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Treatment Types

16134964Treatment type: surgery

If surgery is used for early stage head and neck cancer, it may be the only treatment modality needed and can be curative.2 Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368. Surgery can also be combined with other therapies; for example, surgery can be performed first, followed by radiation therapy.

The treatment goals associated with surgery include removing the entire tumor and keeping the nearby anatomic structures intact.2 Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368. A complication associated with extensive head and neck surgery is that it may be necessary to remove bones, such as part of the jaw, or even entire structures, such as the external ear.2, Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368.3 Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck. 2004 Sep;26(9):759-69. Your doctor is required to clearly state what will happen during your surgery, so you will know what to expect. A concern that many patients have is whether a surgical procedure will impact their appearance or ability to eat or speak.4 Gaziano JE. Evaluation and management of oropharyngeal dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9. Your health care team will use many strategies to retain both form and function, but it may require rehabilitation several months after treatment.

Treatment type: radiation therapy

If radiation therapy is used for early stage head and neck cancer, it may be the only treatment needed and can often be curative.2 Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368. Radiation therapy may also be used sequentially (e.g., after surgery) or concurrently with chemotherapy (chemoradiation).1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. 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.

Radiation therapy uses high-energy rays that disrupt the DNA of targeted cells and induce cell death, which then decreases the size of the tumor.5 Lichter AS, Lawrence TS. Recent advances in radiation oncology. N Engl J Med. 1995;332(6):371-9. To optimally deliver the high-energy rays to the site of the tumor yet protect surrounding tissues, radiation planning is performed before the radiation procedure; basically, imaging of the tumor site is mapped while the patient is positioned in the same manner as the upcoming treatment.6 Vissink A, Burlage FR, Spjkervet FKL, Jansma J, Coppes RP. Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14(3):213-225. Then, during radiation therapy treatment, the patient is carefully positioned in the same place and the beams deliver radiation therapy to the tumor.

Radiation therapy can have the following side effects:

  • Inflammation of the membranes lining the mouth (mucositis); approximately 50 percent of patients who are administered radiation therapy develop this symptom at the time of treatment, and it can cause pain and interfere with eating and/or swallowing7, Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371:1695-1709.8 Forastiere A, Koch W, Trotti A, Sidransky D. Head and Neck Cancer. N Engl J Med. 2001;345(26):1890-1900.
  • Alteration in taste7, Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371:1695-1709.8 Forastiere A, Koch W, Trotti A, Sidransky D. Head and Neck Cancer. N Engl J Med. 2001;345(26):1890-1900.
  • Decreased salivation7, Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371:1695-1709.(xerostomia)
  • Changes in voice (e.g., hoarse voice)7 Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371:1695-1709.
  • Difficulty opening the mouth (trismus)6 Vissink A, Burlage FR, Spjkervet FKL, Jansma J, Coppes RP. Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14(3):213-225.
  • Cavities, which are likely due to decreased salivation6 Vissink A, Burlage FR, Spjkervet FKL, Jansma J, Coppes RP. Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14(3):213-225.
  • Fatigue, experienced by 70 to 80 percent of patients9, Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.10, Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol. 1997 Jul;34(3 Suppl 2):4-12.11, Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008 Jul;16(7):791-801.12 Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12 Suppl 1:4-10.

Treatment type: chemoradiation therapy

Chemoradiation therapy may need to be used following surgery. Alternatively, it may be used as the initial treatment for patients with more advanced head and neck cancer.

Chemoradiation therapy can have the following side effects:

  • Inflammation of the membranes lining the mouth, or mucositis; this symptom interferes with eating or swallowing4 Gaziano JE. Evaluation and management of oropharyngeal dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9.
  • Decreased salivation13 Wendt TG, Grabenbauer GG, Rödel CM, et al. Simultaneous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer: a randomized multicenter study. J Clin Oncol. 1998 Apr;16(4):1318-24.
  • Fatigue, reported by 70 to 80 percent of patients9, Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.10, Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol. 1997 Jul;34(3 Suppl 2):4-12.11, Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008 Jul;16(7):791-801.12 Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12 Suppl 1:4-10.
  • Nausea and/or vomiting14 Doyle C,Kushi LH,Byers T, et al.2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee; American Cancer Society.Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin.2006;56:323-353.
Obviously, you want to get the cancer out of you, but it’s important not to just jump on the first options out there.Tony L. (oral cancer survivor)

References

1 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. 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.

2 Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368.

3 Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck. 2004 Sep;26(9):759-69.

4 Gaziano JE. Evaluation and management of oropharyngeal dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9.

5 Lichter AS, Lawrence TS. Recent advances in radiation oncology. N Engl J Med. 1995;332(6):371-9.

6 Vissink A, Burlage FR, Spjkervet FKL, Jansma J, Coppes RP. Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14(3):213-225.

7 Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371:1695-1709.

8 Forastiere A, Koch W, Trotti A, Sidransky D. Head and Neck Cancer. N Engl J Med. 2001;345(26):1890-1900.

9 Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.

10 Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol. 1997 Jul;34(3 Suppl 2):4-12.

11 Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008 Jul;16(7):791-801.

12 Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12 Suppl 1:4-10.

13 Wendt TG, Grabenbauer GG, Rödel CM, et al. Simultaneous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer: a randomized multicenter study. J Clin Oncol. 1998 Apr;16(4):1318-24.

14 Doyle C,Kushi LH,Byers T, et al.2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee; American Cancer Society.Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin.2006;56:323-353.

15 Horiot JC, Schraub S, Bone MC, et al. Dental preservation in patients irradiated for head and neck tumours: A 10-year experience with topical fluoride and a randomized trial between two fluoridation methods. Radiother Oncol. 1983 Aug;1(1):77-82.

16 Zlotolow IM. Clinical manifestations of head and neck irradiation. Compend Contin Educ Dent. 1997;18(2 Spec No):51-6.

17 Dimeo F, Rumberger BG, Keul J. Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc. 1998 Apr;30(4):475-8.

18 Dimeo F, Schwartz S, Wesel N, Voigt A, Theil E. Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol. 2008;19(8):1495-1499.

19 Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.

20 Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012 Jul-Aug;62(4):243-74.

21 Terrell JE, Fisher SG, Wolf GT. Long-term quality of life after treatment of laryngeal cancer. The Veterans Affairs Laryngeal Cancer Study Group. Arch Otolaryngol Head Neck Surg. 1998 Sep;124(9):964-71.

22 Ashbury FD, Cameron C, Mercer SL, Fitch M, Nielsen E. One-on-one peer support and quality of life for breast cancer patients. Patient Educ Couns. 1998 Oct;35(2):89-100.