How is head and neck cancer treated?

There are multiple modalities of treatment. Earlier stage cancers can typically be treated with a single modality. Oral cancer is treated with surgery in its early stages. If it spreads to the neck, even with just one small lymph node, that turns it into a Stage III cancer. Typically when it’s at Stage III and IV, they're treated with multiple modality treatments. Surgery may be followed by radiotherapy, and depending on the tumor, chemotherapy may be added as well if there are multiple lymph nodes involved in the neck and if cancer has spread outside the lymph nodes. Those are usually the common reasons to give chemo in addition to radiation after the surgery.

Some types of cancer, such as tonsillar cancers, or cancers in the area we call the oropharynx, are often treated with combined chemotherapy and radiation. Again, typically the rule is that a lot of times they can be treated with surgery alone if caught at an early stage.

Patients with cancer related to the human papillomavirus (HPV) will come in presenting with the disease with regional metastasis (spread) in the neck. Our job is to find where the primary site is, so we need to do surgery to create a diagnosis. A lot of times we'll take out the tonsil or remove part of the base of the tongue, and then we'll do surgery to remove all the lymph nodes in the neck. Then we can accurately assess the cancer’s stage. The pathology will also give some information on the tumor’s behavior and indicate whether it is HPV positive, what other types of things it's doing. Next will come radiation, plus or minus chemotherapy.

Treatments for head and neck cancer — compared to other types of cancer — can affect the more animate parts of our body. This can have an impact on our face, our facial expressions, our ability to speak, our ability to swallow, and even our ability to breathe. So it does affect some really critical areas, which is why the treatment doesn't just involve surgery, chemotherapy and radiation. A lot of other important health care practitioners are part of the treatment for head and neck cancer, such as speech and language pathologists who play an important part to help diagnose and then work with patients after they've had their treatment. If a patient has to have the voice box removed, speech and language pathologists help with voice prostheses afterwards to help patients communicate again verbally.

Neck cancer can really sap a lot of energy, so patients are a lot of times very thin. Dietitians are key in helping to make sure patients are well-nourished. Because patients may have problems swallowing, they may need to have a tube inserted into the abdomen to deliver nutrition directly to the stomach while they're getting their chemo and radiation. Speech and language pathologists work with patients with feeding tubes and tubes inserted into the windpipe to assist with breathing. Nursing and care coordinators also are vital members of the team.

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