Advances in radiation therapy technologies offer more treatment options for head and neck cancers.
Cancers of the head & neck are typed and named according to the disease’s original location. This may be on the lips, mouth, nose, salivary glands, sinuses, larynx (voice box), nasopharynx, throat and trachea. Over 21,000 men and 9,000 women are diagnosed with head and neck cancer in the United States each year. If detected at an early stage, head & neck cancers are often curable.
Tobacco use, including cigarettes, cigars and chewing tobacco, causes most oral cancer. This risk is significantly increased with heavy drinking. More than 75% of the people with oral cancer use these substances. Other risk factors include Human Papillomaviruses for cancer of the mouth and throat, family history of oral cancer and diets low in fruits and nuts. Symptoms can include patches inside your mouth or lips, bleeding, loose teeth, earaches, persistent hoarseness and difficulty or pain when swallowing.
The best treatment for head & neck cancer depends on the type of cancer, its location and stage. Whether or not you are a good candidate for surgery and if it is a recurrence of cancer will also help determine your course of therapy. Surgery, radiation therapy, chemotherapy, targeted therapy or a combination are all effective forms of head and neck cancer treatments.
Surgery is a treatment option providing the tumor or tumors can be accessed and removed. Advanced techniques are used, such as laser surgery, depending on the location of the cancer and the best way to reach it. Surgery may include removal of the tumor and surrounding tissue to reduce the chance of leaving any cancer cells behind. In some oral cancer treatment plans, it may be necessary to remove part of the jawbone in which metal plates or bone from another part of the body are used to replace the missing piece.
Your Medical or Surgical Oncologist may recommend one of three different forms of chemotherapy. Neo-adjuvant or primary systemic chemotherapy is used before radiation or surgery. Adjuvant chemotherapy is used after radiation or surgery to destroy any remaining cancer cells. Systemic chemotherapy circulates throughout the body via the bloodstream when the cancer is metastatic.
Targeted therapy uses pharmaceuticals to seek and attack molecules and cellular activity that the cancer depends on to survive and grow. Cetuximab is a monoclonal antibody that targets a protein on the surface of cells in the oral cavity and can be an effective oral cancer treatment. By interfering with the protein, the cells can no longer grow and divide, slowing or stopping the cancer’s growth.
Radiation therapy may be used as a primary treatment when surgery is not an option, post-surgery in order to destroy any cancerous cells left behind, or in combination with chemotherapy and targeted therapy. One of several highly sophisticated forms of External Beam Radiation Therapy or Internal Radiation Therapy may be recommended depending on the size and location of the tumor or tumors.
3D-Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy (IMRT) are two forms of External Beam Radiation Therapy. During 3D-Conformal treatments, a device called a “multi-leaf collimator” will shape the individual radiation beams to “conform” to the shape of your tumor according to the data and instructions it receives from the system computer. IMRT uses thousands of radiation “beamlets” from many different angles to deliver a single dose of radiation. The intensity of the “beamlets” can change during the treatment session to modulate the dose, so that the tumor receives a very precise high dose of radiation, while minimizing damage to surrounding, normal tissue.
Before each session, a Radiation Therapist will carefully position you on the treatment table using a body immobilizer for precise body placement. Image guidance will be used to confirm the location of the tumor before the therapy begins. During your treatment sessions, the radiation delivery system will revolve around you, delivering the radiation according to the plan set by your Radiation Oncologist. Each treatment session lasts from 10 to 30 minutes. If radiation is your primary form of treatment, you will be scheduled for five sessions a week for eight weeks. If it is used in combination with surgery, you will be treated for six weeks. The sessions are pain-free and require no sedation so you can return to your normal activities right away.
Internal Radiation Therapy, also known as Brachytherapy, targets tumors with radiation delivered through a catheter directly to the tumor site. Rarely used alone, High Dose-Rate (HDR) and Low Dose-Rate (LDR) Brachytherapy technologies may be used in conjunction with external radiation for early stage tumors of the lips or mouth. During HDR treatment, a computer-controlled machine sends tiny radioactive pellets into the catheter to deliver the radiation at multiple depths and varying times. The overall treatment time at the tumor site is 10 to 20 minutes. Head and neck cancer treatments may require one session or multiple sessions. The catheters are then removed so that no radioactive material remains in the body. During LDR treatment, tiny radioactive seeds, each the size of a rice grain, are implanted at the tumor site through tiny catheters. The catheters are removed and the seeds remain near the tumor. Over time, the seeds become non-radioactive. You are free to resume normal activity with either treatment.