Head and Neck Cancers
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Head and Neck Cancers
Treatment for head and neck cancers
The main treatments for head and neck cancers are surgery, radiation therapy and chemotherapy. You may have one of these treatments, or a combination. Treatment will be tailored to your specific situation.
Treatment for head and neck cancers can affect your mouth, gums and teeth. Before treatment starts:
See a general dentist or special needs dentist
Have a thorough check-up and ask for an oral health care plan. The plan outlines any dental work you need before treatment starts, and also provides advice on how to care for your mouth before, during and after treatment.
Improve diet and nutrition
People with a head and neck cancer often lose a lot of weight and may become malnourished. A dietitian can suggest ways to maintain your weight by changing your diet or taking special drinks (liquid supplements). This will help improve your strength and lead to better treatment outcomes.
Begin an exercise program
This will help build up the strength needed for recovery. Talk to your doctor about this.
If you are a smoker, it is important to stop smoking before starting treatment. If you continue to smoke, you may not respond to treatment as well as people who don’t smoke. Also, smoking may make side effects worse and increase the chance of a second primary cancer. See your doctor, call the Quitline on
13 7848 or go to Quit for more information.
The aim of surgery is to remove cancerous tissue and, as much as possible, preserve the functions of the head and neck area, such as breathing, swallowing and talking. If you have surgery, the surgeon will cut out the tumour and a margin of healthy tissue, which is checked by a pathologist to make sure all the cancer cells have been removed.
The types of surgery used for the different head and neck cancers are described below. It can be frightening to think about having surgery to your head and neck. Talking to your treatment team can help you understand your situation.
Removing lymph nodes
If the cancer has spread to the lymph nodes in your neck, or it is highly likely to spread, your surgeon will probably remove some lymph nodes. This operation is called a neck dissection or lymphadenectomy. Your surgeon will let you know if this is recommended.
Most often lymph nodes are removed from one side of the neck, but sometimes they need to be removed from both sides. A neck dissection may be the only surgery needed, or it may be part of a longer head and neck operation. The surgeon will make a cut under your jaw and sometimes down the side of your neck. You will often have a small tube (drain) in your neck to remove fluids from the wound for a few days after the surgery. A neck dissection may affect how your neck or shoulder moves and looks. A physiotherapist can help improve movement and function.
How the surgery is done
If you have surgery for a head and neck cancer, different surgical methods may be used to remove the cancer. Each method has advantages in particular situations – your doctor will advise which method is most suitable for you. The options may include:
- endoscopic surgery – uses a long thin flexible tube with a light and camera that is inserted through the nose or mouth so the surgeon can see and remove the cancer; often used for cancers in the nasal cavity, pharyngeal cancers and laryngeal cancers
- trans-oral robotic surgery (TORS) – uses robotic arms to reach cancerous areas through the mouth using standard surgical tools, or specialised tools with laser or robotic technology; often used for oropharyngeal cancers
- open surgery – involves making cuts in the neck or the lines of the face to reach and remove cancers; used for larger cancers and those in difficult positions. Bones of the upper and lower jaw or skull may need to be partially removed.
Endoscopic and trans-oral robotic surgery usually mean less scarring, a shorter hospital stay and faster recovery. However, these types of surgery are not possible in all cases, and open surgery is often the best option in many situations.
After open surgery, reconstructive surgery may be needed to restore functions such as eating, talking and breathing, and to improve how the area looks. Some people have reconstructive surgery at the same time as the surgery, others at a later date.
Reconstructive surgery may involve using skin, bone or tissue from another part of the body to rebuild the area. This is called a free flap. Occasionally synthetic materials such as silicone and titanium are used to recreate bony areas or other structures in the head and neck, such as the palate. This is called a prosthetic reconstruction.
Surgery for oral cancer
The type of surgery will depend on the size and location of the cancer. Localised cancers can be treated by removing part of the tongue, mouth or lip. If the cancer is larger, surgery may be more extensive and you may need reconstructive surgery to help you chew, swallow or speak.
Some tumours can be removed through the mouth, but you may require open surgery for larger tumours. Different types of oral surgery include:
- glossectomy – removes part or all of the tongue
- mandibulectomy – removes part or all of the lower jaw
- maxillectomy – removes part or all of the upper jaw (maxilla).
Surgery for nasal or paranasal sinus cancer
Your doctor may advise you to have surgery if the tumour isn’t too close to your brain or major blood vessels. The type of surgery depends on the location of the tumour and, if you have paranasal sinus cancer, the affected sinuses. You will often need to also have reconstructive surgery.
