Outcomes of Head and Neck cancer

What happens if the treatment is not successful? Where the cancer relapses after radical radiotherapy, salvage surgery is often an option, although it often involves a large and mutilating operation – laryngectomy, removal of half of or the whole tongue (glossectomy), removal of the floor of mouth with reconstruction, pharyngectomy with oesophageal pull-up etc. etc. Before putting a patient up for this type of huge salvage surgery, the doctor will scan carefully to exclude the possibility of metastatic disease and the patient will be fully counselled about the proposed operation and its risks.

 

As has been said above, the patient who relapses in the neck nodes and whose primary tumour has sbeen controlled may well be cured by a radical dissection of that deep cervical chain of nodes. For surgical failures, there are often radiotherapy options for disease above the collar bones (clavicles) and, if the patient did not receive radiotherapy in the first instance this should always be explored. For the previously irradiated patient then close consultation with an expert readiotherapist is made to explore what options (e.g. brachytherapy implant) are available.

 

Where the tumour has resisted all the above or has spread to other organs (frequently the lungs followed later by the bones) then palliative chemotherapy with the same agents mentioned above is an option if the patient is fit enough. However, this option is not always advised, particularly bearing in mind that it is never curative and carries with it toxicity.

 

Therafter therapy follows the usual palliative course for patients whose cancers have extended beyond curative proportions viz. the therapy of symptoms e.g. pain.