The majority of head and neck cancers can be treated, particularly if discovered early. Treatments vary according to the site, stage, age of the patient and his or her general health. Depending on the extent of cancer, your doctor may proceed with either one or a combination of the following treatments.
Surgery
An operation may be done to remove There are different types of surgical procedures depending on the location of cancer. Surgical procedures include, but are not limited to the following:
- Wide local excision: this is a surgical procedure involving the removal of the tumor as well as part of the healthy tissue surrounding it.
- Neck dissection: this involves removal of lymph nodes and other structures in the neck. This procedure is usually done when there are already enlarged lymph nodes in the neck or the cancer is felt to be of high risk of spread to the lymph nodes.
- Transoral robotic surgery: this type of surgery is done for cancer of the oropharynx. Small robotic surgical tools and a camera are used allowing the surgeon to remove cancer in a small space with precision.
- Laryngopharyngectomy: this is the surgical procedure to remove the larynx as well as partially removal the pharynx.
- Cordectomy: this is the surgical removal of the vocal cords only.
- Laryngectomy: this is the surgical removal of the larynx. This can be done as a Hemi laryngectomy or partial laryngectomy in order to preserve the patient’s voice and ability to talk. Total laryngectomy is complete removal of the whole larynx. In a total removal, a hole is created in the neck to ensure the patient is able to continue breathing (tracheostomy).
- Laser surgery: this type of surgery uses high beam lasers to remove cancer, particularly in the larynx.
- Reconstructive surgery: Undergoing surgery may alter the appearance especially if a large structure is removed. Therefore, reconstructive surgery can be done to reconstruct the tissue removed, and re-establish the function to the removed area.
Radiation therapy
Radiation therapy is a treatment of cancer that utilizes high energy X-Ray beams to target and kills cancer cells, preventing them from growing further. It may be used alone or in a combination with other treatments such as surgery. Radiation therapy may also be used after surgery to target small sites that could not be removed surgically. This is called Adjuvant Therapy. There are different types of radiation therapy:
- External beam radiation therapy: this consists of an external machine which is used to target high energy radiation to cancer sites in the head and neck. A mesh mask is worn on the head to keep the head and neck from moving during treatment.
- Internal beam radiation therapy: this is carried out using a radioactive implant straight into or near the tumor to target the cancerous cells and initiate high-dose radiation in a smaller area in less time.
- IMRT (Intensity Modulated Radiation Therapy): This is a particular type of commonly used external beam radiation therapy. The method of therapy aims to target the tumor in an accurate manner with the appropriate amount of dosage whilst avoiding the healthy tissues surrounding the tumor.
Prior to commencing radiation therapy, your doctor may refer you for a dental assessment to review your dental health as radiation can have adverse effects on teeth and lead to decay. The decayed tooth may be extracted prior to radiation therapy.
If you are having radiation therapy to the neck, your doctor may want to check your thyroid hormones levels regularly as they may be affected. Hypothyroidism may develop, and is usually treated with Thyroid Hormone Therapy.
Chemotherapy
Chemotherapy is a treatment of cancer in which drugs are used to halt the growth of cancer cells. It can be taken orally or injected into a vein or muscle. Occasionally, chemotherapy may be administered before surgery and this is called Neoadjuvant Therapy or during radiation therapy to decrease the size of a tumor. Commonly used chemotherapy drugs for head and neck cancer includes Cisplatin, Carboplatin, Docetaxel, Methotrexate & Fluorouracil. Some drugs may be used in combination.
Targeted therapy
This is a treatment method in which drugs or other substances are administered to attack specific types of cancer cells. Targeted therapy interferes with the genes of cancer cells, the environment and tissue proteins that enhance its growth thereby blocking further proliferation. To identify the best therapy, your doctor may run tests to spot the genetics, proteins, and different variables of the tumor. Cetuximab is commonly used as a Targeted Therapy. It works by targeting proteins called Epidermal Growth Factor Receptors (EGFRs) found on the surface of Squamous Cell Cancers.