GENERAL BACKGROUND
Cancer of the head and neck region represents approximately three percent (3%) of all cancers diagnosed in the United States each year. Cancers in this part of the body have been strongly associated with the use of both tobacco and alcohol. Presenting symptoms depend on the site of involvement; however, they can include hoarseness, sore throat, ear pain, difficulty chewing and swallowing, and even potentially, difficulty breathing.

There are many types of cancer that can arise in the head and neck region, but by far the most common type is squamous cell carcinoma which arises from the lining of the mouth and throat. That correlates with the fact that those are the areas which are exposed to the highest concentration of tobacco products like smoke from cigarettes and chewing tobacco.

DIAGNOSIS | Back to Top
Whenever someone is diagnosed with cancer of any type, not only cancer of the head and neck region, it must be staged. This refers to the process of determining if the cancer is limited to where it is observed or felt, or has potentially spread or metastasized elsewhere in the body. This staging procedure can include various x-rays, physical examination, biopsies, and blood tests. Once the extent of the cancer is determined, appropriate treatment recommendations can be made.

It is important to note that cancer in general is treated in a team approach by physicians from multiple specialties. Newly diagnosed cancer patients are oftentimes discussed among cancer doctors in meetings called tumor boards. There, appropriate treatment plans can be formulated and treatment initiated without undue delay.

If very early or small localized cancers are found, they can often be treated very effectively with a solitary type of treatment, such as surgery or radiation therapy. However, if a more advanced cancer is detected, the eventual treatment will likely comprise several different treatments and can often include a combination of surgery, radiation therapy, and even chemotherapy. Again, the final treatment recommendations are based on the latest medical advances and current standards of care.

TREATMENT | Back to Top
Radiation has been used for the treatment of head and neck cancers since its discovery in the late 1800s. The form of radiation that is currently used in the treatment of cancer consists of very powerful x-rays which are commonly generated in large machines called linear accelerators. These x-rays are exactly the same as those that are used in diagnostic x-rays like chest x-rays or CT scans. However, the actual beam of radiation is much more powerful and very finely directed. In fact, the radiation therapy treatment beams are "steered" to within millimeters of where the treating radiation oncologist wishes it to go.

Radiation treatments are generally delivered on a daily basis Monday-Friday for up to six (6) to seven (7) weeks. The actual treatment times are not long, generally in the 15 to 20 minute range. In fact, the actual time receiving the radiation treatment is approximately a minute or two, and most of the daily visits will consist of being set up accurately on the treatment table so the treatments are duplicated exactly each day. The radiation itself cannot be seen, felt, or smelled.

The radiation kills the cancer cells by damaging the DNA in those cells. DNA is the substance in each cell which controls its activities in life. Radiation damages cancer cells with each treatment so when they attempt to divide and grow they are unable to, and they die.
Radiation treatments do indeed treat normal tissue along with the cancers; however, the normal tissue is able to repair the potential radiation damage each day and carry on as normal. As the cancer cells are killed during the treatment, the tumor will often be seen to slowly shrink and will hopefully disappear with time.

SIDE EFFECTS | Back to Top
Potential side effects with head and neck radiation therapy can include the development of a sore throat, hoarseness, and difficulty swallowing. Again, these side effects strictly depend on the area being treated and develop only in areas being treated. For example, delivering radiation treatments to someone's larynx or voice box will not cause their hair to fall out or be sick to their stomach. They could, however, develop hoarseness and a sore throat.

Additional side effects that can develop during the radiation treatments include redness of the skin, which can progress to a mild peeling of the skin similar to a sunburn. All of these side effects mentioned so far are called "acute" side effects, and they go away once the treatments are completed.

There are potential side effects which can also develop during the radiation treatments but often persist or stay with the patient long after the treatments are completed. One of these side effects is called xerostomia or dry mouth. The salivary glands, or spit glands, are located in the head and neck region; when they are exposed to radiation therapy they often do not work as well and can leave the mouth feeling much dryer than normal.

To help limit the amount of dryness patients experience with radiation therapy, a drug has been developed which helps protect the salivary glands from the effects of the radiation.

This drug is called amifostine (Ethyol); it has been shown to help in maintaining the salivary gland function. The amifostine must be delivered through the vein or under the skin shortly before each daily radiation treatment. Potential side effects from this medication include lowering of the blood pressure (hypotension) and nausea and vomiting.

An additional side effect for a gentleman being treated is he will lose the beard in the treatment areas and it will likely not grow back.

PRE-RADIATION THERAPY PROCEDURES
A dental evaluation prior to the start of any radiation therapy is performed. The saliva or spit is very important in keeping the teeth in good condition by keeping bacterial levels down in the mouth and thereby limiting the development of cavities. If the patient experiences dryness of the mouth from the radiation, (s)he will be at increased risk for dental problems in the future.

It is therefore essential that all teeth in bad condition be removed and a general dental cleaning be performed prior to the start of any radiation therapy. In addition, it is often recommended that daily fluoride treatment be applied to any remaining teeth along with frequent dental evaluations (every three to six months).

It will be extremely important throughout the treatment to maintain a very good nutritional intake. It is essential for patients to eat well and in large enough quantities to maintain their weight. If this becomes difficult, different aids can be used to help in maintaining weight. One of these aids is called a PEG feeding tube.

This is a tube placed directly into the stomach and therefore bypass a sore mouth and throat. These tubes are placed on an outpatient basis and are strictly temporary. Once a feeding tube is no longer needed after therapy is completed, it can be easily removed.

These types of feeding tubes are often used when both radiation therapy and chemotherapy are used in the treatment of the cancer.

FUTURE | Back to Top
With the advent of new and ever-changing technology, new techniques are constantly being developed to allow us to deliver the radiation treatments much more accurately and significantly reduce the treatment of normal tissues. A recent development which is now available at our center is intensity modulated radiation therapy (IMRT).

This is a very sophisticated way of delivering the radiation so the disease still receives the same high-dose, cancer-killing dose, but surrounding normal structures can be significantly spared from its effect of the radiation. In head and neck cancer, this is particularly significant in that the salivary glands can often be spared the effects of radiation and a dry mouth can be averted. This technique allows us to deliver very effective cancer treatment and significantly reduce the side effects of the treatment once considered expected.

However, no matter what treatment you receive at our center, you will be followed extremely closely and be cared for by a knowledgeable and caring staff.