1. Clinical Trials
Taking part in a clinical trial
Your consultant, nurse or doctor may suggest you take part in a clinical trial. Head & Neck Cancer Teams run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods. For example, if you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment
Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer. It may be helpful to talk to your specialist or clinical trials nurse, or get a second opinion. If you decide to take part, you can withdraw at any time. For more information
Visit https://clinicaltrials.gov/ – 3 simple steps to find what is available
2. How different cancers are treated
The main treatments for head and neck cancers are surgery, radiotherapy and chemotherapy. These treatments may be used on their own, or in combination.
The choice of treatment will depend on:
- the type, size and location of the tumour
- your age, medical history and general health
- whether the cancer has spread
- the types of symptoms and side effects you experience.
How different cancers are treated
Oral cancer – is commonly treated with surgery, then radiotherapy if required. Chemotherapy is sometimes used in combination with these treatments.
Salivary gland cancer – is usually treated by surgery, followed by radiotherapy. Chemotherapy is not usually given unless the cancer has spread. Chemotherapy may also be offered as palliative treatment.
- Pharyngeal cancer – is usually treated with surgery or radiotherapy, or both. Chemotherapy may also be offered, usually with radiotherapy.
- Laryngeal cancer – is treated with either laser surgery or radiotherapy in the early stages. For larger cancers, radiotherapy is usually combined with chemotherapy
(chemoradiation). Chemotherapy may be given first to ease the pressure on a person’s airway. For advanced cancer, surgery is used only if the cancer comes back or it’s not all destroyed by radiotherapy. Radiotherapy (with or without chemotherapy) will be given after surgery to reduce the chance of the cancer coming back. Nasal or paranasal sinus cancer – is commonly treated with surgery, followed by radiotherapy and/or chemotherapy.
3. Preparing for treatment
Preparing for treatment
Treatment for head and neck cancer, particularly radiotherapy, can cause dental problems. However, these problems can often be prevented.
Before starting cancer treatment it is recommended that you see a dentist or oral medicine specialist for a thorough oral examination and to get an oral health care plan. The plan outlines if any dentistry work is needed to reduce the chance of future dental problems. An oral health care plan also helps you learn good oral health care before, during and after treatment.
The dentist will probably recommend that any teeth that might be affected by radiotherapy are taken out. These teeth may be removed during cancer surgery or before radiotherapy.
Free public dental services
If you hold a Pensioner Concession Card or Health Care Card you may be eligible for free or low cost public dental services.
The aim of surgery is to remove cancerous tissue and preserve the functions of the head and neck, such as breathing, swallowing and speech, as much as possible.
Before recommending treatment, doctors determine how easy it is to access a tumour using surgery, the likely success of a surgery, and whether it will cause major side effects. They weigh up the benefits and impacts of all the treatments, while taking into account your wants, and your general health.
If surgery is minor, recovery is usually fast. There are likely to be few long-term side effects. For more advanced cancer, surgery will be more extensive, lasting up to twelve hours and often causing longer-lasting or permanent side effects.
If a head and neck cancer has spread to the lymph nodes in your neck, or if there is a chance it will spread, your surgeon will probably remove the nodes. This operation is called a neck dissection or lymphadenectomy. In some cases, this may be the only surgery you have, as the primary cancer will be treated with radiotherapy.
The surgeries for the different head and neck cancers are described on the following pages.
The surgery used depends on the size of the cancer and its position, and may involve:
- Endoscopic surgery – uses telescopes and microscopes through the nose and mouth to remove cancers.
- Transoral surgery – involves removing cancers through the mouth using standard surgical tools, or specialised tools incorporating laser or robotic technology.
- Open Surgery – involves making cuts in the neck or the lines of the face to access and remove cancers. Used for larger cancers and those in difficult positions. Bones of upper and lower jaw or skull may need to be removed.
Endoscopic and transoral surgeries minimise damage to surrounding tissues and are often done as a day or overnight procedure. Reconstruction may be required after open surgery.
After surgery to remove advanced cancer, reconstructive surgery may be required to repair defects or restore function. Reconstructive surgery is either carried out at the same time as the resection, or at a later date. It may involve:
- Skin, bone or tissue grafts – involves use of skin, bone or tissue from another part of the body to rebuild the area.
- Prosthetic reconstruction – involves use of synthetic material.
Radiotherapy uses x-rays or electrons to kill or harm cancer cells so they can’t grow and multiply. It can be used alone or with other treatment. Radiotherapy can be given externally or internally.
Also known as brachytherapy, this treatment is occasionally used for oral cancers. Small tubes containing radioactive material are inserted into and around the tumour. Your doctor will give you more information about this treatment.
Before radiotherapy you may need to be fitted for a plastic mask. Wearing the mask will assist you to keep very still during the treatment.
Radiotherapy to the head and neck can affect your teeth and bones, possibly causing osteoradionecrosis (ORN). Your health care team should include a dentist who takes measures to prevent this damage before treatment begins.
External beam radiotherapy
External beam radiotherapy is common for oral, salivary gland, laryngeal, pharyngeal, nasal and paranasal sinus cancers. Treatment is often given using a machine called a linear accelerator.
As a support group we would like to advise you that we are a patient – led self-funding charity.
Our sole aim is to help people, and we offer advice based on our experiences in dealing with Head & Neck Cancer. ‘We are here to support patients, carers and their families who have concerns relating to the cancer ‘Journey’
An introduction to radiotherapy
What is it, how does it work, and what’s it for?
H&N Cancer Patient & Caregiver Book: Follow the link to read the book online;
Radiotherapy, often abbreviated RT, RTx, or XRT, is therapy using ionizing radiation, generally as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator.
