Facts About Head & Neck Cancers

Head and neck cancers encompass malignancies in areas such as the oral cavity, pharynx, larynx, nasal cavity, and salivary glands. According to the American Cancer Society, approximately 54,010 individuals in the United States are diagnosed with head and neck cancers annually, with an estimated 10,850 fatalities resulting from these diseases.

Treatment Approaches for Head and Neck Cancer

The management of head and neck cancers is tailored based on factors including the cancer type, tumor size, stage, location, and the patient’s overall health. A multidisciplinary team—comprising a surgeon, radiation oncologist, and medical oncologist—collaborates to develop an optimal treatment plan. For early-stage cancers, surgery or radiation therapy may suffice. Advanced cases often require a combination of surgery, radiation therapy, and chemotherapy to achieve the best outcomes.

Head and neck cancer treatment options include:

Radiation Therapy

Radiation therapy plays a pivotal role in treating head and neck cancers by targeting cancer cells while sparing surrounding healthy tissue. Advancements in radiation technology have enhanced the preservation of critical structures, leading to improved functional outcomes in speech and swallowing compared to surgical interventions. In certain scenarios, radiation therapy is combined with surgery, chemotherapy, or both to enhance treatment efficacy.

External Beam Radiation Therapy

This modality delivers high-energy X-rays to the tumor site, typically administered daily from Monday to Friday over five to seven weeks. Occasionally, treatments may be scheduled twice daily, depending on the specific case.

Prior to initiating treatment, a planning session known as simulation is conducted. During this session, imaging studies such as CT scans are performed to delineate the treatment area. To ensure precise positioning during therapy, a custom-fitted mask may be created to minimize head and neck movement. Additionally, small skin markings or mask-based markers are used to guide accurate treatment delivery.

Several advanced techniques are employed in external beam radiation therapy:

Three-Dimensional Conformal Radiotherapy (3-D CRT): Utilizes multiple radiation beams shaped to conform to the tumor, minimizing exposure to adjacent healthy tissues.
Intensity-Modulated Radiation Therapy (IMRT): An advanced form of 3D-CRT that modulates the intensity of each radiation beam, allowing for precise dose distribution and reducing the risk of side effects such as xerostomia (dry mouth).
Image-Guided Radiation Therapy (IGRT): Incorporates imaging techniques before each treatment session to ensure accurate patient positioning, thereby enhancing treatment precision and sparing normal tissues.

Internal Radiation Therapy (Brachytherapy)

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.

Dental Care Considerations

Oral health is a critical component of preparing for head and neck radiation therapy. A dental evaluation is recommended prior to treatment initiation to address any existing dental issues, as radiation can increase the risk of oral complications. Preventive measures, such as fluoride treatments, may be advised to protect teeth during and after therapy. If dental extractions or other procedures are necessary, they should be completed before starting radiation to allow adequate healing time.

Self-Care During Treatment

Maintaining overall well-being during radiation therapy is essential. Patients are encouraged to:

Rest Adequately: Ensure sufficient rest and seek support from friends, family, or support groups to cope with the treatment process.
Adhere to Medical Advice: Follow the healthcare team’s instructions diligently and communicate any concerns or uncertainties.
Manage Medications: Inform the medical team about all medications, supplements, or vitamins being taken to avoid potential interactions.
Maintain Nutrition: Consume a balanced diet and consult with a dietitian if experiencing difficulties with eating or taste changes.
Protect Skin: Care for the skin in the treatment area by avoiding sun exposure, extreme temperatures, and using only approved lotions or ointments.
Practice Oral Hygiene: Implement gentle oral care routines, including the use of non-abrasive fluoride toothpaste and gentle flossing, to reduce the risk of infections and tooth decay.

Managing Side Effects

Radiation therapy may lead to side effects, which vary among individuals. Common side effects include:

Fatigue: A general sense of tiredness that typically improves after treatment concludes.
Skin Changes: Irritation or redness in the treated area, similar to a sunburn.
Oral Complications: Dry mouth, thickened saliva, mouth and throat sores, and changes in taste.
Swallowing Difficulties: Pain or discomfort during swallowing.
Voice Changes: Hoarseness or changes in voice quality.
Hair Loss: Loss of hair in the treated area, which may be temporary or permanent.

Many of these side effects can be managed with medications and supportive care. It’s important to report any discomfort to the healthcare team promptly to receive appropriate interventions.

About Our Radiation Oncology Team

Dr. O’Connor and Dr. Montes are experienced radiation oncologists specializing in the treatment of cancer using radiation therapy. Our multidisciplinary team includes radiation therapists, physicists, dosimetrists, oncology nurses, medical assistants, an oncology nurse navigator, and certified nutrition specialists, all dedicated to providing comprehensive and compassionate care throughout your treatment journey.