Nasal and sinus cancers are often close to the eye socket, brain, cheek bones and nose. Your surgeon will talk to you about the best approach and whether any additional structures need to be removed to get the best outcome. Different types of surgery include:
- maxillectomy – removes part or all of the upper jaw (maxilla); may include the upper teeth, part of the eye socket and/or the nasal cavity
- craniofacial resection – removes tissue between the eyes in the nasal cavity; often done endoscopically through the nose but a cut along the side of the nose may also be required; sometimes a neurosurgeon will assist with this surgery
- orbital exenteration – removes the eye and may also remove surrounding tissue around the eye socket
- rhinectomy – removes part or all of the nose
- endoscopic sinus surgery – removes part of the nasal cavity or sinuses through the nostrils, using an endoscope.
The surgeon will consider how the operation will affect how you look, and your ability to breathe, speak, chew and swallow. If your nose, or a part of it, is removed, you may get an artificial nose (prosthesis). This will be synthetic or made of tissue from other parts of your body. In some cases, it can take months to complete the prosthetic or reconstructed nose. Your surgeon will guide you about the timing.
Surgery for salivary gland cancer
Most salivary gland tumours affect a parotid gland. Surgery to remove part or all of a parotid gland is called a parotidectomy. The facial nerve, which controls facial expressions and movement of the eyelid and lip, runs through the parotid gland. If this nerve is damaged during surgery, you may be unable to smile, frown or close your eyes. This is known as facial palsy, and it can take months to a year for movement to improve. In some cases, the facial nerve may need to be repaired with a nerve from another part of the body, often from the leg (nerve graft). If the facial nerve is removed (facial nerve sacrifice), there are procedures that can improve the way your face moves and looks, but it will not look or work the same as before the surgery.
If the cancer affects a submandibular gland or sublingual gland, the gland will be removed, along with some surrounding tissue. Nerves controlling the tongue and lower part of the face may be damaged, causing some loss of function. If the cancer is in a minor salivary gland, it may be removed with endoscopic surgery.
Surgery for pharyngeal cancer
Early pharyngeal cancers are often treated with radiation therapy. Surgery may be an option in some cases depending on where the cancer is located in the throat (pharynx). If the cancer is large or advanced and surgery is an option, the surgery is more likely to be extensive and may require reconstruction. It is also often followed with radiation therapy and possibly chemotherapy.
Some tumours can be removed through the mouth, but you may have open surgery for some advanced cancers. Open surgery is done through a cut in the neck, which may involve the jaw. Different types of pharyngeal surgery include:
- pharyngectomy – removes part or all of the pharynx
- laryngopharyngectomy – removes all of the larynx and part of the pharynx.
This surgery is rare and your treatment team will provide more information about the procedure.
Surgery for laryngeal cancer
If the laryngeal cancer is at an early stage, it may be removed through the mouth using trans-oral surgery. It may take up to six months for your voice to recover. In some cases, there may be long-term or permanent changes to the pitch, loudness or quality of your voice.
If the cancer has advanced, you may need open surgery to remove the larynx (total laryngectomy). This operation removes the whole larynx and separates the windpipe (trachea) from the oesophagus. Following this surgery, you will be breathing through a new hole in the front of your neck called a stoma. This is a permanent change and you will no longer be able to breathe through your nose and mouth. Because this surgery removes your voice box, you won’t be able to speak naturally, but you will work with a speech pathologist to learn new ways to communicate.
If you have a total laryngectomy, your thyroid gland may also be removed (thyroidectomy). If the thyroid is removed, your body will stop producing thyroxine (T4), the hormone that maintains your metabolism, energy levels and weight. You will be prescribed a hormone tablet, which you will need to take every day for the rest of your life.
What to expect after surgery
How long you stay in hospital will depend on the type of surgery you have and how well you recover. If surgery is minor, recovery is usually fast and there are often few long-term side effects. For more advanced cancer, surgery will be more extensive, lasting eight hours or more, and it will often cause permanent side effects.
Side effects after head and neck cancer surgery vary greatly depending on your age, your general health, how extensive the surgery was and whether you also had reconstructive surgery. Your surgeon can give you a better idea of what to expect after the operation.
Pain – You will have some pain and discomfort for several days after surgery, but you will be given pain-relieving medicines to manage this. You may be given tablets, or you may have patient-controlled analgesia (PCA), which delivers a measured dose of pain relief through a drip when you press a button.
Drips and drains – You may have tubes at the surgery site to drain excess fluid from the wound. These are usually removed after a few days, depending on how much fluid is being collected and the type of surgery. You may also have a tube from your bladder to drain urine into a bag. This is known as a catheter.
Speech changes – Your ability to speak may be affected. This may be temporary or longer-lasting.
Sore throat – You may have some throat discomfort from the anaesthetic tube. This kind of discomfort or irritation usually lasts less than 24 hours. You may also have a sore throat as a result of surgery for pharyngeal or laryngeal surgery; this is usually short-term.
