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Head and Neck

This year, about 62,000 Americans will be diagnosed with cancer of the oral cavity, pharynx, larynx and thyroid.

  • More than 25 percent of oral cancers occur in people who do not smoke or have other risk factors.
  • Rates of head and neck cancer are nearly twice as high in men and are greatest in men over age 50.

Risk Factors for Head and Neck Cancer

The use of tobacco and alcohol greatly increases your chances of developing head and neck cancer. Risk factors include:

  • Alcohol consumption.
  • Smoking or use of smokeless tobacco, such as chew or dip.
  • Exposure to wood or nickel dust or asbestos.
  • Plummer-Vinson syndrome (disorder from nutritional deficiencies).
  • Exposure to viruses, including the human papillomavirus (HPV) and Epstein-Barr.

Quitting Smoking

If you quit smoking, the health benefits begin immediately.

  • For patients with head and neck cancer, quitting smoking reduces the risks of infections and developing other cancers.
  • To learn how to quit, ask your doctor or visit http://www.smokefree.gov/.

Symptoms of Head and Neck Cancer

Although there are sometimes no symptoms of head and neck cancer, common complaints include:

  • Lump or sore that does not heal.
  • Sore throat that does not go away.
  • Difficulty or pain with swallowing.
  • Change in your voice or hoarseness.
  • Blood in your saliva or from your nose.
  • Ear pain or loss of hearing.
  • Lump in the neck.
  • Nasal stuffiness that does not resolve.

Diagnosing Head and Neck Cancer

To look for cancer, your doctor will examine all the areas of your head and neck.

  • Your doctor will first feel for lumps on the neck, mouth and throat. He or she may also use a flexible endoscope, a thin, lighted tube that is passed through the nose, to obtain a more comprehensive assessment of the head and neck area.
  • X-ray, CT, MR and PET scans are often needed to show the location and extent of the cancer.
  • To confirm if you have cancer, some tissue will be removed and analyzed. This test is called a biopsy.

Types of Head and Neck Cancers

Head and neck cancers arise from the cells that make up the face, mouth and throat. Because cancers in different locations behave differently, treatment depends on the cancer type and extent. Some common locations include:

  • Nasal cavity/paranasal sinuses.
  • Nasopharynx.
  • Oral cavity (lips, gums, floor of mouth, oral tongue, cheek mucosa, hard palate, retromolar trigone).
  • Oropharynx (base of tongue, tonsils, soft palate, oropharyngeal wall).
  • Larynx (vocal cords and supraglottic larynx).
  • Hypopharynx (pyriform sinuses, post-cricoid area, posterior pharyngeal wall).
  • Salivary glands (parotid, submandibular, sublingual and minor salivary glands).
  • Thyroid.

Cancers arising in the brain or eyes are considered different from head and neck cancers. However, your doctor will check the areas to make sure the cancer has not spread.

Treatment for Head and Neck Cancer

Treatment for head and neck cancer depends on several factors, including the type of cancer, the size and stage, its location, and your overall health.

  • Surgery, radiation therapy and chemotherapy are the mainstays of treating head and neck cancer.
  • For many head and neck cancers, combining two or three types of treatments may be most effective. That’s why it is important to talk with several cancer specialists about your care, including a surgeon, a radiation oncologist and a medical oncologist.
  • An important concept in treating head and neck cancer is organ preservation. Rather than relying on major surgery, an organ preservation approach first uses radiation and chemotherapy to shrink the tumor. This allows for a less extensive surgery and may even allow some patients to avoid surgery altogether.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast.

  • Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks.
  • The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed.
  • 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.
  • Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of the radiation beams. It is currently being studied for treating breast cancer.
  • Side effects might include skin irritation, like a mild to moderate sunburn, mild to moderate breast swelling and fatigue.

Brachytherapy Center of Excellence Program

Brachytherapy, also called internal radiation or seed implants, is the placement of radioactive sources in or just next to a tumor. The radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used. Because the radiation sources are placed so close to the tumor, your doctors can deliver a large dose of radiation directly to the cancer cells with minimal exposure to normal tissue.

The radioactive sources used in brachytherapy, such as thin wires, ribbons, capsules or seeds, come in small sealed containers. Some sources are placed permanently and are referred to as implants. These radioactive sources remain in the body after their radiation has been expended and the source is no longer radioactive. Other sources are placed temporarily inside the body, and the radioactive sources are removed after the prescribed dose of radiation has been delivered.

There are two main types of brachytherapy: intracavity treatment and interstitial treatment. With intracavity treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate.

Often these procedures require anesthesia and brief hospitalization. Patients with permanent implants may have a few restrictions at first and then can quickly return to their normal activities. Temporary implants are left inside of your body for several hours or days. While the sources are in place, you will stay in a private room. Doctors, nurses and other medical staff will continue to take care of you, but they will need to take special precautions to limit their exposure to radiation.

Devices called high dose rate (HDR) remote afterloading machines allow radiation oncologists to complete brachytherapy quickly, in about 10 to 20 minutes. Powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by your radiation oncologist. You may be able to go home shortly after the procedure. Depending on the area treated, you may receive several treatments over a number of days or weeks.

Most patients feel little discomfort during brachytherapy. If the radioactive source is held in place with an applicator, you may feel discomfort from the applicator. There are medications that can help this. If you feel weak or queasy from the anesthesia, your radiation oncologist can give you medication to make you feel better.

Possible Side Effects

Side effects of radiation therapy are limited to the area that is receiving treatment.

  • Side effects can include redness of the skin, sore throat, dry mouth, alteration of taste, pain on swallowing and possible hair loss in the treated area. Fatigue is also very common.
  • Side effects are different for each patient. Medications and nutritional supplements may be prescribed to make you as comfortable as possible.
  • If at any time during your treatment you feel discomfort, tell your doctor or nurse. They may be able to alter the treatment or prescribe a drug to help you feel better.

Mouth Care

It is important to take care of your mouth, teeth and gums during radiation.

  • Careful brushing of your teeth can help prevent tooth decay, gum disease, mouth sores and jaw infections.
  • Be sure to tell your dentist that you received radiation to the head and neck area.
  • Talk to your doctor or dentist about any problems you are having.