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Treatment of head and neck cancer

Adenoid cystic carcinoma of the right upper eyelid (upper panel) and its successful treatment by radical radiotherapy (Bottompanel - this picture taken immediately at the end of the radiotherapy programme showing the marked skin reaction
Adenoid cystic carcinoma of the right upper eyelid (upper panel) and its successful treatment by radical radiotherapy (Bottompanel - this picture taken immediately at the end of the radiotherapy programme showing the marked skin reaction

The treatment of head and neck cancer depends on where it is and if or where it has spread to. If the tumour has not spread to other parts of the body it may be possible to cure.

 

The available treatments for cure are surgery, radiotherapy and chemotherapy. The treatment chosen has to have, a good chance of working, whilst having as little effect on the quality of life after treatment. This is often a difficult balance because some of the surgery needed to cure the tumour may remove an important part for example the voice box or part of the tongue. This has effects on speech and swallowing. The advantage of radiotherapy is that it can destroy the tumour whilst leaving the organ in place so patients are, for example, still able to speak and swallow. However, if the tumour is too large or invades bone or cartilage, radiotherapy does not work so well and surgery may be the only chance of cure.

 

In general, therefore, if the tumour can be removed by an operation without affecting the patient too much, then an operation is recommended. If the operation will significantly affect the patient's function, then radiotherapy is recommended. If, however the tumour is advanced, then an operation is the only choice and the after effects are accepted but minimised as much as possible.

 

Radiotherapy can be given after surgery to minimise the chances of the tumour returning.

 

It is now known that radiotherapy is more effective if chemotherapy is given at the same time. This adds to the side effects and is not suitable for all patients but usually improves the results of treatment.

 

Recent research also suggests that the effect of radiotherapy can be improved if a drug called Cetuximab is given at the same time as the radiotherapy. It is given intravenously weekly during the treatment, with the first treatment being given the week before the radiotherapy starts. Currently, it is generally used if Chemotherapy cannot be given safely.

 

Radiotherapy of the head and neck has a lot of side effects, most of which subside completely 2 to 3 months after the end of the radiotherapy. Some effects may be permanent. One of these is a dry mouth, which occurs if the salivary glands receive a high dose of treatment. However, some specialist centres are able to use a type of radiotherapy called 'intensity modulated radiotherapy' (IMRT) which can keep the dose to normal tissues low whist still treating the tumour to a high dose.  This can avoid the problem of a permanent dry mouth for a lot of patients. IMRT may also allow a technically better treatment of the tumour than standard radiotherapy methods.

 

The treatment of head and neck cancer should be done in specialist centres. This is because the surgery is often complex and requires not only skilled surgeons but also well organised aftercare and rehabilitation. The radiotherapy treatment is also complex and, when combined with chemotherapy, is a tough treatment for patients and so needs specialist expertise.


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