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Head and Neck Cancer

Anatomical facts:

The head and neck region contain many complex anatomical structures. These organs are  responsible  for  functions  necessary  for breathing, eating and speaking.  (Central nervous system cancers are discussed in Cancers of the Brain.) Head and neck cancer is an umbrella term used to describe a complex group of cancers affecting different structures in the head and neck. Most of these tumors originate in the thin cell layer that lines the majority of the head and neck organs, called squamous cells; but other types of cancer also can be found there.

Diagram of throat and neck

Approximately 50,000 people are diagnosed with head and neck cancer each year in the United States. Consuming tobacco (in all forms including pipes, cigars, cigarettes, and chewing tobacco) and prolonged use of alcohol are the main causes for head and neck tumors.

Most information sources divide head and neck cancers into five groups according to the anatomic structure in which the cancer originated these are:

Oral cancers: Oral cancer includes tumors on the lips, gums, tongue, and tonsils. More than half of all head and neck cancers occur in the oral cavity.

Larynx cancer: is the cancer of the voice box and vocal cords.

Nasopharyngeal cancer: this type of cancer affects the naso-pharynx, the air passageway in the upper part of the throat, behind the nose.

Cancers of the nasal cavity: Nasal cavity cancer affects the nose and sinuses.

Cancers of the salivary glands: Salivary glands cancer affects the glands that produce saliva.

Non-Hodgkin’s lymphomas and melanomas may also appear in the head and neck region, but Brain tumors are not considered part of the head and neck cancers.

Treatment of head and neck cancers:

Determining the treatment for head and neck cancers is a complex process and requires the input, cooperation, and coordination of many specialists in the field. Surgeons, medical oncologists, pathologists, radiologists, maxillofacial surgeons, plastic surgeons, speech pathologists, and dieticians are often consulted in order to decide on a treatment plan. In general, patients with early-stage disease that has not spread to the lymph nodes are treated with surgery or radiation therapy. These patients have the best chance of a cure. Patients whose disease has spread to nearby lymph nodes, but not to organs outside of the head and neck, are treated with simultaneous administration of radiation and chemotherapy in addition to surgery. People with disease that has spread to organs outside of the head and neck are treated with chemotherapy. The goal of treatment at this stage is to decrease symptoms and improve quality of life.

Treatment for Laryngeal Cancer

The treatment of laryngeal cancer depends on various factors like location and size of tumor, stage of cancer, general health of the patient and personal preferences.

Surgery

Surgery is the mainstay treatment for people with larynx cancer. The surgical removal of the larynx is called laryngectomy. Additional tissue or lymph nodes may also be removed depending on the extent of the cancer. Surgery is recommended when radiation therapy cannot be given or is not working alone. Surgery may also be done for relieving the symptoms at an advanced stage. Different types of surgical procedures are performed.

The surgery types are as follows:

Partial laryngectomy: It is the surgery to remove the part of the larynx that contains the tumor. The vocal cords are spared so that the patient can speak.

Total laryngectomy: It is the surgery to remove the larynx completely and nearby lymph nodes. An opening through the neck into the trachea is created so that the patient can breathe. This procedure is called tracheostomy. Voice Rehabilitation is required after this surgery.

Cordectomy: It involves the surgical removal of vocal cords.

Supraglottic laryngectomy: It involves the surgical removal of supraglottis.

Hemilaryngectomy: It involves the surgical removal of half of the larynx to avoid complete loss of voice.

Plastic surgery is done to reconstruct the throat after the removal of larynx.

Laser surgery

A laser beam, which precisely cuts off the tumor, is used in this form of therapy. It can be used to remove small laryngeal tumors.

Radiation therapy

Radiation therapy uses high energy X rays to kill cancer cells. Radiation therapy can be given in two ways:

External radiation therapy: A beam of radiation from a machine outside the body is aimed at the larynx. It is usually recommended for laryngeal cancer.

Internal radiation therapy or brachytherapy: Radioactive substance sealed in small devices is placed close to the larynx. Cancer cells are killed by the radiations emitted from the radioactive substances.

Patients with early stage laryngeal cancer, when the tumor is still small, may be treated only with radiation therapy. For larger tumours, external radiation is often used together with chemotherapy to shrink the tumor. Radiation can be a part of adjuvant therapy (treatment after surgery). This decreases the chances that the disease will re-emerge.

