The American Cancer Society estimates that in the United States, approximately three to five percent of all cancers will be in the head and neck region. This year, an estimated 65,410 people (48,000 men and 17,410 women) will develop head and neck cancer.

Treating Head and Neck Cancer
Treatment for head and neck cancers depends on several factors. These include the type of cancer, tumor size and stage, tumor location and the patient’s general health. Effective treatment for head and neck cancers requires a team approach. The team includes a surgeon, a radiation oncologist and a medical oncologist. Surgery and/or radiation therapy are the best options for cancer found in its early stages. For more advanced tumors, combination therapy including surgery, radiation therapy and/or chemotherapy may yield the best results.

Head and neck cancer treatment options include:

Radiation Therapy
Radiation therapy is one of the best treatments available for head and neck cancer. It involves a radiation oncologist delivering focused radiation to kill cancer cells. Surrounding healthy tissue may also be affected. However, healthy normal cells are better able to heal from radiation injury. For head and neck cancer, new technologies in radiation treatment allow for preservation of important organs. These new techniques can give patients equal cure rates with better swallowing and/or voice function when compared to surgically removing a tumor. In some cases, radiation will be combined with surgery, chemotherapy, or both.

Surgery
Surgery is another important approach to head and neck cancer treatment. From biopsy to evaluating the nose, mouth and throat with a flexible endoscopic camera, your surgeon can determine whether the tumor has spread. If surgery will be part of your treatment, your surgeon will aim to remove the tumor along with some surrounding healthy tissue. Depending on the tumor location and size, the surgeon may also remove lymph nodes. The lymph nodes are part of the normal immune system. Lymph nodes are a common path for spreading in some tumors. Ask your doctors whether you need treatment for the lymph nodes in the neck.

In some cases, surgery is combined with radiation therapy. If radiation therapy is the main treatment, some surgery may be helpful afterwards. This is determined on a case-by-case basis. If surgery is the main treatment, radiation therapy may be helpful after surgery if more advanced disease is found.

Medical Therapy
Surgery and radiation therapy focus directly on treating the tumor. Medication is often recommended to improve cure rates. A medical oncologist will evaluate you and determine which medications may be most helpful. Ask your medical oncologist whether these drugs may be helpful for you.

DENTAL CARE

Dental care is an essential part of preparing for radiation treatment. Before you begin head and neck radiation therapy, you may need to be examined by a dentist or oral surgeon. Your mouth may become dry during and following the treatments. This puts you at increased risk for cavities. Your dentist may make fluoride carriers for your teeth to improve dental health.

If the dentist determines that you need any dental work like having bad teeth removed, this must to be done before beginning treatment. After radiation treatment your jawbone may not heal as well. Dental work may delay starting radiation treatment for up to two weeks to allow time for healing. Ask your doctor whether you need to see your dentist before starting treatment.

EXTERNAL BEAM RADIATION THERAPY

External beam radiation therapy involves a series of painless sessions. Treatments are usually scheduled daily, Monday through Friday, for five to seven weeks. In some cases, your radiation oncologist may schedule your radiation treatments to be twice a day.

Before beginning treatment, you will be scheduled for a planning session. Your radiation oncologist will map where to treat. This procedure, called simulation, involves having X-rays and/or a CT scan.

To help you stay in position during treatment, your doctor may use a plastic mask over your head and shoulders. You can see and breathe through this form-fitting mask. It is made to comfortably minimize movement during treatment. Other devices may be used to ensure that radiation to normal parts of the mouth is avoided. You may also receive tiny marks on your skin, like a permanent tattoo, to help precisely position you for daily treatment. Sometimes, these marks can be made on the plastic mask so there are no permanent marks on your skin.

Different techniques can be used to give radiation for head and neck cancer:

• 3-Dimensional Conformal Radiotherapy (3-D CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the affected area.
• Intensity Modulated Radiation Therapy (IMRT) is a specialized form of 3-D CRT that varies the intensity of each radiation beam. IMRT can help lower the chance of having a dry mouth or other side effects.

INTERNAL RADIATION THERAPY

Internal radiation therapy is also called brachytherapy. This treatment involves inserting radioactive material into a tumor or surrounding tissue to give a more focused dose of radiation. For head and neck cancers, brachytherapy is often used with external beam radiation therapy. It may also be used alone or after surgery. During brachytherapy, your radiation oncologist places thin, hollow, plastic tubes into the tumor and surrounding tissue. These tubes are loaded with tiny radioactive seeds that remain in place for a short time to kill the cancer. The seeds and the tubes are then removed. With low dose rate brachytherapy, the seeds will be left in place for one to three days. For high dose rate brachytherapy, a single radioactive seed stops at various positions along the tubes for short intervals to deliver the dose. It is usually administered in a few sessions over two or more days.

CARING FOR YOURSELF DURING TREATMENT

It is important to care for yourself as well as possible during radiation therapy.

• A balanced diet, a mild amount of physical activity, and taking time to rest are all important parts of your cancer treatment.
• Nutrition is important. Eat a balanced diet. Let your doctor know if you have trouble swallowing, food tastes funny or you have trouble eating.
• Follow your doctor’s orders, and if you are unsure of anything, ask your nurse or doctor any question you may have about your treatment.
• Be sure to tell your radiation oncologist about any vitamins or dietary supplements that you are currently taking to make sure they are safe to take during radiation therapy.
• Treat the skin exposed to radiation with special care. Stay out of the sun, avoid hot or cold packs, and only use lotions and ointments after checking with your doctor or nurse.
• You should also be sure to clean the skin over the areas receiving radiation therapy with warm water and mild soap.

Completing treatment and recovery can be challenging. Seek out help from support groups and friends ahead of time. If you have a support network in place before and during treatment, it will be easier to get through side effects since people you can count on will be around to help you. If you need additional support, let your nurse or doctor know.

POSSIBLE SIDE EFFECTS

External beam radiation therapy is not invasive, so it is rare for side effects to show up immediately. Side effects are different for each patient. In some cases, side effects lessen within several weeks, but with more intensive treatment the time for improvement takes longer.

• Mild tiredness may develop. However, fatigue from radiation therapy should improve within a few weeks after radiation treatment ends.
• Skin irritation may occur including redness, peeling or blistering and some swelling or tenderness and pain.
• Difficulty or pain when swallowing is common as well as dry mouth or thick phlegm.
• Change in voice may occur along with swelling of the voice box and hoarseness.
• Hair loss on the head, neck and face may be experienced.
• Irritation of the mouth and throat often occurs, causing pain, as well as change in taste.
• Weight loss is likely due to the possible side effects.

The way that food tastes and the amount of saliva you produce should improve after treatment ends, and pain should start to resolve.

Some side effects can be controlled with medications and changes to your diet. Ask your doctor or nurse whether you should make changes to your diet. Tell them if you experience any discomfort so they can help you feel better.

© American Society for Radiation Oncology, 2019.