Head and Neck Cancer: Treatment Choices

There are many treatment choices for head and neck cancer. The one that's best for you depends on things like:

• The type of cancer
• The size of the tumor and where it is in your body
• Results of lab tests
• Extent of the disease, called the stage
• Your overall health
• Your age
• Your personal concerns and preferences

You may have questions and concerns about your treatment choices. You may want to know how you'll feel, how you'll look, how your body will work after treatment, and if you'll have to change your normal activities.

Your doctor is the best person to answer your questions. They can explain what the treatment choices are, how well treatment is expected to work, what the risks and side effects may be, and how much it's likely to cost.

Your doctor may advise a specific treatment. Or they may offer more than one and ask you to decide which one you'd like to use. It can be hard to make this decision. It's important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your doctor about how much time you can take to explore your choices. You may want to get a second opinion before deciding on your treatment plan. You may also want to involve your family and friends in this process.

Treatment for cancer is either local or systemic. You may have both.

• Local treatments remove, destroy, or control cancer cells in a certain place in the body. Surgery and radiation therapy are local treatments.
• Systemic treatments destroy or control cancer cells throughout the body. Chemotherapy, immunotherapy, and targeted therapy are examples.

Treatment may control or cure the cancer. It can also improve your quality of life by helping to control the symptoms of the disease. The goal of head and neck cancer treatment is to do one or more of these things:

• Remove the primary (main) cancer tumor or other tumors
• Kill cancer cells or keep them from growing or spreading
• Keep the cancer from coming back or delay its return
• Ease symptoms of the cancer, such as pain or pressure in nearby tissues

Each type of treatment has a different goal. Talk to your doctor about treatment goals so you know what to expect.

Here's a list of common head and neck cancer treatments:

Radiation therapy uses strong X-rays to kill cancer cells and shrink tumors. This is sometimes the only type of treatment needed for head and neck cancer. More often, radiation is given along with chemotherapy or targeted therapy. Sometimes it's used to shrink a tumor before surgery so it's easier to remove without damaging nearby healthy tissues. It might be used after surgery, too, to kill any cancer cells that may be left behind. Radiation therapy can also be used if the cancer comes back after treatment.

The goal of surgery is to take out the tumor along with an edge of healthy tissue around it. Nearby lymph nodes might also be taken out if the cancer has spread to them. The smaller the tumor, the better the chance of keeping normal functions, such as speaking and swallowing. Surgery may also be done to put in infusion ports for chemotherapy or to place a feeding tube. Plastic or reconstructive surgery may be needed after treatment to help restore appearance and function in the area that was treated.

This is the use of strong medicines to treat cancer. One goal of chemotherapy (or chemo) is to reduce the size of a tumor before using other types of treatment. It can also help decrease the chance that the cancer will spread to other parts of your body. Chemo is most often given at the same time as radiation. This is called chemoradiation. The chemo helps the radiation work better. Chemo may also be used for more advanced cancers, when radiation therapy or surgery can't be used. Or it may be used when the cancer has spread to other parts of the body.

This treatment uses medicines that target certain parts of cancer cells. For instance, many head and neck cancer cells are controlled by a protein called EGFR, which helps them grow. A medicine called cetuximab targets these cells. It blocks EGFR so that cancer cell growth slows or stops. Medicines that target EGFR are sometimes used to treat head and neck cancers.

These medicines help your immune system find and kill cancer cells. Some head and neck cancer cells use a protein called PD-L1 to keep your immune system from attacking them. Medicines that block PD-L1 can boost the immune system against these cancer cells.

Researchers are always finding new ways to treat cancer. These new methods are tested in clinical trials. Taking part in a clinical trial means you get the best treatment available today, and you might also get new treatments that are thought to be even better. Talk with your doctor to find out if there are any clinical trials you should think about.