The patient will be given a mask designed for each individual. This helps to precisely locate the position where radiation is given every time. It is important for a smoker to quit smoking while they are undergoing treatment.

Side effects of radiation will be different depending on what part of the head or neck receives the radiation. One may feel more tired than usual or notice changes to the skin (it may be red or tender) where the treatment was given.

Sore throat, difficulty in swallowing, change in voice, fatigue, weight loss, reddening and drying of skin where radiation is given are some of the side effects of radiation therapy.

These side effects are a result of damage to normal cells. The side effects will usually go away when treatment is over and the normal cells repair themselves. A few side effects, such as a dry mouth, can last a long time.

Chemotherapy

Chemotherapy refers to the use of drugs to kill cancer cells. When drugs are administered through a vein or by mouth, then this kind of chemotherapy is called systemic chemotherapy. This form of chemotherapy is used when cancer has spread all throughout the body and surgery is not possible. Direct administration of the chemotherapeutic agent to the target organ is called regional chemotherapy. The side effects depend on the kind of drugs used and their dose.

Laryngeal cancer patients may be treated with a combination of chemotherapy and radiation therapy. This treatment saves the patient’s ability to talk. Advanced stage laryngeal cancer may also be treated with chemotherapy together with radiotherapy.

Targeted Therapy

Targeted therapy refers to the use of certain drugs that inhibit the growth of cancer cells by blocking the effect of defective genes and proteins. Side effects are decreased when targeted therapy is used. It may be used together with radiation therapy. A monoclonal antibody, Cetuximab (Erbitux), binds to epidermal growth factor receptors in the cell membrane of cancer cells and prevents the growth and survival of the cancer cells. This drug has been approved for the treatment for laryngeal cancer.

Effects of head and neck cancers:

Tumors in the head and neck region may have devastating consequences on the patient’s quality of life. Side effects of these cancers and their treatment may include difficulties in eating and drinking, severe weight loss, dry mouth, dental problems, speech impairments, and facial deformities. Some patients may need to use assistive devices such as feeding tubes and communication tools. The physical changes and difficulties may put a strain on the patient’s emotional well-being and social relationships. In addition, many patients struggle with guilt because lifestyle choices cause so many of these cancers. Patients who smoke need information on smoking cessation. It has been demonstrated that people with head and neck cancers who quit smoking during treatment have a better chance of a cure.

Clinical trials

Clinical trials refer to those kinds of treatment which are not yet standardized. It is a part of research that aims to develop better strategies for the treatment of cancer. The patients may willingly participate in clinical trials.

References

Hristov B, Bajaj GK. Radiotherapeutic management of laryngeal carcinoma. Otolaryngol Clin North Am. 2008 Aug; 41(4):715-40, vi. Review

Dirix P, Lambrecht M, Nuyts S. Radiotherapy for laryngeal squamous cell carcinoma: current standards. Expert Rev Anticancer Ther. 2010 Sep; 10(9):1461-9. Review.

Haigentz M Jr, Silver CE, Hartl DM, Takes RP, Rodrigo JP, Robbins KT, Rinaldo A, Ferlito A. Chemotherapy regimens and treatment protocols for laryngeal cancer. Expert Opin Pharmacother. 2010 Jun; 11(8):1305-16. Review.

This article was originally published on 7/12/2014 and last revision and update of it was 9/14/2015.

Additional Resources:

Carper, Elise, Hu Kenneth, and Kuzin, Elena. 2007. / 10O Questions and Answers about Head and Neck Cancer. Sudbury, MA: Jones and Bartlett. Detailed information about head and neck cancer is presented in an easy-to-read question-and-answer format. The book includes lists of web sites, literature, and resources on specific topics related to head and neck cancer.

Thomas, Jack E., and Robert L. Keith. 2005. Looking Forward: The Speech and Swallowing Guidebook for People with Cancer of the Larynx or Tongue. 4th ed. New York: Thieme Medical. The first part of this guidebook explains the anatomy of the head andneck region and the various therapies used to treat cancers of the larynxor tongue, including surgery, radiation therapy, and chemotherapy. Thesecond part provides techniques and exercises for improving speech andswallowing, tips on tube feeding and speaking with assistive devices.