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Neck Cancers

Deciding on a Treatment Plan

Your doctors will typically use the National Comprehensive Cancer Network (NCCN®) Clinical Practice Guidelines In Oncology (NCCN Guidelines®)for Head and Neck Cancers to decide on the appropriate treatment course.6Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2013. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed June 20, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc. If NCCN Guidelines® are not followed, they will discuss it with you and explain why your situation might be special.

Before starting treatment, your doctor will make sure that the following steps are completed.

Preoperative Evaluation

  • A full history and physical examination
  • An evaluation by the members of a head and neck cancer team
  • A biopsy to confirm a diagnosis of cancer
  • Possibly, testing for HPV
  • Evaluation of the lungs to check for spread
  • Imaging of the primary tumor (if known) and the neck
  • Maybe a PET-CT for advanced cancers
  • Possible dental evaluation with or without jaw imaging
  • Nutrition, speech and maybe even a hearing evaluation
  • Preoperative medical clearance and optimization of medical conditions

Then your doctor will recommend a course of treatment for you, depending on a number of factors. As with all cancers in the head and neck, there are three general therapeutic options to consider, which may be used alone, together, or one after the other:

Treatment decisions for tumors in the neck require a discussion among all types of doctors involved in treating these types of cancers.

For metastatic tumors, you should read about the treatments for the primary tumor site.

Sarcoma

Sarcomas of the head and neck should be treated by a team of doctors in radiation, oncology and surgery. This team should have experience in dealing with these types of cancers. According to the NCCN Guidelines, if the sarcoma is resectable, without causing major problems in function afterwards, there are two options for initial treatment:7Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Soft Tissue Sarcoma V.1.2013. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed July 17, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

  • For stage I disease, surgery should be first, and then radiation should be considered depending on findings during the surgery.
  • For stage II and III disease that can be resected, there are many different options that use different orders of the three main treatment types (surgery, radiation, chemotherapy). You should speak to your doctor about which they are recommending for you and why.
  • For unresectable disease (meaning it cannot be removed without causing you major problems), some combination of chemotherapy and radiation will be suggested. If some of the cancer remains and it is now possible to remove it, your doctor now might recommend surgery.

Lymphoma

For lymphoma, radiation can be used in select cases; but generally, chemotherapy is the main therapy. Surgery plays very little role in the treatment of lymphoma, except to help with biopsies. You should be treated by a team of doctors experienced in dealing with lymphoma since the exact treatment regimens can get very complex, particularly since there are so many different types of lymphomas. It is important that a specialized pathologist analyze the tissue to determine the exact type of lymphoma before you start any treatment.

References

1 Gurney JG, Young JL, Roffers SD, Smith MA, Bunin GR. SEER pediatric monograph – soft tissue sarcomas. National Cancer Institute. Page 111. http://seer.cancer.gov/publications/childhood/softtissue.pdf.

2 Fletcher CDM, Rydholm A, Singer S, Sundaram M, Coindre JM. Soft Tissue Tumours. In: Barnes EL, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumours: pathology & genetics WHO Classification. Lyon: IARCPress; 2005.

3 Zhang MQ, El-Mofty SK, Dávila RM. Detection of human papillomavirus-related squamous cell carcinoma cytologically and by in situ hybridization in fine-needle aspiration biopsies of cervical metastasis: a tool for identifying the site of an occult head and neck primary. Cancer. 2008;114(2):118-23.

4 Cunningham MJ, Myers EN, Bluestone CD. Malignant tumors of the head and neck in children – a 20 year review. International Journal of Pediatric Otorhinolaryngology. 1987;(13)3:279-292.

5 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Page 611.

6 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2013. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed June 20, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

7 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Soft Tissue Sarcoma V.1.2013. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed July 17, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

8 Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.