Head and Neck Cancer

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 in the vocal cords behave very differently than those that arise in the back of the tongue, which is only 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 from the cells that line the inside of the nose, mouth and throat. Squamous cell cancer is often associated with a history of smoking or exposure to the human papilloma virus (HPV). Other less common types of head and neck cancers include salivary gland tumors, lymphomas, and sarcomas. Methods of prevention include avoidance of exposure to alcohol and tobacco products as well as vaccination of children and young adults against HPV.

Cancers spread in four main ways. The first is direct extension from the primary site to adjacent areas. The second is spread through the lymphatic channels to lymph nodes. The third is spread along nerves (perineural spread) to other areas of the head and neck. The fourth is spread through the blood vessels to distant sites in the body. In head and neck cancer, a spread to the lymph nodes in the neck is relatively common.

  • What are my treatment options?

    The three main types of treatment for managing head and neck cancer are radiation therapy, surgery, and chemotherapy. The primary treatments are radiation therapy, surgery, or both combined; chemotherapy is often used as an additional, or adjuvant, treatment. The optimal combination of the three treatment modalities for a patient with a particular head and neck cancer depends on the site of the cancer and the stage (extent) of the disease.

In general, patients with early-stage head and neck cancers (particularly those limited to the site of origin) are treated with one modality—either radiation therapy or surgery. Patients who have more extensive cancers are often treated with concurrent chemotherapy and radiation therapy. Sometimes, depending on the clinical scenario, patients are treated with surgery followed by postoperative radiation therapy and chemotherapy.

If the plan of treatment is radiation therapy alone for the primary cancer, the neck is also treated with radiation therapy. In addition, surgery to remove involved lymph nodes in the neck (called a neck dissection) may be necessary if the amount of disease in the neck nodes is relatively extensive or if the cancer in the neck nodes has not been eliminated completely by the end of the radiation therapy course.

Another treatment that might be necessary before or after radiation therapy is surgery. In general, if the surgical removal of the primary tumor is indicated, radiation is given afterward if necessary. Sometimes, however, the cancer is extensive or it is not feasible to completely remove the cancer initially. Radiotherapy is then given first to try to shrink the tumor, and surgery will follow radiotherapy.

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