Treatment

Treatment Information

It is possible to cure many types of head and neck cancer, particularly if they are discovered early. While eliminating cancer is the main aim of treatment, it is also important that the function of nearby nerves, organs and tissues are preserved whenever possible. Quality of life considerations are a key focus of treatment planning, with doctors assessing how treatment might affect patients' functioning.

In New Zealand, people diagnosed with head and neck cancer are assessed by a multidisciplinary cancer team. This team includes a variety of specialists who aim to provide a balanced opinion and choices for treatment. Specifically, members of your team may include:

  • Medical Oncologist

  • Radiation Oncologist

  • Head and Neck Surgeons

  • Plastic Surgeon

  • Oral Medicine Specialist

  • Dental Surgeons

  • Radiologist

  • Histopathologist

  • Head and Neck Nurse Specialists

  • Speech and Language Therapist

  • Dietitian

  • Social Worker

The head and neck cancer multidisciplinary team approach is to help the individual and to recognise that each individual who is diagnosed with cancer is unique and has unique needs.

The most common treatment options for people with head and neck cancer are described in more detail below. These options include surgery, radiation therapy, and chemotherapy. Any one of these treatments or, indeed, a combination of them, can make up your treatment plan. Decisions about which treatment is most appropriate will be made by considering a wide range of factors, such as your type and stage of the cancer, possible side-effects of treatment, your preferences, as well as your overall health. It is a good idea for you to take time to learn about the different treatment options that are available, and the consequences that different treatments can have. This way, you and your doctor will be able to work together to figure out the best treatment for you.

Surgery

What it involves

Surgery is typically performed by a surgical oncologist (a doctor who specialises in treating cancer using surgery). The types of surgery for head and neck cancer can include:

  • Excision: An operation to remove the tumour and some of the healthy tissue that surrounds it.

  • Laser technology: Surgery performed with the assistance of laser technology. This technique is most often used to treat an early stage tumour, particularly in people with cancer affecting the larynx.

  • Lymph node dissection: Surgery to remove lymph nodes in the neck. This is done if the doctor suspects the cancer has spread to the lymph nodes. Sometimes lymph node dissection will take place at the same time as excision.

  • Reconstructive (plastic) surgery: This type of operation is done in order to restore a person's appearance following head and neck surgery that has resulted in disfigurement. For example, if surgery has required major tissue removal (e.g. removal of the jaw, skin, pharynx, or tongue), reconstructive surgery can be done to replace this tissue.

Sometimes people with head and neck cancer will need more than one surgery. However, this is dependent on the location, stage, and type of cancer that a person has. It is not always possible to completely remove head and neck cancer with surgery. Instead, it will be necessary to have additional treatment (radiation and/or chemotherapy) in order to destroy any cancer cells that could not be removed during surgery.

Side effects

Surgery can have a big impact on your physical functioning, producing changes in the ability to chew, swallow, and speak. This is typically a result of swelling in the mouth and throat area. In some cases this swelling may cause difficulty breathing. If surgery takes place inside the neck, or involves the removal of the larynx (a laryngectomy), this can cause you to experience numbness in parts of your neck or throat, due to nerves being cut.

Surgery can also have a big impact on your appearance - you may find that you look different after surgery for head and neck cancer. For example, it is common to have a swollen face and neck for a few weeks after the surgery takes place. However, in some cases swelling can last longer, especially if lymph nodes have been removed.

Sometimes a tracheotomy is needed to ensure that your breathing passage remains open. This is a tube inserted into the windpipe in the neck. This allows secretions to be removed and for the lungs to be ventilated. The larynx is bypassed and the voice cannot be used while a "cuffed" tracheostomy tube is in place. This is usually a temporary situation, lasting up to 2-3 weeks.

Chemotherapy

What it involves

Chemotherapy involves using medications that can kill cancer cells, typically by damaging these cells as they grow and divide. Systemic chemotherapy is most commonly used to treat head and neck cancers. This involves delivering anti-cancer medications orally or intravenously so that they may enter the bloodstream, making it possible for the medication to attack cancer cells that have spread to the lymph nodes and other organs.

If you need chemotherapy you will be placed on a chemotherapy regimen (schedule), consisting of a specific number of chemotherapy cycles over a set time period. Usually medications are administered once every few weeks. You may receive just one kind of chemotherapy medication at a time or, instead, a combination of medications. These medications are administered by a medical oncologist who is a doctor specialized in treating cancer with medication.

There are a number of different ways that chemotherapy can be delivered:

Intravenously (IV): This involves the infusion of liquid medication directly into a vein. Most traditional chemotherapy medications use this method.

Orally: Some chemotherapy medications can be taken be mouth and swallowed as a pill, capsule, or liquid. This method of administration is becoming more and more common.

Injected: Chemotherapy medication can be injected into a muscle or the fatty part of a person's arm, leg, or abdomen.

