Head and Neck Cancer: Types of Treatment
Treatment overview
Cancers of head and neck can be cured, especially if they are diagnosed early . Eradication of the cancer is the primary goal of treatment, but preserving the function of the nearby nerves, organs, and tissues is also equally important. We always consider how treatment might affect a person’s quality of life, such as how a person feels, looks, talks, eats, and breathes after the treatment .Our aim is always to restore the person back to his normal self as much as possible.
Overall, the main treatment options are surgery, radiation therapy, chemotherapy, and targeted therapy. Surgery or radiation therapy by themselves or a combination of these treatments may be part of the treatment plan.
Treatment options depend on several factors, including the type and stage of head and neck cancer, possible side effects, and the patient’s preferences and overall health. Patients should take time to learn about all of your treatment options. Patients are also encouraged to ask questions about things that they have not understood or they are confused about. Patients are always encouraged to talk to us about the goals of each treatment and what you can expect while receiving the treatment.
Surgery
During surgery, the goal is to remove the cancerous tumor and some surrounding healthy tissue during an operation. Types of surgery for head and neck cancer include:
Depending on the location, stage, and type of the cancer, some people may need more than 1 operation. Sometimes, it is not possible to completely remove the cancer, and additional treatments may be necessary. For example, surgery may be followed by radiation therapy, chemotherapy, or both to destroy cancer cells that cannot be removed during surgery.
Side effects of surgery
Side effects of surgery depend on the type and location of the surgery. Every patient is encouraged to talk with their doctor about the side effects expected from a specific surgery and how long the side effects are likely to last. Common side effects from head and neck surgery include temporary or permanent loss of normal voice, impaired speech, and hearing loss. People often have difficulty chewing or swallowing after cancer surgery, which may require a tube inserted in the stomach for feeding purposes. If lymph nodes were removed, there may be stiffness in the shoulders afterward. In addition, lymphedema can occur. After a total laryngectomy, which is the removal of the larynx, people may have decreased thyroid gland function that will need to be managed, such as by taking thyroid hormone medication. Another potential side effect is swelling of the mouth and throat area, making it difficult to breathe. If this side effect develops, patients may receive a temporary tracheostomy, which creates a hole in the windpipe to make breathing easier.
Some people experience facial disfigurement from surgery. Reconstructive surgery (see above) may be recommended to help appearance or maintain important functions, such as chewing, swallowing, and breathing. Patients should meet with different members of the health care team to help them make decisions about their treatment and understand the recovery process. Programs that help patients adjust to changes in body image may be useful both before and after the surgery. Talking with your doctor about what to expect and how recovery will be handled can help you cope.
Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have.
Radiation therapy
Radiation therapy (also called radiotherapy) uses high-energy radiation in the form of photons (such as X-rays) or subatomic particles (such as electrons, protons or neutrons) to damage the DNA inside your cancer cells.
A radiation therapy treatment usually consists of a specific number of settings (fractions) given over a set period of time. It can be the main treatment for head and neck cancer, or it can be used after surgery to destroy any microscopic disease remaining after surgery.
The most common type of radiation therapy is called external-beam radiation therapy (EBRT), which is radiation given from a machine outside the body. There are different ways in which EBRT can be administered.
One specific type is called 3D CRT.
Another specific type of external-beam radiation therapy is called intensity-modulated radiation therapy (IMRT).
IMRT is designed so that the beam of X-ray radiation aimed at your tumour conforms closely to the tumor’s size, shape and contours. The beam can be split into smaller beamlets of different strengths to deliver a higher dose of radiation to the tumour and lower doses to nearby healthy tissue. By combining IMRT with image-guided radiation therapy (IGRT), we are able to deliver very precise radiation therapy to your cancer while sparing normal structures.
Proton therapy is another type of external-beam radiation therapy that uses protons rather than x-rays. At this time, proton therapy is not a standard treatment option for most types of head and neck cancer. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy.
Dental Screening and TreatmentBefore beginning radiation therapy for any type of head and neck cancer, patients are screened for dental ailments by the Dentist. Because 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.
Speech and Language TherapyPeople should also receive an evaluation from a speech-language pathologist who has experience treating people with head and neck cancer. It is best that patients begin speech and swallowing therapy early, even before radiation therapy begins to help prevent long-term problems with speech or eating.
Pain SpecialistPatients may experience short- and long-term pain or difficulty swallowing, changes in voice because of swelling and scarring, and loss of appetite due to a change in their sense of taste.
In addition, radiation therapy to the head and neck may cause redness or skin irritation in the treated area, swelling, dry mouth or thickened saliva from damage to salivary glands, bone pain, nausea, fatigue, mouth sores, and sore throat. Many of these side effects go away soon after treatment has finished. Other side effects may include hearing loss due to a build-up of fluid in the middle ear, a build-up of earwax that dries out because of the radiation therapy’s effect on the ear canal, and scarring (fibrosis).
Radiation therapy also may cause a condition called hypothyroidism in which the thyroid gland (located in the neck) slows down and causes the patient to feel tired and sluggish. This is checked for once every 6 months and it is treated with thyroid hormone replacement medication. Patients are encouraged to talk to the doctor about what side effects of radiation therapy to expect before treatment begins, including how these side effects can be prevented or managed.
Medical Oncology (Systemic Therapy)
Systemic therapy is the use of drugs to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. These are generally prescribed by an expert medical oncologist.
Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or as a tablet or capsule that is taken orally.
The types of systemic therapies used for head and neck cancer include:
A person may receive 1 type of therapy at a time or a combination of therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.
The medications used to treat cancer are always evolving. New medicines and therapies are emerging rapidly. Talking with your doctor is the best way to learn about the medications prescribed to you, their aim, and their potential side effects. It is also important to let your doctor know if you are taking any other medicines or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications.
Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells, usually by preventing the cancer cells from growing, dividing, and making more cells.
A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time, or a combination of different drugs given at the same time.
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhoea. These side effects usually go away after treatment is finished.
Targeted therapy
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells with only limited damage to healthy cells.
Different tumours have different targets. To find the most effective treatment, we do different tests to identify the genes, proteins, and other factors in the cancer. This information then helps to plan the most appropriate cancer.
EGFR inhibitors. For head and neck cancers, treatments that target a tumor protein called epidermal growth factor receptor (EGFR) may be recommended. Researchers have found that drugs that block EGFR help stop or slow the growth of certain types of head and neck cancer.
Immunotherapy
Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.