Radiation Therapy for Head and Neck
Cancer
Facts
About Head and Neck Cancer
This year, about 62,000 Americans
will be diagnosed with cancer of the oral cavity, pharynx, larynx
and thyroid.
- More than 25 percent of oral cancers occur in people who do
not smoke or have other risk factors.
- Rates of head and neck cancer are nearly twice as high in men
and are greatest in men over age 50.
Risk
Factors for Head and Neck Cancer
The use of tobacco and alcohol
greatly increases your chances of developing head and neck cancer.
Risk factors include:
- Alcohol consumption.
- Smoking or use of smokeless tobacco, such as chew or dip.
- Exposure to wood or nickel dust or asbestos.
- Plummer-Vinson syndrome (disorder from nutritional deficiencies).
- Exposure to viruses, including the human papillomavirus (HPV)
and Epstein-Barr.
Quitting
Smoking
If you quit smoking, the
health benefits begin immediately.
- For patients with head and neck cancer, quitting smoking reduces
the risks of infections and developing other cancers.
- To learn how to quit, ask your doctor or visit http://www.smokefree.gov/.
Symptoms
of Head and Neck Cancer
Although there are sometimes
no symptoms of head and neck cancer, common complaints include:
- Lump or sore that does not heal.
- Sore throat that does not go away.
- Difficulty or pain with swallowing.
- Change in your voice or hoarseness.
- Blood in your saliva or from your nose.
- Ear pain or loss of hearing.
- Lump in the neck.
- Nasal stuffiness that does not resolve.
Diagnosing
Head and Neck Cancer
To look for cancer, your
doctor will examine all the areas of your head and neck.
- Your doctor will first feel for lumps on the neck, mouth and
throat. He or she may also use a flexible endoscope, a thin, lighted
tube that is passed through the nose, to obtain a more comprehensive
assessment of the head and neck area.
- X-ray, CT, MR and PET scans are often needed to show the location
and extent of the cancer.
- To confirm if you have cancer, some tissue will be removed and
analyzed. This test is called a biopsy.
Types
of Head and Neck Cancers
Head and neck cancers arise
from the cells that make up the face, mouth and throat. Because
cancers in different locations behave differently, treatment depends
on the cancer type and extent. Some common locations include:
- Nasal cavity/paranasal sinuses.
- Nasopharynx.
- Oral cavity (lips, gums, floor of mouth, oral tongue, cheek
mucosa, hard palate, retromolar trigone).
- Oropharynx (base of tongue, tonsils, soft palate, oropharyngeal
wall).
- Larynx (vocal cords and supraglottic larynx).
- Hypopharynx (pyriform sinuses, post-cricoid area, posterior
pharyngeal wall).
- Salivary glands (parotid, submandibular, sublingual and minor
salivary glands).
- Thyroid.
Cancers arising in the brain
or eyes are considered different from head and neck cancers. However,
your doctor will check the areas to make sure the cancer has not
spread.
Treatment
for Head and Neck Cancer
Treatment for head and neck
cancer depends on several factors, including the type of cancer,
the size and stage, its location, and your overall health.
- Surgery, radiation therapy and chemotherapy are the mainstays
of treating head and neck cancer.
- For many head and neck cancers, combining two or three types
of treatments may be most effective. That's why it is important
to talk with several cancer specialists about your care, including
a surgeon, a radiation oncologist and a medical oncologist.
- An important concept in treating head and neck cancer is organ
preservation. Rather than relying on major surgery, an organ preservation
approach first uses radiation and chemotherapy to shrink the tumor.
This allows for a less extensive surgery and may even allow some
patients to avoid surgery altogether.
External
Beam Radiation Therapy
External beam radiation therapy
involves a series of daily outpatient treatments to accurately deliver
radiation to the cancer.
- Painless radiation therapy treatments are delivered in a series
of daily sessions. Radiation treatments take only a few minutes,
but each session takes about half an hour to get checked in, change
clothes, get into position and receive the radiation. For some
conditions, radiation is given twice a day, with a four to six
hour gap between treatments.
- Treatments are usually scheduled Monday through Friday, for
five to eight weeks. However, your radiation oncologist may schedule
your treatments more or less often depending on your cancer.
- 3-dimensional conformal radiotherapy (3D-CRT) combines multiple
radiation treatment fields to deliver precise doses of radiation
to the affected area. Tailoring each of the radiation beams to
accurately focus on the patient's tumor allows coverage of the
cancer while at the same time keeping radiation away from nearby
healthy tissue.
- Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT
that further modifies the radiation by varying the intensity of
each radiation beam. This technique allows a precise adjustment
of radiation doses to the tissue within the target area. IMRT
may allow doctors to direct a higher radiation dose to the affected
area and keep more radiation away from nearby healthy tissue.
- To help you keep still during treatment, your doctor may use
a plastic head or shoulder mask. These devices are specially fitted
for you and are painless to use.
Brachtherapy
Also called brachytherapy,
internal radiation therapy involves surgically implanting radioactive
material into a tumor or surrounding tissue. For head and neck cancers,
brachytherapy is often used in conjunction with external beam radiation
therapy, but may be used alone.
- During low-dose-rate brachytherapy, your radiation oncologist
implants thin, hollow, plastic tubes in and around a tumor.
- These tubes are loaded with tiny radioactive seeds that remain
in place for one or several days to kill the cancer. The seeds
and the tubes are then removed. Sometimes, tiny radioactive seeds
are implanted directly into the tumor and remain permanently.
- For high-dose-rate brachytherapy, your doctor implants hollow
tubes in and around the tumor site.
- After these tubes are implanted, they are then connected to
a special brachytherapy machine that houses a high activity radioactive
source. According to your doctor's specifications, the seed is
automatically delivered from the machine and into the tubes, delivering
localized radiation over several minutes to kill the cancer.
Possible
Side Effects
Side effects of radiation
therapy are limited to the area that is receiving treatment.
- Side effects can include redness of the skin, sore throat, dry
mouth, alteration of taste, pain on swallowing and possible hair
loss in the treated area. Fatigue is also very common.
- Side effects are different for each patient. Medications and
nutritional supplements may be prescribed to make you as comfortable
as possible.
- If at any time during your treatment you feel discomfort, tell
your doctor or nurse. They may be able to alter the treatment
or prescribe a drug to help you feel better.
Mouth
Care
It is important to take care
of your mouth, teeth and gums during radiation.
- Careful brushing of your teeth can help prevent tooth decay,
gum disease, mouth sores and jaw infections.
- Be sure to tell your dentist that you received radiation to
the head and neck area.
- Talk to your doctor or dentist about any problems you are having.
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