Intra-arterially (IA): Medication can be injected into an artery responsible for supplying blood to C tumour.

Intraperitoneally: This method of administration involves injecting medication into the abdomen or peritoneal cavity (the part of the body that contains the intestines, liver, and stomach).

Topically: Chemotherapy medication can be applied as a cream and rubbed into the skin.

Side effects

Not all people respond in the same way to chemotherapy. Side effects vary among individuals and also depend on the dose of medication they have received and for how long they have been taken. However, some side effects that you might experience following chemotherapy treatment include: nausea and vomiting, fatigue, hair loss, diarrhoea, loss of appetite, mouth sores, and a heightened risk of infection. Fortunately, there are ways to lessen some of these side effects, for example, by taking medication to help prevent or reduce no used. For most people, the side effects of chemotherapy go away at the end of treatment.

Radiotherapy

What it involves

Radiotherapy involves using carefully directed and controlled high energy x-rays to kill cancer cells. If you need radiotherapy, you will have a radiotherapy regimen (schedule) consisting of a specific number of radiotherapy sessions over a set period of time (most often the dose of radiation needed to kill a tumour cannot be delivered all at once). Scheduling sessions over time helps to make sure that the side effects of radiotherapy are minimised. Each session usually lasts only a few minutes (although it can take up to 15 to 30 minutes to set up the equipment and put you in position). Radiotherapy might be the sole treatment used for your head and neck cancer or it might be used in combination with other treatments, such as surgery. It is typically delivered by a radiation oncologist, who is a doctor specialised in using radiotherapy to treat cancer.

The most common form of radiotherapy is called external-beam radiation therapy, that is, radiation given from a machine outside the body.

Specific types of external-beam radiation therapy include:

  • Intensity-modulated radiation therapy (IMRT): This allows for a more precise dose of radiotherapy to be targeted to a malignant tumour, while minimising the dose delivered to surrounding healthy cells. It also causes fewer side effects.

  • Proton therapy (also called proton beam therapy): This is a type of radiation treatment that uses protons rather than x-rays. However, proton therapy is not a standard treatment option for most head and neck cancers.

  • Another type of radiotherapy is internal radiotherapy (brachytherapy), which uses a radioactive source and implants very close to or inside the tumour (the radioactive source is placed so that it harms as few normal cells as possible). Internal radiation therapy lets the radiation oncologist give a higher dose of radiation to a smaller area than might be possible using external radiation treatment.

If you are having radiotherapy to your head and neck, it is likely that you will need to wear a plastic mask during your treatment. Some types of mask are transparent while others aren't. The mask will have air holes, and holes can be cut for your eyes, nose and mouth. The purpose of the mask is to keep your head from moving during treatment - this helps to make sure that your treatment is as accurate as possible.

Prior to undergoing radiotherapy for head and neck cancer, you are encouraged to speak with an oral medicine specialist (a member of your multidisciplinary team).

Radiotherapy can cause tooth decay and may result in teeth needing to be removed; but by visiting a dentist beforehand tooth decay can be prevented.

Side effects

Radiotherapy itself is painless (much like getting a regular X-ray). However, there are a number of side effects associated with this treatment. One of the major side effects is inflammation of the membranes lining the mouth and throat (mucositis), which tends to cause discomfort in the mouth and/or pain swallowing. The other major side effect of radiotherapy is dryness of the mouth (xerostomia). This is caused when the radiation beams affect the production of saliva. Dryness in the mouth is associated with a number of other symptoms, including:

  • Dry cracked lips

  • Short or long term difficulty swallowing

  • Ulceration of the mouth, lips and throat

  • Thick saliva

  • A stiff jaw

  • Redness or skin irritation

  • Loss of taste and smell

  • Reduced appetite

People undergoing radiotherapy treatment are at risk of malnutrition. Because of this, you may need a feeding tube to meet your nutritional needs. Tube feeding can either be delivered via a nasogastric feeding tube, which is a fine tube inserted through the nose into the stomach, or a gastrostomy tube which is inserted through the skin of the abdomen directly into the stomach. Both of these methods allow the delivery of nutrients directly into the stomach.

Some of the side effects of radiotherapy can have a big impact on your ability to work or function normally. For example, side effects can make it difficult to enjoy food and make social interaction tricky, as eating in public can feel embarrassing and awkward.

However, members of your multi-disciplinary team (speech and language therapists) will work with you before treatment to help prevent any long-term problems with speaking or eating.

Radiotherapy can also lead to a condition called hypothyroidism (often referred to as an underactive thyroid). This is a common disorder in which the thyroid gland (located in the neck) does not produce enough thyroid hormone. The symptoms include feelings of tiredness and sluggishness. The good news is that hypothyroidism can be easily treated with thyroid hormone therapy. If you are undergoing radiotherapy to the neck area it is important that you have your thyroid checked regularly.