What Are Treatment Options for Mouth and Throat Cancer?
After evaluation by a surgical or radiation oncologist to treat the cancer, there will be ample opportunity to ask questions and discuss which treatments are available.
- The doctor will explain each type of treatment, elaborate the pros and cons, and make recommendations.
- Treatment for head and neck cancer depends on the type of cancer and whether it has affected other parts of the body. Factors such as age, overall health, and whether the patient has already been treated for the cancer before are included in the treatment decision-making process.
- The decision of which treatment to pursue is made with the doctor (with input from other members of the care team) and family members, but ultimately, the decision is the patient's.
- A patient should be certain to understand what will be done and why, and what he or she can expect from the choices. With oral cancers, it is especially important to understand the side effects of treatment.
Like many cancers, head and neck cancer is treated on the basis of cancer stage. The most widely used therapies are surgery, radiation therapy, and chemotherapy.
- The medical team may include an ear, nose, and throat surgeon; an oral surgeon; a plastic surgeon; and a specialist in prosthetics of the mouth and jaw (prosthodontist), as well as a specialist in radiation therapy (radiation oncologist) and medical oncology.
- Because cancer treatment can make the mouth sensitive and more likely to be infected, the doctor will probably advise the patient to have any needed dental work done before receiving treatments.
- The team will also include a dietitian to ensure that the patient gets adequate nutrition during and after therapy.
- A speech therapist may be needed to help the patient recover his or her speech or swallowing abilities after treatment.
- A physical therapist may be needed to help the patient recover function compromised by loss of muscle or nerve activity from the surgery.
- A social worker, counselor, or member of the clergy will be available to help the patient and his or her family cope with the emotional, social, and financial toll of your treatment.
Treatment falls into two categories: treatment to fight the cancer and treatment to relieve the symptoms of the disease and the side effects of the treatment (supportive care).
Surgery is the treatment of choice for early stage cancers and many later stage cancers. The tumor is removed, along with surrounding tissues, including but not limited to the lymph nodes, blood vessels, nerves, and muscles that are affected.
Radiation therapy involves the use of a high-energy beam to kill cancer cells.
- Radiation can be used instead of surgery for many stage I and II cancers, because surgery and radiation have equivalent survival rates in these tumors. In stage II cancers, tumor location determines the best treatment. The treatment that will have the fewest side effects is usually chosen.
- Stage III and IV cancers are most often treated with both surgery and radiation. The radiation is typically given after surgery. Radiation after surgery kills any remaining cancer cells.
- External radiation is given by precisely targeting a beam at the tumor. The beam goes through the healthy skin and overlying tissues to reach the tumor. These treatments are given at the cancer center. Treatments are usually given once a day, five days a week, for about six weeks. Each treatment takes only a few minutes. Giving radiation this way keeps the doses small and helps protect healthy tissues. Some cancer centers are experimenting with giving radiation twice a day to see if it increases survival rates.
- Unfortunately, radiation affects healthy cells as well as cancer cells. Damage to healthy cells accounts for the side effects of radiation therapy. These include sore throat, dry mouth, cracked and peeling lips, and a sunburn-like effect on the skin. It can cause problems with eating, swallowing, and speaking. The patient may also feel very tired during, and for some time after, these treatments. External beam radiation can also affect the thyroid gland in the neck, causing the level of thyroid hormone to be low. This can be treated.
- Internal radiation therapy (brachytherapy) can avoid these side effects in some cases. This involves implanting tiny radioactive "seeds" directly into the tumor or in the surrounding tissue. The seeds emit radiation that destroys tumor cells. This treatment takes several days and the patient will have to stay in the hospital during the treatment. It is less commonly used for oral cancers than external radiation therapy.
Chemotherapy refers to the use of drugs to attempt to kill cancer cells. Chemotherapy is used in some cases before surgery to reduce the size of the cancer, or after surgery, or in combination with radiation to enhance the local, regional, and distant control of the disease and hopefully the cure rate of the treatment. Hidden cancer cells may escape the area being treated by surgery or radiation and it is those cells which result in recurrences of the cancer and which chemotherapy hopes to prevent by killing such cells. A person's treatment plan will be individualized for his or her specific situation. Targeted therapy refers to the use of newer drugs or other substances that block the growth and spread of cancer by interfering with molecules specific to the particular type of tumor. Older chemotherapy drugs are less specific, or targeted, but rely on cancer cells being less able to recover from their effects than can normal cells.
Treatment of recurrent tumors, like that of primary tumors, varies by size and location of the recurrent tumor. The treatment given previously is also taken into account. For instance, sometimes further surgery can be done. If a site of recurrence was already treated by external radiation therapy may be difficult to treat a second time with external radiation. Often chemotherapy may be tried if a recurrence is inoperable, or further radiation with curative intent is not feasible.
Weight loss is a common effect in people with head and neck cancers. Discomfort from the tumor itself, as well as the effects of treatment on the chewing and swallowing structures and the digestive tract, often prevents eating.
Medications will be offered to treat some of the side effects of therapy, such as nausea, dry mouth, mouth sores, and heartburn.
The patient will probably see a speech therapist during and for some time after treatment. The speech therapist helps the patient learn to cope with the changes in the mouth and throat after treatment so that he or she can eat, swallow, and talk.