Head & Neck
Treatment Planning
Advances in understanding and treating head and neck cancer are bringing hope to many people affected by this disease. More treatments are now available, and research in clinical trials is ongoing to find more effective therapies and better ways to manage side effects of the disease and its treatment.
After you receive a diagnosis, you will work closely with your doctor to develop a treatment plan. It is an important time to discuss your concerns and your expectations for maintaining independence with certain physical activities of daily living, as treatment may change the way you breathe, speak or eat. Your doctor will focus on preserving – as much as possible – your ability to perform these functions normally.
Try to learn as much as you can before you begin treatment so you are not surprised later. It is crucial that you are comfortable with your decision. Always request explanations for anything you do not understand.
Your doctor may ask you about your smoking status to determine the potential effectiveness of radiation therapy and surgical treatments. Smoking is known to reduce treatment effectiveness and is also associated with an increased risk of second cancers.
Throughout treatment, your doctor will continually monitor your condition and make adjustments as needed. Keep in mind that cancer is an ever-changing condition that presents many challenges.
Treatment Options
Treatments are described as first line, second line and so on. First-line therapy is the first treatment used. Second-line therapy is given when the first-line therapy doesn’t work or is no longer effective. You may also hear a treatment called standard of care, which refers to the best treatment known for a specific type and stage of cancer.
Following are some of the common treatments for head and neck cancers.
Surgery is used to remove a solid tumor. It may offer the best chance of controlling the disease and keeping it from spreading, especially for people with early-stage disease. Surgery may be used to stage and treat the cancer or to relieve or prevent symptoms that might otherwise occur later. Many types of surgery are available. A neck dissection, which is the removal of lymph nodes and surrounding tissue from the neck, is a common procedure that may be used. Surgery may also accompany other treatment types.
Reconstructive surgery may be an option to restore appearance or functionality (see Reconstruction & Rehabilitation).
Radiation therapy uses high-energy radiation to destroy cancer cells and shrink tumors. Some people with localized disease or bone pain that does not lessen with chemotherapy may receive it to specific parts of the body.
External-beam radiation therapy (EBRT) is delivered from a machine and is used to treat many types of head and neck cancer. Different types of EBRT include proton therapy, three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), hyperfractionated therapy and stereotactic radiosurgery.
Internal radiation therapy, also called brachytherapy, uses a radioactive substance sealed in needles, seeds, wires or catheters that are placed directly into or near the cancer.
Radioactive iodine treatment involves giving radioactive iodine (I-131) in liquid or pill form to treat some forms of thyroid cancer. It may be used after surgery in patients with thyroid cancer who are at increased risk of recurrence. The radioactive iodine will concentrate in any remaining thyroid tissue, and the radiation will kill the cancer cells.
Drug therapy is systemic therapy that travels throughout the body and may include chemotherapy, hormone therapy, immunotherapy or targeted therapy (see Figure 1).
Chemotherapy is typically part of the treatment plan for most types of head and neck cancer. It may be given alone or in combination with other forms of treatment. In early stages, it may be used before surgery (neoadjuvant) to help shrink the tumor, or after surgery (adjuvant) to kill remaining cells. It may be given intravenously (IV) through a small tube inserted into a vein or port, or taken orally as a pill. It is typically delivered in cycles, with treatment periods followed by rest periods to give the body time to recover.
Hormone therapy is a part of treatment, if the thyroid is partially or fully removed, to supplement the hormone the gland makes. It may also be used to slow down the growth of remaining differentiated cancer cells. It is typically given as a pill that is taken daily.
Immunotherapy helps the body’s own immune system recognize and destroy cancer cells. It may be used as first-line therapy for metastatic, recurrent or unresectable (inoperable) head and neck cancers. And, it may be indicated when the cancer progresses on or after platinum-based chemotherapy. By training the immune system to respond to cancer, this strategy has the potential for a response that can extend beyond the end of treatment. The main type of immunotherapy approved for head and neck cancers is immune checkpoint inhibitors, which prevent the immune response from slowing down, so that immune cells continue fighting cancer. It may be given intravenously (IV) through a vein or a port or as an injection.
Targeted therapy uses drugs or other substances to identify and attack specific types of cancer cells. Targeted therapy is designed to affect only cancer cells. Some of these drugs are oral medications given in pill form, and others are given by IV. Some may be given alone or in combination with other drug therapies.
When given for head and neck cancers, these drugs target specific genes, such as BRAF, RET and NTRK, or proteins and growth factors, including VEGF, EGFR and MEK. It may be used with or without chemotherapy and after surgery for advanced stage head and neck cancers.
