The treatment of head and neck cancer depends on the size and location of the tumor, whether the cancer has spread and the person’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.
Many cancers of the head and neck can be cured, especially if they are found early. Although curing the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs and tissues is also very important. When the doctors plan treatment, they consider how treatment might affect a person’s quality of life, such as how a person feels, looks, talks, eats and breathes.
Head and neck cancer specialists often form a multidisciplinary team to care for each patient, and an evaluation should be done before any treatment begins. The team may include medical and radiation oncologists; surgeons; otolaryngologists (ear, nose and throat doctors); plastic surgeons; maxillofacial prosthodontists; dentists; physical therapists; speech pathologists; audiologists; psychiatrists; nurses; dietitians; and social workers. It is imperative that a comprehensive treatment plan is established prior to the start of therapy, and patients may need to be seen by multiple specialists before a treatment plan is fully developed.
There are three main treatment options for head and neck cancer: surgery, radiation therapy and chemotherapy.
During surgery, the doctor performs an operation to remove the cancerous tumor and some of the healthy tissue around it, called a margin. The goal of surgery is to remove all of the tumor and leave negative margins, or no trace of cancer in the healthy tissue. If the doctor suspects that the cancer has spread, then the doctor may remove lymph nodes in the neck, possibly causing stiffness in the shoulders afterward. Sometimes, it is not possible to completely remove the cancer and additional therapies might be necessary.
Depending on the location, stage and the type of cancer, some people may need more than one operation to remove the cancer and to help restore the appearance and function of the tissues affected. If the surgery requires major tissue removal (for example, jaw, skin, pharynx or tongue), plastic surgery may be used to replace the missing tissue. A prosthodontist may be able to make an artificial dental or facial part to restore the ability to swallow and speak. A speech pathologist may then be needed to assist the patient to swallow and communicate using new techniques or special equipment.
Sometimes, surgery is followed by radiation treatment to destroy cancer cells not removed during surgery. Chemotherapy may or may not be given.
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Radiation can be administered in two ways: externally and internally. External-beam radiation therapy is conducted with a radiation beam aimed at the tumor.
A new method of external radiation therapy, known as intensity modulated radiation therapy (IMRT), allows for more effective doses of radiation therapy to be delivered while reducing the damage to healthy cells and causing fewer side effects.
Radiation therapy can be the main treatment for head and neck cancer, or used after surgery to destroy small pockets of cancer that cannot be removed surgically.
Before beginning radiation treatment for any head and neck cancer, patients should receive a thorough examination from an oncologic dentist, a dentist with experience in treating people with head and neck cancer. Since radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning treatment. People should also receive an evaluation from a speech pathologist who has experience treating people with head and neck cancer. Since radiation therapy can cause throat swelling and scarring, voice and swallowing are often affected.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given orally (by mouth); given intravenously (in a vein); injected either into a muscle, under the skin or directly into the cancerous tumor; or applied onto the surface of the skin.
Chemotherapy can be used in the initial treatment either neoadjuvant (before) or adjuvant (after) surgery, radiation therapy or both.
Many combined treatments (chemotherapy and radiation therapy) are performed as part of a clinical trial, which are research studies to find new treatments.