservation with radiation treatment can get rid of a tumor without invasive procedures such as surgery.
Radiation therapy involves delivering focused radiation to treat cancer cells by destroying their ability to multiply. Surrounding healthy tissue is also affected by radiation and may have some damage. However, healthy normal cells are better able to heal from radiation injury, compared to cancer cells, because they have maintained the ability to repair radiation-induced damage.
For head and neck cancer, radiation often allows organ-sparing treatment that can give patients better swallowing and/or voice function with equal cure rates as compared to surgically removing a tumor. In some cases, radiation will be combined with surgery, chemotherapy or both.
Surgery is an important curative approach to treatment. From biopsy to evaluating the nose, mouth and throat with a flexible endoscopic camera, your surgeon can fully assess whether the tumor has spread. If surgery will be part of your treatment, your surgeon can remove the tumor with a rim of normal tissue. Depending upon the tumor location and how advanced it is, the surgeon may also surgically remove lymph nodes in the neck. The lymph nodes, part of the normal immune system, are a common path for spread in some tumors. Ask your doctors the likelihood of the lymph nodes being involved and whether you need surgery or radiation for the lymph nodes in the neck.
In some cases, surgery is combined with radiation. If radiation is the main treatment, some surgery may be helpful afterwards but is determined on a case-by-case basis. If surgery is the main treatment, radiation may be helpful after surgery if more advanced disease is found.
While surgery and radiation 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 in accomplishing those goals. Two of the main categories of systemic therapy (treatment that is injected into a person's blood system) are:
- Chemotherapy has the ability to 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, but chemotherapy is usually delivered during radiation therapy. In some cases, chemotherapy may be helpful before radiation treatment. This type of treatment is called neoadjuvant chemotherapy.
- Targeted therapy involves focusing anti-cancer treatment on certain molecules, such as the epidermal growth factor receptor (EGFR). It can be used with radiation therapy as well.
Ask your medical oncologist whether these drugs may be helpful for you.
Dental care is an essential part of preparing for treatment. Ask your doctor whether or not you need to see your dentist before starting treatment.
If you have teeth, before you begin head and neck radiation therapy you will need to be examined by a dentist or oral surgeon for a pre-radiation dental evaluation. As your mouth becomes dry following the treatments, you may be at risk for increased cavities. Therefore the dentist will make fluoride carriers for your teeth to use on a daily basis.
If the dentist determines that you need any dental procedures or if you need bad teeth removed, this must to be done prior to initiating radiation therapy because your jaw bone does not heal as well following radiation therapy. It is important to be aware that this may delay starting radiation treatment for up to two weeks to allow time for healing.
External beam radiation therapy involves a series of daily treatments that accurately deliver radiation to the area needing treatment. The radiation beam usually comes from a machine called a linear accelerator. Before beginning treatment, you will be scheduled for a session to map out the area to be treated. This will frequently involve having a CT scan. Landmarks placed on your skin (often tiny tattoos) allow the radiation therapists delivering your treatments to position you in the same position each day.
To minimize side effects, the treatments are usually spread out over several weeks, five days a week (Monday through Friday). This allows your doctors to get enough radiation into your body to kill the tumor cells, while giving healthy cells time to recover each day.
Technical terms that may be mentioned for head and neck cancer treatments include three dimensional conformal radiation therapy (3-D CRT), intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT). Your radiation oncologist can provide more information about these different techniques.
The CyberKnife System offers non-invasive radiation therapy treatments for head and neck cancers. With the CyberKnife System, we can treat head and neck tumors with pinpoint accuracy in just one to five treatments. Unlike conventional radiation therapy, the CyberKnife System leverages advanced robotics to precisely target tumors with high doses of radiation, minimizing damage to surrounding healthy tissue and minimizing side effects. The physicians of Peninsula Radiation Oncology Center have access to the Alaska CyberKnife Center at Providence Cancer Center in Anchorage. Ask your physician if the CyberKnife System is right for you.
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, but it may also be used alone or given 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 times to deliver an equivalent dose and is usually given in a few sessions over two or more days. The exact type of brachytherapy and lengths of time the seeds are in place will depend on your cancer and treatment plan.
- Side effects that occur are not the same for all patients. Ask your doctor what you might expect from your specific treatment program.
- It is likely you will receive chemotherapy in addition to radiation therapy. The side effects from the chemotherapy will depend on the type being prescribed and how often you are to receive the treatments. Ask your medical oncologist about what chemotherapy side effects you may experience. Side effects often can be controlled with medications or changes in your diet. Tell your doctor or nurse if you experience any side effects, so they can work to help you feel better.
Get plenty of rest during treatment, and don't be afraid to ask for help. Follow your doctor's orders. Ask if you are unsure about anything. Tell your doctor about any medications or vitamins 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. They might be able to help you change the way you eat. 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 and clean the area with warm water and mild soap.
Good dental care can lessen the risk of mouth infections and tooth decay. Careful brushing of your teeth can help prevent tooth decay, gum disease and jaw infections. Use a fluoride toothpaste without abrasives. Floss gently between your teeth daily using a waxed, non-shredding dental floss. It may help to rinse daily with a salt and baking soda solution. If you have questions about your dental care, ask your dentist and radiation oncologist.
Completing treatment and recovery can be challenging. Seek out help from support groups and friends ahead of time, since you should have support in place before you start getting side effects. If you need additional support, let your doctor and nurse know.
*Content provided by the American Society for Radiation Oncology, www.rtanswers.org, and the American Cancer Society.