Breathing difficulties – If your mouth, tongue or throat is expected to be swollen after the surgery, it could make breathing difficult. The surgeon may discuss inserting a temporary tracheostomy in your neck to allow you to breathe. Surgery to the nasal cavity may change the way you breathe through your nose. This may be temporary or longer-lasting.
Eating and drinking – You will usually have a drip to give you fluids. You will start with drinking clear liquids, move on to pureed food, and then soft foods. If eating and drinking is going to be difficult or delayed, a temporary feeding tube may be inserted through your nasal passageway for a few days or weeks. Alternatively, a gastrostomy tube, known as a PEG or a RIG feeding tube, may be inserted into your stomach. If you have reconstructive surgery to your mouth or throat, you may have a feeding tube to allow the free flap to heal.
Movement – Your health care team will encourage you to walk the day of the surgery, or the day after, depending on how extensive your surgery was. Moving around as much as possible will speed up your recovery and reduce the chance of blood clots or infections. The nurse or a physiotherapist will show you how to move around safely. A physiotherapist will teach you breathing or coughing exercises to help keep your lungs clear and reduce the risk of getting a chest infection.
Also known as radiotherapy, this treatment uses a controlled dose of radiation to kill or damage cancer cells. The radiation is targeted at the cancer, and treatment is carefully planned to do as little harm as possible to healthy body tissue near the cancer. Radiation therapy can be given externally or internally, but for head and neck cancers it is usually given externally.
Radiation therapy can be used on its own as the main treatment for pharyngeal and laryngeal cancers, especially to preserve important functions such as speech, swallowing and breathing.
When radiation therapy is used after surgery (adjuvant treatment), the aim is to eliminate any cancer cells that may not have been removed during surgery and reduce the chance of the cancer coming back. You will probably start radiation therapy as soon as your wounds have healed and you’ve recovered your strength, usually within six weeks. Adjuvant radiation therapy is sometimes given together with chemotherapy (chemoradiation). This is because chemotherapy makes cancer cells more sensitive to radiation.
External beam radiation therapy
External beam radiation therapy is commonly used to treat oral, salivary gland, pharyngeal, laryngeal, nasal and paranasal sinus cancers. The treatment can be delivered in different ways, including intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and TomoTherapy. These techniques deliver radiation precisely to the affected area, which reduces treatment time and side effects.
Having external beam radiation therapy
Before radiation therapy starts you will be fitted for a plastic mask, called an immobilisation mask. Wearing the mask will help you keep still and ensure the radiation is targeted at the same area during each session. You can see and breathe through the mask, but it may feel strange and claustrophobic at first.
During treatment, you will lie on a table under a machine called a linear accelerator. You will wear the mask for 10–20 minutes during treatment (longer during the planning session). Treatment itself is painless and is usually given Monday–Friday as outpatient treatment for 6–7 weeks. You will be monitored by the radiation therapists throughout. Let them know if wearing the mask makes you feel uncomfortable, as this can be managed.
Side effects of radiation therapy
The side effects vary depending on the area treated, the number of treatments, the type of radiation therapy you have and whether it is combined with chemotherapy.
Side effects often peak in the final week of treatment, or shortly afterwards, then start to ease 2–3 weeks after treatment ends. Some side effects may last longer, be ongoing or appear several months or years later. The most common short-term and long-term side effects are listed below.
During or immediately after treatment – fatigue, mouth sores, taste changes, loss of appetite, dry mouth and thick saliva, skin redness and burning in the area treated, breathing difficulties, weight loss.
Ongoing or permanent – dry mouth, thick saliva, difficulties with swallowing and speech, changes in taste, fatigue, muscle stiffness, neck swelling, appetite and weight loss, oral thrush, hoarseness, dental problems, difficulty opening the mouth, hair loss.
Some people find that food and fluid goes into the windpipe instead of the food pipe. This is called aspiration and it can block the airways and cause difficulty breathing. Some people develop an underactive thyroid (hypothyroidism) and may need to take thyroid hormone replacement tablets after radiation therapy.
Radiation therapy to the head and neck can damage blood vessels, causing bone in the lower jaw to die. This is called osteoradionecrosis (ORN).
ORN affects around 5–7% of people who have radiation therapy to the head and neck. It can occur months or years after treatment.
Having any necessary dental work before treatment starts reduces the risk of ORN.
Treatment may include antibiotics, other medicines or surgery. To help the bone heal, you may also have hyperbaric oxygen treatment (breathing in concentrated oxygen in a pressurised chamber).
Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. The aim is to destroy cancer cells while causing the least possible damage to healthy cells. You will probably receive chemotherapy by injection into a vein (intravenously) at treatment sessions over several weeks.
