Head & Neck

Overview

Head and neck cancer describes a variety of malignant tumors that affect the mouth, pharynx (throat), larynx (voice box), sinuses, nose, thyroid and salivary glands (see Figure 1). Most of these cancers begin in the squamous cells that make up the moist tissues lining the nose, mouth and throat; others form in the cells of the thyroid and salivary glands.

To better understand head and neck cancer, it helps to have a general understanding of cancer. Cells are the basic units of the body, and normal cells grow, divide and die in a predictable way. Cancer cells, however, are abnormal cells that grow and divide out of control quickly. When these cells continue to multiply, even when your body does not need new cells, they form a disorganized mass composed of billions of cells, called a tumor. A tumor can be harmless (benign) or harmful (malignant). A malignant tumor is called cancer.

Physical and emotional changes

The areas affected by head and neck cancer treatment control some of your most vital functions, including breathing, swallowing, chewing and speaking. As a result, treating head and neck cancer is more than removing a tumor and killing cancer cells. It also includes repairing your body to enable those functions to still occur.

The size and location of a tumor often makes reconstructive surgery a necessity. If the tumor is small, the surgeon may be able to remove it without damaging too much tissue or bone. If the tumor is large, a reconstructive surgeon may be called in to help rebuild the damaged body part. For example, treatment for cancer that has invaded the mandible, or jawbone, may require surgery to remove part of the jaw. A reconstructive surgeon may be able to remove and reshape bone from the patient’s leg or arm into a new jaw bone. Along with helping restore appearance, the reconstructed jaw bone restores function, such as chewing and a comfortable bite for the top and bottom teeth. In addition, the new jawbone prevents that side of the face from sinking in without a bone to provide structure. (See Reconstruction.)

Surgery in the head and neck area can change your appearance, sometimes drastically. Reconstructive surgery may be an option. Although the goal of reconstructive surgery is to return your physical appearance as close as possible to what it was before surgery, you should prepare for some physical and cosmetic differences. You may perform some of those vital functions differently, and you may look different. This can be an emotional time, and your feelings about your self-image and your abilities to perform certain functions can affect your quality of life, including your relationships, finances and ability to earn a living. Talk with your doctor before you begin treatment so you know what to expect and how long your treatment may take. Talking with a therapist or other survivors can help you navigate this sensitive time.

Figure 1.

Oral side effects

Most people are aware of common side effects of cancer treatment like alopecia (hair loss) and nausea, but many don't realize how common it is to develop complications that affect the mouth. These problems may interfere with cancer treatment and diminish your quality of life. Treatments for head and neck cancers, such as radiation therapy, surgery and chemotherapy, can cause oral complications ranging from dry mouth to life-threatening infections. It is crucial to add a dentist to your treatment team who is aware of your situation and is able to monitor you closely during and after treatment. Contact your treatment team when you first notice a mouth problem, if an existing problem gets worse or if you notice any changes that concern you. (See Side Effects.)

 

Some common head and neck cancer drugs

  • bleomycin sulfate (Blenoxane)
  • cabozantinib (Cometriq)
  • cetuximab (Erbitux)
  • cisplatin (Platinol)
  • docetaxel (Taxotere)
  • doxorubicin hydrochloride (Adriamycin)
  • hydroxyurea (Hydrea)
  • lenvatinib (Lenvima)
  • methotrexate sodium (Methotrexate LPF)
  • nivolumab (Opdivo)
  • pembrolizumab (Keytruda)
  • pilocarpine hydrochloride (Salagen)
  • sorafenib tosylate (Nexavar)
  • vandetanib (Caprelsa)

 

Your treatment team

A variety of specialists will work together to treat the physical and emotional aspects of your head and neck cancer. Your team members may include the following:

  • An otolaryngologist, a doctor who specializes in certain diseases of the head and neck (also known as an ear, nose, and throat, or ENT, doctor)
  • A head and neck surgeon and a facial plastic surgeon
  • A neurosurgeon, a doctor who specializes in surgery on the brain, spine and other parts of the nervous system
  • A radiation oncologist, a doctor who treats cancer with radiation therapy
  • A medical oncologist, a doctor who treats cancer with medicines such as chemotherapy
  • An oral surgeon and a dentist to perform dental surgery and manage dental side effects
  • A psychiatrist, psychologist or therapist
  • A nutritionist, speech and language pathologist, and a rehabilitation specialist also may be on your team.

Reducing your risk

Due to the increased chance of developing another primary cancer, understanding the risk factors of head and neck cancer is important. Risk factors include poor dental hygiene, smoking cigarettes, chewing tobacco and drinking excessive amounts of alcohol. Many head and neck cancers are linked to tobacco and alcohol use, and the risk of head and neck cancer is higher for people who use both tobacco and alcohol than for people who use only one or the other.

Another risk factor is human papillomavirus (HPV), which is particularly associated with cancers of the tonsils and base of the tongue (see Throat Cancer). In addition, prolonged exposure to the sun has been linked to cancer of the lip. Exposure to radiation, especially in childhood, is a risk factor for thyroid cancer and salivary gland cancer.

 

Thermoplastic Mask

Certain precautions are necessary to ensure your safety during radiation treatments because the radiation must target the same spot every time. To make sure you are placed in exactly the same position for each treatment session, body molds or other immobilizing devices may be necessary. A special mesh head mask, called a thermoplastic mask, may be created from a mold of your face and head. In most cases, semi-permanent marks or permanent tattoos may be placed on your skin to indicate the exact location the radiation beams must hit to reach the tumor.

Wearing the mask and being unable to move can be traumatic, especially if you suffer from claustrophobia. Your treatment team will help make you as comfortable as possible, so tell them if you feel anxious. They will work with you to find a position you are comfortable with during every treatment. If necessary, your doctor may prescribe medication to ease anxiety and help you relax for your treatments.

 

Additional Resources

 

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