How Is Head and Neck Cancer Treated?
Diagnosis and treatment of a patient with head and neck cancer varies with the type, stage, and location of the cancer, as well as the patient’s age and overall state of health.
The goal of treatment is to remove the cancer, while sparing healthy tissue and reducing side effects. The ultimate goal is to enable the patient to resume normal activities and daily life after treatment of the cancer.
Because the head and neck are delicate and complex parts of the body and affect how we look, talk, breathe, and eat, a diagnosis and treatment plan will involve multiple specialists. Each patient’s plan of care will include treatment, rehabilitation, and follow-up care.
The multidisciplinary care of a patient with head and neck cancer is usually managed by one of the following head and neck specialists who serves as the primary caregiver for the patient during cancer treatment and coordinates the participation of other specialists. Other members of the medical team may include oral surgeons, dentists, and plastic surgeons, as well as nurses, social workers, speech and swallowing experts, and patient navigators.
- A head and neck surgical oncologist is a specialist trained in surgical conditions of the head and neck who performs surgery in the head and neck region. In addition, the head and neck surgical oncologist works together with a reconstructive surgeon to restore the function and appearance of the head and neck.
- A medical oncologist is a physician who treats cancer with chemotherapy (cancer-killing) drugs.
- A radiation oncologist is a doctor who specializes in the application of radiation therapy to kill cancerous tissue.
The goal of treatment is not only to remove cancerous tissue, but to also maintain quality of life and restore normal function and appearance. Treatment of most head and neck cancers involves one or more of the following procedures:
Surgery and Minimally Invasive Procedures
Often, surgery plays a major role in the management of head and neck cancers. The surgical oncologist removes tumors while preserving surrounding tissues. If the patient has a very large or complex tumor, the procedure may involve a team of two or more specialists operating at the same time.
Before surgery, radiation therapy and/or chemotherapy may be used to shrink the tumor. These therapies may also follow surgery to destroy any remaining cancer cells.
Physicians at BMC are pioneers in the development of minimally invasive surgeries and treatments for head and neck cancer. These innovative techniques reduce or eliminate surgical incisions, expose patients to less risk, lower post-operative pain, and shorten recovery time. One of these state-of-the-art practices is transoral robotic surgery (TORS).
BMC was the first organization to perform TORS in New England. This procedure utilizes the da Vinci robot to remove tumors that are extremely difficult to reach using traditional methods. This FDA-approved surgery spares patients from a large incision through their chin and throat to reach the tumor. Recovery time is shortened, and speech, swallowing, and other quality of life activities are preserved.
BMC also offers laser treatment. CO2 lasers were developed in the 1970s. The use of lasers for treatment of head and neck malignancies has continued to improve the outcomes of patients suffering from head and neck cancer. The procedure is minimally invasive and very effective.
Other state-of-the-art, minimally invasive surgical techniques in use at BMC include
- Endoscopic parathyroid surgery
- Endoscopic resection of nasopharyngeal, sinus, and skull base tumors using BrainLab image guidance
- Endoscopic transoral laryngeal surgery
Reconstructive surgery is another specialty at BMC. These practices include microvascular reconstruction—the transfer of tissue from one part of the body to another to restore function, as well as outward appearance. Other reconstructive techniques combine surgery with an oral surgeon and an ears, nose, and throat (ENT) surgeon collaborating with a prosthodontist to ensure the most appropriate dental rehabilitation. The goal of all of these is to restore a patient’s face to as close to its pre-cancer appearance as possible.
Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT). Radiation may be used as a solitary treatment to cure the tumor or in combination with surgery and/or chemotherapy. The equipment used to deliver the radiation therapy is called a linear accelerator. The linear accelerator has a moveable arm, which enables the radiation to be focused on the part of your body where the cancer is located. Developments in EBRT equipment have enabled physicians to offer conformal radiation. With conformal radiation, computer software uses imaging scans to map the cancer three-dimensionally. The radiation beams are then shaped to conform, or match, the shape of the tumor.
Radiation works by breaking a portion of the DNA of a cancer cell, which prevents it from dividing and growing. Radiation therapy can be systemic, meaning it moves throughout your bloodstream. Systemic therapies are usually given as an injection into a blood vessel or are taken as a pill. Systemic treatments expose your entire body to cancer-fighting medication. Radiation therapy is typically given as a "local" treatment however, meaning it affects only the part of the body that needs therapy.
External Beam Radiation Therapy
External beam radiation therapy is one of the most common types of radiation for cancer treatment. Radiation comes from a machine outside the body and delivers radiation to a specific location inside the body.
CyberKnife delivers highly targeted beams of radiation directly into tumors, in a pain-free, non-surgical way. Guided by specialized imaging software, we can track and continually adjust treatment at any point in the body, and without the need for the head frames and other equipment that are needed for some other forms of radiosurgery.
Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV). When chemotherapy drugs enter the bloodstream, it destroys cancer cells. Chemotherapy is particularly useful for cancers that have metastasized, or spread. Chemotherapy attacks all quickly-dividing cells, regardless of whether they are cancerous which can cause a number of side effects, including hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, and low blood counts. Low blood counts can increase a patient’s risk of infection, bruising or bleeding, fatigue, and shortness of breath. The side effects of chemotherapy are generally temporary and often go away once treatment is completed. Chemotherapy regimens vary from patient to patient. They are generally repeated several times in cycles, with three to four weeks separating each cycle to allow damaged normal cells time to recover. After the first two or three sessions of chemotherapy, patients may have a CT or PET scan to see if the drug(s) is effective. If the drug(s) is not working, it may be switched out for a new drug(s).
Integrative medicine practices have been shown to reduce cancer-related symptoms such as pain, anxiety, nausea, and fatigue. The Program for Integrative Medicine and Health Care Disparities in the Department of Family Medicine at BMC combines conventional medical treatments with evidence-based complementary therapies. Free therapeutic massage to decrease preoperative anxiety and postoperative pain in cancer patients undergoing surgical procedures is available. In the Moakley Building, where BMC conducts much of its cancer care, a registered yoga instructor holds free biweekly yoga classes, and a licensed acupuncturist offers free acupuncture to cancer patients. Participants in these sessions have gained notable clinical benefits, reporting decreases in pain, depression, anxiety, nausea, and fatigue. Services to individual patients complement group activities. Consultations that focus on stress management, nutrition, and coordination of complementary therapies are also available.