Treatment

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.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

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 they plan treatment, doctors 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 (specialists who perform restorative surgery in the head and neck areas); dentists; physical therapists; speech pathologists; audiologists; psychiatrists; nurses; dietitians; and social workers. It is extremely important that a comprehensive treatment plan is established prior to the start of therapy, and people may need to be seen by multiple specialists before a treatment plan is fully developed.

In addition, this evaluation may include testing for HPV infection. As outlined in the Risk Factors section, HPV has been linked to a higher risk of head and neck cancer. Whether a person has HPV can also be a factor in determining which treatments are likely to be most effective, in some cases.

Descriptions of the most common treatment options for head and neck cancer are listed below. There are three main treatment options: surgery, radiation therapy, and chemotherapy. One of these therapies, or a combination of them, may be used to treat the cancer.

Surgery

During surgery, the doctor performs an operation to remove the cancerous tumor and some of the healthy tissue around it (called a margin). A surgical oncologist is a doctor who specializes in treating cancer using surgery. The goal of surgery is to remove all of the tumor and leave negative margins (no trace of cancer in the healthy tissue). Laser technology may be used to treat early-stage tumors, especially in larynx cancer. 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; additional treatments might be necessary.

Depending on the location, stage, and the type of the 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, removing the jaw, skin, pharynx, or tongue), reconstructive or 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 help the patient relearn how to swallow and communicate using new techniques or special equipment.

Sometimes, surgery is followed by radiation treatment and/or chemotherapy to destroy cancer cells that cannot be removed during surgery.

Side effects of surgery depend on the type and location of the surgery, and may include:

• Swelling of the mouth and throat area, making it difficult to breathe. Some patients may receive a temporary tracheostomy (a hole in the windpipe) to make breathing easier.
  
  
• Temporary or permanent loss of normal voice or impaired speech
  
  
• Difficulty chewing or swallowing. A tube may be inserted in the stomach for feeding purposes.
  
  
• Facial disfigurement. Reconstructive surgery may be required to maintain appearance or body functions, such as chewing, swallowing, or breathing.
  
  
• Hearing loss
  
  
• Decreased functioning of the thyroid gland, especially after a total laryngectomy (the removal of the larynx) and/or radiation therapy

Learn more about cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.

Specific types of external-beam radiation therapy include intensity modulated radiation therapy (IMRT), which allows for more effective doses of radiation therapy to be delivered while reducing the damage to healthy cells and causing fewer side effects. Proton therapy (also called proton beam therapy) is another type of external-beam radiation therapy, using protons rather than x-rays. At this time, however, proton therapy is not a standard treatment option for most head and neck cancers.

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 experienced 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. Learn more about dental health during cancer 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.

Radiation therapy to the head and neck may cause the following side effects:

• Redness or skin irritation to the treated area
  
  
• Swelling
  
  
• Dry mouth or thickened saliva, from damage to salivary glands
  
  
• Bone pain
  
  
• Nausea
  
  
• Fatigue
  
  
• Mouth sores and/or sore throat
  
  
• Dental problems (usually preventable)
  
  
• Painful or difficulty swallowing (short and long-term)
  
  
• Changes in voice because of swelling or scarring
  
  
• Loss of appetite, due to a change in sense of taste
  
  
• Hearing loss, due to buildup of fluid in the middle ear
  
  
• Buildup of earwax that dries out because of the radiation therapy’s effect on the ear canal
  
  
• Fibrosis (scarring)

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. Every patient who receives radiation therapy to the neck area should have his or her thyroid checked regularly. Learn more about radiation therapy

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Targeted therapy

Targeted therapy is a treatment that targets faulty genes or proteins that contribute to cancer growth and development. Targeted therapies against a tumor protein called epidermal growth factor receptor (EGFR) may be used. Learn more about targeted treatments.

Find out more about common terms used during cancer treatment.