Head & Neck Cancer & Treatment Options

According to the American Cancer Society, almost 72,000 men and women were diagnosed with cancers of the head and neck area in 2008.  35,310 of them were diagnosted with cancers of the oral cavity (mouth) and pharynx (throat) alone. Risks are greatest in men over the age of 50, but it can occur at a younger age.

Risk Factors

Risk for the development of certain head and neck cancers increases with age. Certain practices increase the risk of developing cancer. Risk factors include:

• Smoking or use of smokeless tobacco, such as chew or dip
• Alcohol consumption
• Diet low in fruits and vegetables is associated with an increased risk for oral cancers
• Exposure to viruses especially human papillomavirus (HPV)
• Prolonged occupational exposure to wood dust, asbestos or other chemicals
• Approximately 30% of lip cancers occur in individuals with occupations requiring prolonged outdoor exposure to sunlight

Diagnosis

Among the most common complaints leading to a diagnosis of a cancer of the head and neck area, with or without symptoms are:

• Lump or a sore that does not heal
• Persistent sore throat
• Difficulty or pain with swallowing
• Hoarseness or voice changes that last more than 2 weeks
• Ear pain or hearing loss
• Nasal stuffiness that does not go away
• Neck lump

Your doctor will use several approaches to look for your cancer:

• Physical examination by looking and feeling for lumps or sores in the neck, mouth and throat
• Using a thin flexible, lighted tube that is passed through the nose to obtain a more detailed assessment of the throat
• X-ray, CT, MRI or PET scans to identify the location and extent of the cancer
• Removal of a small piece of tissue (biopsy) to look at under the microscope to determine if cancer is present and if so, the type and stage of the cancer

Types of Head and Neck Malignancies

Head and neck cancers arise from the cells that make up the face, mouth and throat. Depending on the location of the cancer, recommended treatment options may vary. Some of the most common locations where cancer can occur include:

• Nasal cavity and paranasal sinuses (areas around or near the nose)
• Nasopharynx (area in back of the nose toward the base of the skull)
• Oral cavity which includes the lips, gums, floor of mouth, tongue, cheek mucosa (inside lining of the cheeks), hard palate (bony roof of mouth), retromolar trigone (area behind the wisdom teeth)
• Oropharynx which includes the base of tongue (back third of the tongue), tonsils, soft palate and oropharyngeal wall
• Larynx which includes the vocal cords and supraglottic larynx (area above the vocal cords)
• Hypopharynx (entrance to the esophagus; makes sure food goes around the larynx and into the esophagus) which includes the pyriform sinuses, post-cricoid area, and posterior pharyngeal wall (back wall of the throat)
• Salivary glands (parotid, submandibular, sublingual and minor salivary glands). These glands make saliva that keeps the mouth moist and helps digest food
• Thyroid

Treatment

Treatment of tumors of the head and neck can have significant effects on appearance. Important functions such as speaking and swallowing can be considerably affected. In certain situations a combination of treatment types (surgery, chemotherapy, and/or radiation therapy) may be recommended in order to preserve function as much as possible. Sometimes the chemotherapy and radiation therapy are used first in order to shrink the tumor. Many times this allows for a less extensive surgery or no surgery.

Surgery

The type, extent and timing of surgery will depend on the location and stage of the tumor.

Chemotherapy

This involves the administration of anticancer drugs for certain stages of head and neck cancers. It may be delivered to help shrink a tumor before surgery or after surgery when there is no evidence of cancer, but a chance it may come back.  Sometimes it will be given at the same time as radiation therapy.

Radiation Therapy

Radiation therapy plays a major role in the treatment of head and neck cancers. There are several methods by which the radiation therapy treatments can be given: External beam radiation or Brachytherapy.

• External beam radiation therapy involves a series of painless, daily (Monday through Friday) outpatient treatments delivered over approximately five to eight weeks. Sometimes the treatment is delivered twice each day with a six-hour gap between treatments. The two main techniques for delivering external beam radiation therapy are:
  • 3-dimensional conformal therapy (3-D conformal) refers to a method of treatment delivery that incorporates 3-dimensional computer planning and treatment systems to produce a high-dose area of radiation that conforms to the shape of the area to be treated. This technique allows the delivery of precise doses of radiation to the tumor through multiple treatment fields while sparing surrounding tissues.
  • Intensity modulated radiation therapy (IMRT) which utilizes a more sophisticated system of shields within the machine allowing a higher dose of radiation to be delivered to the tumor from multiple angles, while minimizing the effects on surrounding tissue. This form of 3-D conformal radiotherapy allows a precise adjustment of radiation beams to the tissue within the target area. It is used when a high dose of radiation is necessary to treat the tumor and critical normal tissue (i.e. salivary gland, structures near the eye or spinal cord) can be spared.

• Brachytherapy is a form of internal radiation therapy involving the surgical implantation of radioactive material into a tumor or surrounding tissue. It is often used in addition to external beam radiotherapy, but under some circumstances is used alone.
  • High-dose-rate brachytherapy (HDR) involves the placement of several hollow tubes in and around the tumor site. After these tubes are in place, a small amount of radioactive material is passed through these catheters by a special machine so high doses of radiation can be delivered to a precise area. The radiation is removed at the end of each treatment, but the catheters remain in the area until the radiation treatments are completed. 

Special Instructions

If you will be receiving radiation therapy to an area that will include the jaw, you will be referred to a dental oncologist (a dentist or oral surgeon who has special training in the effects of cancer surgery or radiation therapy on normal tissues) prior to beginning your treatment. They can prescribe mouth care and prevention regimens that are valuable for keeping teeth healthy despite mouth dryness that can occur when the salivary glands are in the treatment field.
During the course of your treatment you may also meet with a registered dietitian who will educate you about eating tips and nutritional supplements to assist you to maintain your weight throughout your treatment course. Sometimes your doctor will recommend the placement of a feeding tube or PEG tube (a small feeding tube that goes directly to the stomach) prior to beginning radiation therapy to ensure you are able to maintain adequate nutrition during your treatment.

Treatment Side Effects

Side effects of treatment may include redness of the skin in the treatment area (similar to sunburn), sore throat, dry mouth, taste changes, pain with swallowing, fatigue and possible hair loss in the treatment field. Side effects may differ depending on the individual and the area under treatment. Medications and nutritional supplements may be recommended to keep you comfortable during your treatment.