Treatment for head and neck cancer
Cancers affecting the head and neck are uncommon, so people with this type of cancer are usually treated in specialist hospitals.
For most people, the aim of treatment is to remove or destroy all of the cancer and to reduce the chances of it coming back. The treatment you’re offered will depend on where the cancer is in your head or neck, the stage of the cancer, its size and your general health.
The most important factor when trying to cure the cancer is making sure that all the cancer is removed or destroyed. But your doctors will also try to reduce the long-term effects of treatment on you. For example, they will plan your treatment so that your appearance and ability to speak, chew and swallow are affected as little as possible. Before you decide on the best treatment, it’s important to discuss with your doctor or nurse specialist how the different treatment options may affect you.
The team giving you your treatment will explain to you what’s involved and will give you help and support in coping with any side effects. Some people also use complementary therapies to help them cope with treatment side effects. Most cancer specialists are happy for their patients to use complementary therapies but it’s always important to check with them first before trying a complementary therapy.
Treatment for early stage cancer
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If the tumour is small and hasn’t spread to lymph nodes or elsewhere, it can usually be treated with either surgery or radiotherapy.
Small cancers in the mouth can often be removed with surgery. This may cause only small changes to speech, chewing or swallowing that can be adapted to quite quickly.
Radiotherapy may be the preferred treatment for cancers in areas of the head and neck that are difficult to reach, or where removing tissue can cause major changes in speaking or swallowing.
Treating locally advanced cancer
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If a head and neck cancer is larger, or has spread to lymph nodes in the neck, more than one type of treatment is usually needed. This may be either:
a combination of chemotherapy and radiotherapy - called chemoradiation
surgery followed by radiotherapy, chemotherapy or chemoradiation.
Planning your treatment
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In most hospitals, a team of specialists will plan your treatment. This multidisciplinary team (MDT) may include:
An ear, nose and throat (ENT) surgeon - a specialist in treating conditions of the ear, nose, throat and neck. They may also be called an otolaryngologist.
An oral and maxillofacial surgeon - a highly qualified specialist who has trained both as a doctor and a dentist. They specialise in treating conditions affecting the mouth, jaw, face and neck. As well as operating to remove the cancer they also rebuild tissue lost due to the cancer or surgery.
A plastic and reconstructive surgeon - a surgeon skilled in rebuilding tissue in the head and neck.
An oncologist - a doctor who specialises in cancer treatments such as radiotherapy, chemotherapy and targeted therapy.
A radiologist - a doctor who helps to analyse scans and x-rays.
A pathologist - a doctor who advises on the type and extent of the cancer.
A clinical nurse specialist - a nurse who gives support, practical advice and information about any aspect of your illness or treatment.
A speech and language therapist - a therapist who specialises in helping with speech or swallowing problems.
A dietitian - someone who advises you on how to make sure you get all the nutrients your body needs.
The team will often include a number of other healthcare professionals, such as:
an oral hygienist
an occupational therapist
a psychologist or counsellor.
Your doctors may offer you a choice of treatments if more than one treatment is equally effective for your type and stage of cancer. Some people find it hard to make a decision.
If you’re asked to make a decision, make sure that you have enough information about the different treatment options, what is involved and the side effects you might have, so that you can decide what the right treatment is for you.
Remember to ask questions about anything that you don’t understand or feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your doctor, specialist nurse, or with our cancer support specialists.
We have a section about making treatment decisions, which you might find useful.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need explanations repeated. It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
Benefits and disadvantages of treatment
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Many people are frightened at the idea of having cancer treatments because of the side effects that can occur.
Some people ask what would happen if they didn’t have any treatment. Although treatments for head and neck cancer can cause side effects, you’ll be given help and support to control and manage these. Treatment can be given for different reasons and the potential benefits will vary depending on your particular situation.
Your doctor can tell you if the main aim of treatment is to try to cure the cancer, to control the cancer for a time or to decrease symptoms and improve your quality of life. They can also tell you the possible side effects of each treatment and whether these are likely to be temporary or permanent.
Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information.
If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.
Before treatment starts
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You will usually be advised to have a complete dental check-up and to have any dental work you need before your treatment begins.
Your cancer doctor may refer you to a dentist with experience in treating people who have head and neck cancers, or you may be asked to see your own dentist. If you’re going to have radiotherapy and some of your teeth are unhealthy, you may need to have these removed before you start treatment.
You may also be referred to an oral hygienist, who can give you advice on how to care for your teeth and gums. Knowing how to care for your mouth is very important because cancer treatment may make it more sensitive and prone to infection, particularly if you have radiotherapy.
You can find out more about looking after your mouth and teeth, during and after treatment.
Speech, swallowing and eating
You will be seen by the dietitian and/or the speech and language therapist before having surgery or radiotherapy.
They can help with any swallowing, speech or dietary issues you may have before your treatment. They will also advise you on the likely effects that treatment may have on functions such as swallowing and speaking, as well as what can be done to help.
Sometimes radiotherapy can lead to severe difficulty in swallowing, particularly if it’s combined with chemotherapy (chemoradiation). Usually this is temporary and settles within a few weeks of completing treatment.
If your oncologist thinks you may be at risk of developing swallowing difficulties, they may suggest a small operation to put a tube through the skin of your tummy into your stomach so that you can be fed through the tube for a while. This is known as a PEG (percutaneous endoscopic gastrostomy) tube or RIG (radiologically inserted gastrostomy) tube. Once your swallowing improves, the tube can be removed.
Our section on nutritional support
discusses PEG tubes and feeding in detail.
If you’re a smoker, stopping smoking will increase the chances of your treatment being effective. Continuing to smoke increases treatment side effects and the risk of the cancer coming back. Smoking also increases your risk of developing a second cancer in your head or neck, and of developing cancer in other parts of your body, such as your lungs.
Smoking can be a difficult habit to break, especially when you’re stressed, but there are organisations and self-help groups that can help you. Your GP can also give advice and provide nicotine replacement therapies on prescription, such as nicotine patches, gums and inhalers.
Our section on giving up smoking has practical tips on how to stop smoking and ‘stay stopped’.
Avoiding alcohol, particularly spirits, will also help make your treatment more effective and reduce the risk of side effects. If you’d like support to help reduce your alcohol intake, your specialist nurse or doctor can arrange this for you.