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Neck Cancers

Deciding on a Treatment Plan

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. If the sarcoma is resectable, without causing major problems in function afterwards, there are two options for initial treatment:

 

  • 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

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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 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.

7 Yuek B. Measuring and Reporting Quality of Life in Head and Neck Cancer. mcLEan, Virginia; 2002.

8 Arens C. Transoral treatment strategies for head and neck tumors. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2012;11:Doc05.

9 Weinstein GS, O'malley BW, Magnuson JS, et al. Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins. Laryngoscope. 2012;122(8):1701-7.

10 Li Y, Taylor JM, Ten haken RK, Eisbruch A. The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2007;67(3):660-9.

11 Garden AS, Morrison WH, Wong PF, et al. Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2007;67(2):438-44.

12 Eisbruch A, Levendag PC, Feng FY, et al. Can IMRT or brachytherapy reduce dysphagia associated with chemoradiotherapy of head and neck cancer? The Michigan and Rotterdam experiences. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S40-2.

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14 Lee NY, O'meara W, Chan K, et al. Concurrent chemotherapy and intensity-modulated radiotherapy for locoregionally advanced laryngeal and hypopharyngeal cancers. Int J Radiat Oncol Biol Phys. 2007;69(2):459-68.

15 Beadle BM, Liao KP, Giordano SH, et al. Reduced feeding tube duration with intensity-modulated radiation therapy for head and neck cancer: A Surveillance, Epidemiology, and End Results-Medicare Analysis. Cancer. 2017;123(2):283-293.

16 Pfister DG, Cassileth BR, Deng GE, et al. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol. 2010;28(15):2565-70.

17 Scarantino C, Leveque F, Swann RS, et al. Effect of pilocarpine during radiation therapy: results of RTOG 97-09, a phase III randomized study in head and neck cancer patients. J Support Oncol. 2006;4(5):252-8.

18 Holliday EB, Frank SJ. Proton radiation therapy for head and neck cancer: a review of the clinical experience to date. Int J Radiat Oncol Biol Phys. 2014;89(2):292-302.

19 Miller RC, Lodge M, Murad MH, Jones B. Controversies in clinical trials in proton radiotherapy: the present and the future. Semin Radiat Oncol. 2013;23(2):127-33.

20 Zenda S, Kawashima M, Nishio T, et al. Proton beam therapy as a nonsurgical approach to mucosal melanoma of the head and neck: a pilot study. Int J Radiat Oncol Biol Phys. 2011;81(1):135-9.

21 Fukumitsu N, Okumura T, Mizumoto M, et al. Outcome of T4 (International Union Against Cancer Staging System, 7th edition) or recurrent nasal cavity and paranasal sinus carcinoma treated with proton beam. Int J Radiat Oncol Biol Phys. 2012;83(2):704-11.

22 Demizu Y, Fujii O, Terashima K, et al. Particle therapy for mucosal melanoma of the head and neck. A single-institution retrospective comparison of proton and carbon ion therapy. Strahlenther Onkol. 2014;190(2):186-91.

23 Fuji H, Yoshikawa S, Kasami M, et al. High-dose proton beam therapy for sinonasal mucosal malignant melanoma. Radiat Oncol. 2014;9:162.

24 Allen AM, Pawlicki T, Dong L, et al. An evidence based review of proton beam therapy: the report of ASTRO's emerging technology committee. Radiother Oncol. 2012;103(1):8-11.

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