The treatment plan for an individual patient diagnosed with head and neck cancer depends on a number of factors, including the exact location of the tumor, the stage of the cancer and the person’s age and general health. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy or a combination of treatments.
The patient and the doctor should consider treatment options carefully. They should discuss each type of treatment and how it might change the way the patient looks, talks, eats or breathes.
Surgery for head and neck cancers often changes the patient’s ability to chew, swallow or talk. The patient may look different after surgery, and the face and neck may be swollen. The swelling usually goes away within a few weeks. However, if lymph nodes are removed, the flow of lymph in the area where they were removed may be slower and lymph could collect in the tissues, causing additional swelling (lymphedema). This swelling may last for a long time or be permanent.
After a laryngectomy (surgery to remove the larynx) or other surgery in the neck, parts of the neck and throat may feel numb because nerves have been cut. If lymph nodes in the neck were removed, the shoulder and neck may become weak and stiff.
Patients who receive radiation to the head and neck may experience redness, irritation and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Other problems that may occur during treatment are loss of taste, which may decrease appetite and affect nutrition and earaches (caused by the hardening of ear wax). Patients may also notice some swelling or drooping of the skin under the chin and changes in the texture of the skin. The jaw may feel stiff, and patients may not be able to open their mouth as wide as before treatment.
Patients should report any side effects to their doctor or nurse, and discuss how to deal with them.
Rehabilitation and Support Options
The goal of treatment for head and neck cancers is to control the disease, but doctors are also concerned about preserving the function of the affected areas as much as they can and helping the patient return to normal activities as soon as possible. Rehabilitation is a very important part of this process. The goals of rehabilitation depend on the extent of the disease and the treatment that a patient has received.
Depending on the location of the cancer and the type of treatment, rehabilitation may include dietary counseling, speech therapy and/or learning how to care for a stoma. A stoma is an opening into the windpipe through which a patient breathes after a laryngectomy (complete removal of the voice box). The patient breathes through an opening in the neck called a laryngostoma.
Sometimes, especially with cancer of the mouth, a patient may need reconstructive and plastic surgery to rebuild bones or tissues. However, reconstructive surgery may not always be possible because of damage to the remaining tissue from the original surgery or from radiation therapy. If reconstructive surgery is not possible, a prosthodontist may be able to make a prosthesis (an artificial dental and/or facial part) to restore satisfactory swallowing, speech and appearance. Patients will receive special training on how to use the device.
Patients who have trouble speaking after treatment may need speech therapy. Often, a speech-language pathologist will visit the patient in the hospital to plan therapy and teach speech exercises or alternative methods of speaking. Speech therapy usually continues after the patient returns home.
Eating may be difficult after treatment for head and neck cancer. Some patients receive nutrients directly into a vein after surgery or need a feeding tube placed directly into the stomach, until they can eat on their own. A feeding tube is a flexible plastic tube that is usually passed into the stomach through the nose or an incision in the abdomen. A swallowing therapist can help patients learn how to swallow again after surgery.
Regular follow-up care is very important after treatment for head and neck cancer to make sure that the cancer has not returned, or that a metastasis (spread of the cancer from the area where it began) has not developed. Depending on the type of cancer, medical checkups may include exams of the stoma, if one has been created, and of the mouth, neck and throat. Regular dental exams may also be necessary.
From time to time, the doctor may perform a complete physical exam, blood tests, X-rays and scans. The doctor may monitor vocal cord function, especially if the head or neck was treated with radiation and is likely to counsel patients to stop smoking. Research has shown that continued smoking by a patient with head and neck cancer may reduce the effectiveness of treatment and increase the chance of a second primary cancer.