Chemotherapy may be given for a range of reasons:
- in combination with radiation therapy (chemoradiation), to increase the effects of radiation
- before surgery or radiation therapy (neoadjuvant chemotherapy), to shrink a tumour
- after surgery (adjuvant chemotherapy), along with radiation therapy, to reduce the risk of the cancer returning
- as palliative treatment to relieve pain and improve quality of life
Side effects of chemotherapy
Chemotherapy can affect the healthy cells in the body and cause side effects. Everyone reacts differently to chemotherapy, and effects will vary according to the drugs you are given. Some people may have few side effects, while others have many. Often, chemoradiation causes more severe side effects than if you have chemotherapy and radiation therapy separately. Your medical oncologist or nurse will discuss the likely side effects with you, including how they can be prevented or controlled with medicine.
Common side effects include tiredness and fatigue; nausea and/or vomiting; tingling or numbness in fingers and/or toes (peripheral neuropathy); changes in appetite and loss of taste; diarrhoea; hair loss; low red blood cell count (anaemia); hearing loss; ringing in the ears (tinnitus); a drop in levels of white blood cells, which may increase the risk of infection; and mouth sores.
Keep a record of the names and doses of your chemotherapy drugs handy. This will save time if you become ill and need to visit the hospital emergency department.
Targeted therapy drugs affect specific features of cancer cells to block their growth. One targeted therapy drug called cetuximab is available in Australia for squamous cell carcinomas in the head and neck area, when people cannot take the standard chemotherapy drug. Cetuximab is a monoclonal antibody that binds to the surface of cancer cells and stops them growing and dividing. Cetuximab is given through a drip into a vein. For head and neck cancer, it is used with radiation therapy.
Side effects of targeted therapy
The most common side effects of cetuximab are skin problems (such as redness, swelling, an acne-like rash or dry, flaky skin), mouth sores, tiredness and diarrhoea. Your doctor may be able to prescribe medicine to prevent or treat side effects.
Immunotherapy is a type of cancer drug treatment that focuses on using the body’s own immune system to fight cancer. Some cancer cells create barriers known as “checkpoints” to block the immune system. Drugs called checkpoint inhibitors help make the cancer cells visible to the body’s own immune system. Once the barrier is removed, the immune system can recognise and destroy the cancer.
Nivolumab is a checkpoint inhibitor used to treat some types of advanced head and neck cancer. Nivolumab is usually administered into a vein (intravenously). Pembrolizumab has also been approved to treat squamous cell carcinomas in the head and neck, but is not yet subsidised on the PBS for head and neck cancers (as of August 2019).
Side effects of immunotherapy
The side effects of immunotherapy are caused by an overactive immune system attacking the normal parts of the body. Not everyone will experience the same effects. Common side effects include fatigue, skin rash and diarrhoea, but as any part of the body can be attacked by the immune system, other side effects can occur. Early side effects can usually be controlled before they become severe, so let your treatment team know as soon as they appear.
Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease. Many people think that palliative treatment is for people at the end of their life. However, it may be beneficial for people at any stage of advanced head and neck cancer.
As well as slowing the spread of cancer, palliative treatment can help manage symptoms such as pain and help you live as fully and comfortably as possible. Treatment may include radiation therapy, chemotherapy or other drug therapies.
This information is reviewed by
This information was last updated September 2019 by the following expert content reviewers: A/Prof David Wiesenfeld, Oral and Maxillofacial Surgeon, Director, Head and Neck Tumour Stream, The Victorian Comprehensive Cancer Centre at Melbourne Health, VIC; Alan Bradbury, Consumer; Dr Ben Britton, Senior Clinical and Health Psychologist, John Hunter Hospital, NSW; Dr Madhavi Chilkuri, Radiation Oncologist, Townsville Cancer Centre, The Townsville Hospital, QLD; Jedda Clune, Senior Dietitian (Head and Neck Cancer), Sir Charles Gairdner Hospital, WA; Dr Fiona Day, Staff Specialist, Medical Oncology, Calvary Mater Newcastle, and Conjoint Senior Lecturer, The University of Newcastle, NSW; Dr Ben Dixon, ENT, Head and Neck Surgeon, Peter MacCallum Cancer Centre and St Vincent’s Hospital Melbourne, VIC; Emma Hair, Senior Social Worker, St George Hospital, NSW; Rosemerry Hodgkin, 13 11 20 Consultant, Cancer Council WA; Kara Hutchinson, Head and Neck Cancer Nurse Coordinator, St Vincent’s Hospital Melbourne, VIC; A/Prof Julia Maclean, Speech Pathologist, St George Hospital, NSW; Prof Jane Ussher, Chair, Women’s Health Psychology, Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, NSW; Andrea Wong, Physiotherapist, St Vincent’s Hospital Melbourne, VIC..