This is a broad category that includes tumors in many areas of the head and neck, but is separate from brain cancer. Because surgery presents significant risk to critical structures in this area, radiation is often the first choice for treatment, often provided in conjunction with chemotherapy. However, older radiation delivery methods can expose nearby, healthy tissue to damage.
Cutting-edge therapies such as Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) enable physicians to deliver higher doses of precisely focused radiation to cancerous head and neck tumors while sparing nearby healthy tissue.
What Is Head and Neck Cancer?
Head and neck cancers include many types of malignancies (cancerous tumors) in the face, mouth and throat. Some common locations include:
- nasal cavity/paranasal sinuses.
- oral cavity (lips, gums, floor of mouth, tongue, cheeks).
- mouth, jaw, throat and ears.
- pharynx, nasopharynx, oropharynx (base of tongue, tonsils).
- larynx (voice box) and hypopharynx.
- salivary glands.
- skin of head and neck.
- neck and metastases (spread) to the neck.
The way a particular head and neck cancer behaves depends on the site in which it arises (the primary site). For example, cancers that begin on the vocal cords behave very differently than those that arise in the back of tongue, just an inch or less from the vocal cords.
The most common type of cancer in the head and neck is squamous cell carcinoma, which arises in the cells that line the inside of the nose, mouth and throat. Other less common types of head and neck cancers include lymphomas and sarcomas.
Who Gets Head and Neck Cancer?
According to the National Cancer Institute, cancers of the head and neck account for six percent of all malignancies in the United States. Whites currently have the highest incidence rates of head and neck cancers, but African Americans have the highest mortality. Overall, about 62,000 Americans are diagnosed with the disease each year.
The incidence of thyroid cancer has increased in all races and in both males and females in the past two decades. Thyroid cancer incidence is almost three times higher in females than in males and more than two times higher in whites than in African Americans. However, despite the increase in incidence, death rates have remained very low.
The most significant risk factors for head and neck cancer are alcohol and tobacco. Other risk factors include:
- Occupation – exposure to wood or nickel dust or asbestos increases risk significantly.
- Plummer-Vinson Syndrome (disorder from nutritional deficiencies).
- Exposure to viruses, including the human papillomavirus (HPV) and Epstein-Barr, can increase risk.
- Poor oral hygiene.
- Gender – rates of head and neck cancer are nearly twice as high in men and are greatest in men over age 50.
How Do I Know If I Have Head and Neck Cancer?
Often, there are no symptoms of head and neck cancer. However, common complaints include:
- lump or sore that does not heal.
- sore throat that does not go away.
- difficulty or pain with swallowing.
- hoarseness or change in your voice.
- blood in saliva or from the nose.
- ear pain or loss of hearing.
- lump in the neck.
- nasal stuffiness that does not resolve.
There are several tests physicians can use to further the diagnostic process and look for tumors. These include:
- Medical exams, to feel for lumps on the neck, mouth and throat.
- Endoscopy, a procedure in which the physician uses a thin, lighted tube (called an “endoscope”) that is passed through the nose to obtain a more comprehensive assessment of the head and neck area.
- X-ray, CT, MRI and PET scans, which are often needed to show the location and extent of the cancer.
To confirm a cancer diagnosis, a sample of the tumor (called a “biopsy”) is removed and analyzed in the medical lab. Lymph nodes are olive-shaped glands that carry cancer from one area of the body to another. If it is suspected that the cancer has spread to the lymph nodes in the neck, these may be biopsied as well.
What Are My Treatment Options?
Many head and neck cancers can be cured if found early. Physicians use the results of diagnostic tests to determine the site of the cancer and to stage it—or tell how far it has spread. This helps determine the outlook for recovery and the best course of treatment. It is important to understand that treatments to this area of the body can affect eating, breathing, talking or appearance. They may also require rehabilitation and/or reconstructive surgery. Patients should work together with their physician to choose the best treatment options, and understand the risks and benefits of each.
While it is not usually the first treatment choice for head and neck cancer, surgery may be used to remove the primary tumor. This is typically followed by radiation therapy or chemotherapy to kill any remaining cancer cells. The type of surgery performed depends on the location of the cancer. For instance, surgeries in the nasal cavity are often performed with an endoscope (a thin, flexible lighted tube inserted into the nasal cavity or sinus) to see and remove the tumor, rather than cutting through the bone to open up the whole cavity. If the cancer has spread to the lymph nodes in the neck, these may be removed as well.
Chemotherapy (also called “chemo”) employs oral or injected drugs to kill cancer cells. These drugs enter the bloodstream and travel throughout the body, making the treatment useful for cancers that have spread to distant organs. It is also used to shrink head and neck tumors prior to surgery.
Because chemo kills some normal cells in addition to malignant ones, it can cause side effects that vary depending on the type of drug used. These include, but are not limited to, fatigue, nausea, vomiting, loss of appetite, hair loss, mouth sores, changes in menstrual cycle and infertility. It can also cause low white blood cell and platelet counts resulting in higher risk of infection and easy bruising/bleeding. Chemotherapy is often used concurrently with radiation therapy.
With head and neck cancers, preserving vital organs in the area is extremely important. For this reason, radiation is often the first treatment approach with the goal of eliminating, or at least shrinking, the tumor prior to surgery. Surgical removal of the lymph nodes may be necessary if the cancer has spread and not all of the disease is eliminated by radiation. Radiation can be delivered internally or externally. Side effects of radiation are usually limited to irritation around the radiation site, although many patients also report fatigue.