Chemoradiation,also called chemoradiotherapy, combines chemotherapy with radiation therapy. It makes cancer cells more sensitive to radiation, making it easier for the radiation to kill them.
Watchful waiting, sometimes known as active surveillance, may be recommended for tumors that appear to be growing very slowly. Delaying treatment postpones potential treatment side effects for as long as possible while the doctor closely monitors for signs the cancer has progressed or returned.
Clinical trials are medical research studies that may offer access to leading-edge treatments not yet widely available. They may be an option at any stage, even as a first-line treatment (see Clinical Trials, page 12). Ask your doctor if you should consider a clinical trial.
Some Head and Neck Cancer Drugs
These therapies may be used alone or in combination.
| Some head and neck cancer drugs |
| bleomycin sulfate (Blenoxane) |
| cabozantinib (Cabometyx, Cometriq) |
| cetuximab (Erbitux) |
| cisplatin (Platinol) |
| dabrafenib (Tafinlar) and trametinib (Mekinist) |
| docetaxel (Taxotere) |
| doxorubicin hydrochloride (Adriamycin) |
| entrectinib (Rozlytrek) |
| hydroxyurea (Hydrea) |
| larotrectinib (Vitrakvi) |
| lenvatinib (Lenvima) |
| methotrexate sodium (Methotrexate LPF) |
| nivolumab (Opdivo) |
| pembrolizumab (Keytruda) |
| pralsetinib (Gavreto) |
| selpercatinib (Retevmo) |
| sorafenib (Nexavar) |
| vandetanib (Caprelsa) |
Thermoplastic Mask
A necessary safety measure during radiation therapy
For radiation therapy to be most effective, the radiation beams must target the same spot every time. In most cases, semi-permanent marks or permanent tattoos are placed on your skin to indicate the exact location the radiation beams must hit to reach the tumor. To ensure your safety, you must be in the same position for every treatment.
Body molds or other immobilizing devices, such as a special mesh head mask called a thermoplastic mask, may be necessary. The mask is created from a mold of your face and head and is a tight fit. Wearing it and being unable to move can cause anxiety, especially if you are claustrophobic. Your treatment team will help make you as comfortable as possible, so tell them if you feel anxious. Your doctor may prescribe medication to help you relax.
HPV and Cancer
Human papillomavirus (HPV), a virus that can lead to cancer, is the most common sexually transmitted disease in the United States. Most people acquire it at some point in their lifetime, and the majority are able to heal from the infection, often without symptoms. If the infection does not resolve, however, it may lead to the development of cancer.
Key facts about HPV:
- More than 150 types of HPV exist and about 40 types can be spread through sexual contact from the skin and mucous membranes (lining of the mouth, throat or genital tract).
- HPV-related throat cancers are increasing fastest among men in the United States.
- Nine strains of HPV are known to cause cancer, with HPV being linked to approximately 70 percent of oropharyngeal (throat) cancers.
- Oropharyngeal cancers affect the middle part of the throat, including the base of the tongue and tonsils, and are the most common type of cancer caused by HPV.
- HPV is also linked to anal, cervical, penile, vaginal and vulvar cancers.
If your doctor suspects throat cancer, you will likely be tested for the HPV biomarker. Its presence helps your doctor appropriately stage the cancer and determine the treatment that may be most effective for you. HPV biomarker testing may also be conducted to predict an HPV-associated throat cancer recurrence.
Your health care team and the listings in the back of this guide are valuable resources for learning more about HPV and how your diagnosis may affect your loved ones. Ask your doctor about the recommended screenings and vaccinations for your partner and your children, as well as the potential benefit of being vaccinated after receiving your head and neck cancer diagnosis. Although HPV vaccination does not treat existing infections or diseases (this is why the HPV vaccine works best when given before any exposure to HPV), it can prevent new infections with the types of HPV that most often cause oropharyngeal and other cancers.
Three vaccines are approved by the U.S. Food and Drug Administration (FDA) for male and female children and young adults, 9 to 26 years old, to provide protection against new HPV infections and include:
- Gardasil (Human Papillomavirus Quadrivalent [Types 6, 11, 16, and 18] Vaccine, Recombinant).
- Gardasil 9 (Human Papillomavirus 9-valent Vaccine, Recombinant). Gardasil 9’s approval was recently expanded to include males and females ages 27 through 45 years.
- Cervarix (Human Papillomavirus Bivalent [Types 16 and 18] Vaccine, Recombinant).
Making certain lifestyle choices may help decrease the chance of getting the virus, such as using condoms and dental dams properly to lower the chance that HPV is passed from one person to another.
