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CCOI

General Information about H&N (Head and Neck) Cancer

Head and neck cancer generally develops from smoking and drinking. However there are also certain viruses that have been implicated in its development. Most head and neck cancers are very responsive to chemotherapy along with radiation. Head and neck cancers originate from the nasopharynx, nasal cavity, oropharynx, oral cavity, salivary glands, larynx, hypopharynx, and thyroid.

Facts about H&N Cancer

  • Nasopharyngeal cancer is very common countries in Asia and are caused by EBV (Epstein-Barr Virus)
  • Oropharyngeal cancers are now commonly caused by HPV (Human Papilloma Virus), the prognosis of these cancers are much better than cancers caused by smoking and drinking
  • HPV associated oropharyngeal cancers commonly affect younger patients
  • Most cancers are of the squamous cell carcinoma histology – these are very responsive to chemotherapy and radiation

Signs and Symptoms of H&N Cancer

  • Difficulty and pain with swallowing
  • In advanced stages patients may have trouble breathing
  • Mass in the neck or head and neck region
  • Weight loss

Helpful Terms Regarding Head and Neck Cancers

  • Dyspnea Difficulty in breathing
  • Dysphagia – Difficulty with swallowing
  • Hemoptysis - The process of coughing up blood
  • Neck dissection Surgical removal of the lymph nodes in the neck
  • Concurrent chemoradiation Treatment with chemotherapy and radiation at the same time
  • Post-operative (adjuvant) radiation Radiation given after surgery to address any remaining gross or microscopic disease.

Treatment of Head and Neck Cancer

Treatment of head and neck cancer depends heavily on the site and stage of disease. Below is a general outline of treatment options. Depending on the site most patients will need a dental evaluation by a dentist trained in managing patients undergoing radiation. Unhealthy teeth may need to be extracted

Nasopharynx

Treatment commonly involves radiation. Advanced stage patients may need concurrent chemoradiation. Surgery is almost never used in this disease site.

Nasal cavity

Surgery is the mainstay of treatment. Some patients may need post-operative radiation if high risk features are found. Radiation can also be used prior to surgery to help shrink the tumor to make the surgery easier.

Oropharynx

In general this includes the tonsils, base of tongue, soft palate and other structures. Radiation along with possibly chemotherapy can result in excellent outcomes.

Oral cavity

Surgery is the mainstay of treatment. If high risk features are found after the surgery, adjuvant radiation and possibly concurrent chemotherapy may be recommended

Salivary glands

Surgery is the main stay of treatment. If high risk features are found adjuvant radiation may be recommended.

Larynx /hypopharynx

Historically patients were treated with surgery. However in an attempt to preserve the voice box definitive chemoradiation has been used with good results. Surgery is now reserved for persistent of recurrent disease. Some patients with very advanced disease may also be treated directly with surgical resection.

Thyroid

Surgery is the mainstay of treatment. Depending on the type of thyroid cancer additional radiation may be required. Some forms of thyroid cancer require ingesting a radioactive molecule that targets residual microscopic cancer.

Frequently Asked Questions

Q: What are the acute side effects from radiation to the H&N area?

A: Depending on the site that gets radiation, patients can have dry mouth, mouth sores, taste changes, trouble swallowing, weight loss, and a skin reaction much like a sun burn. Most of the side effects do resolve with time. Some patients however experience a permanent dry mouth due to radiation to the salivary glands.

Q: How do I prepare for the radiation?

A: If you have lost a lot of weight or are having difficulty eating, a stomach tube may be inserted to help keep up your nutrition status. You will also need
to be evaluated by a dentist who specializes in treating patients undergoing radiation. Any unhealthy teeth may need to be extracted prior to start radiation.

Q: Are there any dietary restrictions?

A: If you develop mouth sores, your oral cavity and throat may be very sensitive. Spicy foods and carbonated beverages may irritate these areas more. Do not smoke or drink during treatment, it can make your side effects worse and delay recovery. Towards the latter part of the treatment you will most likely be eating soft foods and perhaps a liquid diet. We advise that you take in at least 6 cans of Ensure/Boost to help keep your weight stable. Shakes with added protein also aid in the recovery.

Q: What is the recovery?

A: Most patients will start to eat solid foods 2 months after finish radiation. It is a slow recovery process before most patients are back eating a solid det. Taste changes may persist for up to 6 months to a year. Most patients do gain most of their taste back. Salivary function will also improve in the first couple of years. Recovery of salivary function depends heavily on the location of the cancer and dose of radiation given.