Head & Neck

Treatment Options

Many factors will influence your treatment options, including the stage of disease, the location and size of the tumor, and your overall health status. Your doctor will also focus on preserving (as much as possible) the ability to talk, eat and breathe normally. Talk to your health care team about whether the goal of treatment is to cure the cancer or to keep it under control and relieve symptoms. Understanding the goal, as well as the benefits and risks of each option, will help you be more prepared to make shared treatment decisions with your doctor.

Surgery is the primary method for treating many solid tumors. Removing a tumor may offer the best chance for controlling the disease and keeping it from spreading, especially for people with early-stage disease. Sometimes it is the only treatment needed for early-stage cancer. Many types of surgeries are available to treat head and neck cancers, including those to stage the cancer or to relieve or prevent symptoms that might otherwise occur later. A neck dissection, which is the removal of lymph nodes and surrounding tissue from the neck, is a common procedure during head and neck cancer treatment. Advances in surgical techniques are contributing to the likelihood of shorter recovery times with fewer side effects. Surgery is often used in addition to other treatment types.

Chemotherapy uses powerful drugs to kill rapidly multiplying cells. Treatment with chemotherapy is known as a regimen, and it is typically delivered in cycles, with treatment periods followed by rest periods to give your body time to recover. A specific strategy may consist of a single chemotherapy drug or a combination, given at the same time or one after another. It may be given intravenously through a small tube inserted into a vein or taken orally as a pill, and it may be used in conjunction with other therapies.

Chemoradiation combines chemotherapy with radiation therapy. It makes cancer cells more sensitive to radiation, making it easier for the radiation to kill them.

Radioactive iodine treatment involves giving radioactive iodine (I-131) in liquid or pill form. It may be used after surgery in patients who are at increased risk of recurrence. The radioactive iodine will concentrate in any remaining thyroid tissue, and the radiation will kill the cancer cells.

Radiation therapy is the use of high-energy particles, such as X-rays, to kill cancer cells and may be used alone or with other treatments. It is sometimes recommended when cancer has spread to the bones, and it is commonly used after surgery to try to kill any remaining cancer cells to lower the risk of recurrence. When it is used this way, it is called adjuvant therapy. Radiation therapy may also be used to manage pain.

Radiation therapy is delivered externally and internally. External-beam radiation therapy (EBRT) is delivered from a machine. It is a local treatment, which means it treats a specific part of your body. EBRT is used to treat many types of cancer, and it is a form of radiation that will not make you radioactive. You may safely be around people of all ages. There are many types of EBRT, including proton therapy, 3-D conformal radiation therapy, intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery.

Brachytherapy is a type of internal radiation therapy in which radioactive material sealed in needles, seeds, wires or catheters is placed directly into or near a tumor.

Targeted therapy identifies targets that play important roles in the growth and survival of cancer cells and in developing agents that can attack them. These agents block the signals that proteins and other molecules send along signaling pathways, which are systems in the body that direct basic cell functions, such as cell division and death. Unlike chemotherapy, which attacks healthy cells as well as cancer cells, targeted therapy is designed to affect only cancer cells. Many targeted therapy drugs are oral medications, and some may be given in combination with other treatments.

Immunotherapy harnesses the potential of the body’s own immune system to recognize and attack cancer cells. Training the immune system to respond to cancer has the potential for a more lasting response that can extend beyond the end of treatment, offering long-term protection against cancer. This capability makes immunotherapy very different from other types of cancer treatments. Immunotherapy for the treatment of head and neck cancers involves the use of drugs known as immune checkpoint inhibitors. These inhibitors may be given with or without chemotherapy. This approach may be used for advanced head and neck cancers that did not respond to standard treatment.

Clinical trials should be considered along with other treatment types. A clinical trial may be an alternative if your current treatment isn’t working well or if side effects are severely affecting your quality of life. Participating in a clinical trial will not jeopardize your care. You will always be guaranteed to receive at least the standard of care for your type of head and neck cancer.

 

Some Common Head and Neck Cancer Drugs*

  • bleomycin sulfate (Blenoxane)
  • cabozantinib (Cometriq)
  • cetuximab (Erbitux)
  • cisplatin (Platinol)
  • dabrafenib (Tafinlar) and trametinib (Mekinist)
  • docetaxel (Taxotere)
  • doxorubicin hydrochloride (Adriamycin)
  • hydroxyurea (Hydrea)
  • larotrectinib (Vitrakvi)
  • lenvatinib (Lenvima)
  • methotrexate sodium (Methotrexate LPF)
  • nivolumab (Opdivo)
  • pembrolizumab (Keytruda)
  • sorafenib tosylate (Nexavar)
  • vandetanib (Caprelsa)

       *As of 5/8/19
 

Thermoplastic Mask: A Safety Measure During Radiation Therapy

For radiation therapy to be most effective, the radiation beams must target the same spot every time. In most cases, semi-permanent marks or permanent tattoos are placed on your skin to indicate the exact location the radiation beams must hit to reach the tumor. To ensure your safety, you must be in the same position for every treatment. Sometimes, 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. Wearing the mask and being unable to move can be upsetting, especially if you suffer from claustrophobia. Your treatment team will help make you as comfortable as possible, so tell them if you feel anxious. If necessary, your doctor may prescribe medication to ease anxiety and help you relax for your treatments.

 

 

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