Brachytherapy With brachytherapy, radioactive seeds (pellets) are placed into the head and neck tissue, next to the cancer. The seeds give off small amounts of radiation over several weeks. For head and neck cancers, brachytherapy is often used with external-beam radiation therapy. This radiation method carries small risks associated with seed migration within the body.
External-Beam Radiation Therapy External-beam radiation is much like getting a regular x-ray, but with a much higher dose of radiation. Precisely-focused beams of radiation are focused on the affected area from outside the body. Therapy is administered five days a week for a defined number of weeks, depending on the size, location and type of tumor. This schedule allows enough radiation to get into the body while giving healthy cells time each day to recover. The treatment itself takes only minutes and is usually painless, but since nearby healthy tissue can be damaged, radiation that reaches vital organs in the head and neck area can pose a risk. In addition, radiation therapy to the head and neck area may increase the risk of mouth infections and tooth decay. Due to the complicated structures involved in this area of the body, external-beam radiation is used primarily for palliative treatment in the case of head and neck cancers.
IMRT/IGRT is rapidly replacing traditional external-beam radiation therapy for treating certain cancers. These methods deliver higher radiation doses more precisely to cancerous tumors while avoiding healthy tissue. With IMRT/IGRT, physicians can more effectively treat tumors in the head and neck while reducing the chance of side effects caused by damage to important surrounding tissue and structures. IGRT can also potentially shorten the duration of therapy and enable physicians to treat some head and neck cancers for which traditional radiation therapy was not an option.
Your Head and Neck Cancer Treatment Partner
At Rainier Cancer Center, we offer patients a variety of treatment options, from traditional radiation to cutting-edge therapies such as IMRT/IGRT that may not be widely available in other treatment centers. Regardless of the treatment path, we pride ourselves on providing each patient with the best outpatient experience in the most comfortable atmosphere. Treating Head and Neck cancer can be a complicated process, so our personal Cancer Navigators help each patient personally through their journey.
IMRT & IGRT: Fighting Head and Neck Cancer with Precision
Quick and painless, external-beam radiation has long been used to destroy cancer cells. The latest methods—Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT)—provide the most advanced technology for fighting cancer. Used alone or together, these therapies allow higher doses of radiation to be delivered with greater precision and accuracy without destroying surrounding, healthy tissue. For head and neck cancer it has great advantages over conventional radiation therapy because of its ability to spare critical structures such as salivary glands, mucosa, the spinal cord and the larynx.
For patients, IMRT/IGRT means:
- more effective treatment focused on cancer cells.
- less radiation exposure to normal tissue.
- potentially fewer and milder side effects.
- treatment for some tumors that couldn’t previously be treated by radiation.
How IMRT Works
IMRT is a specialized radiation therapy that uses powerful treatment planning software to calculate precise beam angles, shapes and exposure times tailored to each tumor. The radiation beam can be broken up into many smaller beams and the intensity of each small beam can be adjusted individually. This may allow a higher dose of radiation to be delivered to the tumor with less risk to nearby healthy tissue, potentially decreasing the duration of treatment and increasing the chance of a cure.
How IGRT Works
Tumors can move during a course of treatment. IGRT combines imaging and treatment capabilities on a single machine. This way, tumors can be tracked between, as well as during, treatments, allowing radiation to be focused more precisely. Images captured before each radiation session are compared to previous sessions so that clinicians know the exact location of the tumor each time. IGRT software also accounts for breathing and motion during treatment, ensuring the radiation stays focused on the tumor.
What to Expect During Treatment
The treatment process is similar for IMRT, IGRT and traditional external-beam radiation therapy.
First, we’ll schedule an appointment with a radiation oncologist. During this visit, we’ll perform a simulation of the treatment. You will be positioned on the treatment machine the same way you will be for actual treatment. The radiation oncologist will determine the need to use an immobilization device (such as a cast, mold or headrest) to keep you in the same position during treatment. Then, we’ll take a CT scan to precisely map your anatomy. Using information from the CT scan, the radiation therapist will mark the area(s) to be treated, either on your skin or on the immobilization device. Simulation sessions take 30 to 60 minutes and may be repeated at intervals throughout your course of treatment.
Next, your radiation oncologist and treatment team will design a treatment plan tailored to you. They will use information from the simulation session, anatomical maps obtained from the CT scan, previous medical tests and, in many cases, sophisticated treatment planning software.
For head and neck cancer, radiation therapy is typically administered 5 days per week for 6 to 7 weeks. However, your treatment team will determine the best course of treatment for you. During each session, positioning takes from 5 to 15 minutes. Actual treatment time lasts about 10 minutes and is painless. The radiation is delivered using a machine called a “linear accelerator” which generates x-rays or photon radiation. The linear accelerator moves so that patients can lie comfortably without being re-positioned during treatment.
The treatment room is spacious, and you will not be completely enclosed by equipment. A radiation therapist will position you to ensure successful treatment then go to an adjoining control room. From there, he or she will monitor you closely during radiation treatment using video cameras. The therapist can hear you at all times, and the treatment can be immediately discontinued if you feel uncomfortable or ill. If IMRT/IGRT are employed, the therapist may move the machine or treatment table during treatment to best target the exact area of the tumor. Once each treatment is complete, you can return to your normal daily activities as tolerated.
A follow up exam with your radiation oncologist will be scheduled after your last treatment to discuss side effects. From there, physicians will determine the proper course of ongoing treatment.