Some side effects begin during treatment, whereas others can appear weeks or months afterwards. Most side effects of radiotherapy only last for a few days or weeks after treatment has finished. However, some, such as tiredness or hair loss, can last a few months.
Intensity-modulated radiation therapy (IMRT) is an advanced type of radiation therapy used to treat cancer and noncancerous tumours. IMRT uses advanced technology to manipulate photon and proton beams of radiation to conform to the shape of a tumour.
Side Effect (IMRT)
With intensity modulated radiotherapy techniques there is very little normal tissue in the treatment area. So, the risk of side effects is low. But unfortunately, you can still have side effects. As with any external beam radiotherapy, the side effects only affect the part of the body that the radiotherapy treatment is aimed at. Proton therapy is a type of radiation treatment that uses Protons to treat cancer. It’s also called Proton beam therapy. A Proton is a positively charged particle. At high energy, Protons can destroy cancer cells.
Side Effects (Proton)
In general, common side effects of proton therapy include:
- Fatigue, Mouth, eating and digestion problems
- Headaches, Hair loss around the part of your body being treated.
- Skin redness around the part of your body being treated.
- Soreness around the part of your body being treated.
For more information on radiotherapy side effects, see the side effects section of the website
Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. The aim of chemotherapy is to destroy cancer cells while doing the least possible damage to healthy cells. You will probably receive chemotherapy by injection into a vein (intravenously) at treatment sessions over several weeks. Chemotherapy may be given in a number of ways, for a range of reasons:
Chemotherapy side effects
There are many possible side effects of chemotherapy, depending on the drugs you are given. Many side effects are preventable and treatable. Combined chemoradiation may cause more severe side effects than if you have chemotherapy and radiotherapy separately, but the side effects can be managed. The combined treatment approach is almost always only used when the aim of treatment is cure or prolonged remission.
Call Cancer Council 13 11 20 for your free copy of Understanding Chemotherapy or visit your local Cancer Council website.
Possible side effects from chemotherapy
- tiredness and fatigue
- nausea and/or vomiting
- tingling due to nerve damage
- taste changes
- poor appetite
- hair loss
- hearing loss
- an increased risk of infection
- mouth sores
- memory problems (chemo brain)
7. Feeding Tube Peg
Patients with advanced head and neck cancer can experience significant difficulties in swallowing as a consequence of the cancer or as a result of treatment. Difficulty swallowing (dysphagia) is more common in cancer of the back of the mouth and throat and in patients having radical treatment such as chemo radiotherapy or surgery followed by radiotherapy.
There are various ways to help give patients the extra nutrition needed to get though treatment. Percutaneous endoscopic gastrostomy (PEG) tubes we first described by Gauderer in 1980 and are a tube placed in to the tummy under local anaesthetic with sedation (please see the patient information leaflet). The other way of getting the tube into the tummy is using x-rays to guide its placement radiologically inserted gastrostomy (RIG). PEGS are usually temporary and are moved between 6 to 12 months following treatment. In the Unit only 8% of patients treated by primary surgery for oral and oropharyngeal cancer had a long-term PEG. The major PEG related problems are not those of discomfort, leakage or blockage, but interference with family life, intimate relationships, social activities, and hobbies. More can be done to counsel and support patients with long-term PEG placement. Please contact your Oncologist or Clinical Nurse for additional information.
Treatment for head and neck cancer may include surgery and/or oncological treatments such as radiotherapy or chemotherapy. There is also increasing evidence for the use of biologically targeted agents, such as viruses. These treatments may result in physical, emotional and psychological problems. It is common for people to experience swallowing and/or speech and voice problems from the point of diagnosis, for the duration of, and beyond the completion of oncological treatments.
Speech & Language Therapist
- Speech and language therapists (SLTs) have expertise in assessing, diagnosing and managing disorders of communication, speech, voice and swallowing as a result of head and neck cancer.
- SLTs develop and support the communication skills of both the patient and communicative partners.
- SLTs have a unique and essential role to help facilitate a laryngeal voice restoration post laryngectomy.
- SLTs contribute to the decision-making process of selection of prosthesis, care and management in Surgical Voice Restoration service (SVR) post laryngectomy.
- Early SLT intervention for swallowing problems associated with head and neck cancer requires a thorough assessment that may include both video fluoroscopy and/or FEES (fibreoptic endoscopic evaluation of swallowing) in addition to bedside assessment which may take place prior to any treatment.
This page is in memory of the great work Phil Johnson, Phil was diagnosed in 2009 and he always said “I was diagnosed with throat cancer back in 2009 and though the care I received was absolutely superb, I was greatly aggravated that my specialist team bemoaned the fact that government spending cuts were having a direct effect on the equipment needed, which is vital to our condition” so he went about setting up his 20-20 charity to support both health professional teams and patients.
The charity meant the world to Phil, he was so devoted to a cause and he did it with so much enthusiasm, with so much energy that he barely had anything left for himself
Phil passed away on the 7th January 2022 and will be sadly missed by all of us and our thoughts go out to his wonderful wife and family.
9. Palliative Treatment
Palliative treatment helps to improve people’s quality of life by reducing symptoms of cancer without aiming to cure the disease.
Palliative treatment can assist with managing symptoms such as pain and nausea, as well as slowing the spread of cancer. In rare cases, palliative treatment is offered in an attempt to delay the onset of symptoms. Treatment may include radiotherapy, chemotherapy or other medications and always involves consideration of the potential benefits and side effects.
Palliative treatment may be beneficial for people at any stage of advanced disease, as well as those requiring end-of-life care.
Call Cancer Council 13 11 20 for more information about palliative care, advanced cancer and cancer pain.