While many cancers of the head and neck are curable, treatment depends on where the cancer is, the severity of the disease, and the patient's age and overall health. The primary method of treatment is surgery (removing the cancer cells). Radiation (using high-dose X-rays to kill cancer cells) and chemotherapy (using high-dose anti-cancer medication) are also used.
Great advances have been made in surgical procedures so that structures affected by cancer can either be spared from removal, or reconstructed well enough that the patient is not disfigured. The larynx, or voice box, can be saved in half the cases in which it would have been removed in the past. When part of the lower or upper jaw needs to be removed, doctors can now refashion a jawbone using bone from the patient's leg, hip, or shoulder blade. The tongue can even be reconstructed with appropriate soft tissue from various parts of the body.
For patients in whom a structure cannot be saved or restored, there are several new ways of helping to improve speech, swallowing, and other functions. Doctors can now restore a patient's vocal ability using a quick implant procedure. Other options for restoring a person's vocals include an electrolarnyx - a device placed against the neck to help form words and a tracheosophageal puncture - a surgical procedure that restores the patient's ability to deliver air into the throat and eventually allows speech.
Using a simultaneous, two-team approach during surgery, oncologic and reconstructive surgeons work alongside one another. Their team efforts, combined with the anesthesia and operating room nursing staff, has significantly shortened procedure times. After surgery, the team of nurses, speech pathologists, and social workers work with patients to help them recover and rehabilitate quickly.
Radiation typically involves external beam radiation. Another technique, known as intensity modulated radiation therapy, allows for very precise delivery of radiation therapy to tumors. Studies are showing that in some cases, radiation therapy alone, or sometimes combined with chemotherapy, is just as effective as surgery.
Chemotherapy is often used to enhance the response of cancer cells to radiation therapy and makes it possible to preserve organs, such as the larynx and tongue. Chemotherapy drugs include cisplatin, fluorouracil, methotrexate, carboplatin, and paclitaxel.
Recently, the use of targeted therapy has shown progress and we have started using agents that specifically target growth receptors on tumor cells, such as cetuximab and erlotinib.