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Head and Neck Cancer

By Hoyt A. “Tres” Childs, III, M.D., radiation oncologist at Alliance Cancer Care

April is Head and Neck Cancer Awareness Month.  Most head and neck cancers form in the lining of the mouth, throat, or voice box and are typically squamous cell carcinomas, although there are other less common types.  This group of cancers are strongly associated with tobacco use, alcohol use, and the human papillomavirus (HPV virus).

In 2021, there were an estimated 54,000 new cases of head and neck cancers diagnosed in the United States.  Over 10,000 people died from this type of cancer.  Head and neck cancers are more common in men than women and are often diagnosed in patients over 50 years old.

Symptoms of head and neck cancer may include a lump in the neck, hoarseness, difficulty swallowing, unintentional weight loss, and pain in the mouth, throat, ear, or neck.  The most common group of head and neck cancers occur in the oropharynx, which is an area in the head and neck that includes the soft palate, base of the tongue, and tonsils.  The HPV virus very frequently causes these tumors.  There is now a vaccine that will likely prevent this type of cancer (and female cervical cancer) and is recommended for men and women up until age 45. Read more about HPV vaccination here.

What happens when I am diagnosed with oropharyngeal cancer?

If your doctor suspects you have a head and neck cancer in the oropharynx, you will likely be recommended to have a biopsy.  A biopsy is when a doctor takes a piece of tissue from the tumor in your body to test for cancer.  If the biopsy shows cancer, you will have scans to help with evaluating the spread of the cancer.  Your doctor(s) will then be able to help determine your stage of cancer and the appropriate treatment recommendations.

The stage of cancer is determined based on the size of the “primary cancer,” which is where the cancer initially started, and if the cancer has spread to nearby lymph nodes or other parts of the body.  This step is very important before recommending treatment.

What are treatment options for oropharyngeal cancer?

Your doctors will evaluate your specific cancer type, stage, and your overall health status to determine the best treatment for you.  Treatment for head and neck cancers may involve surgery, chemotherapy, or radiation therapy.  In the early stages of oropharyngeal cancer, either surgery or radiation alone may be sufficient to provide very high rates of cure.  In more advanced stage cancer when the cancer is more extensive, treatment likely combines either surgery with radiation or chemotherapy with radiation.

What type of side effects occur with oropharyngeal cancer treatment?

Side effects depend greatly on the type of treatment and the size of the tumor.  Surgery may alter the ability to swallow and can cause swelling in the neck called lymphedema.  Radiation therapy can cause fatigue, difficulty swallowing, dry mouth, and taste loss during treatment, which will recover slowly over time.  Chemotherapy may cause fatigue, nausea, and low blood counts, which recover after treatment ends.  Some patients require a temporary feeding tube during treatment, which allows food, medications, and nutrition to go into the stomach without having to swallow.

What kind of recovery is involved after treatment?

If surgical treatment is recommended, your surgeon will discuss planned surgical approaches with potential complications, as well as the benefits of surgical therapy alone or in combination with chemotherapy and radiation therapy with the intent of cure.  Most patients are healed within four weeks and ideally begin radiation therapy six weeks after surgery if indicated.

Recovery from radiation is slow.  Radiation side effects take several weeks to develop to their peak, and similarly, they take several weeks to improve and completely resolve.  During and after radiation treatment, patients may meet with a speech and language pathologist, who is an expert in teaching exercises to strengthen the muscles of the mouth and throat to improve speech, tongue mobility, and swallowing.  Patients may also find physical therapy helps to reduce lymphedema or stiffness in the neck that may develop with surgery and radiation treatment.

Recovery from chemotherapy is similar to radiation treatment.  It takes several weeks for the fatigue to improve and for the blood counts to recover to normal levels.  When this has normalized, patients generally feel more energy and can focus on returning to a “new normal” lifestyle.

What happens after treatment?

After completing treatment for head and neck cancer, your doctors will see you frequently to ensure that the cancer is in remission.  This is also an important time to monitor for side effects of treatment and provide early intervention for improving these side effects.  Over time, these appointments will become less frequent.

Head and neck cancers may be preventable by receiving the HPV vaccine, and by quitting smoking or heavy alcohol use.  If you are interested in the HPV vaccine, please discuss it with your healthcare providers.

 If you struggle with tobacco or alcohol use, here are some resources for you:

Alabama Quit Now: 1-800-QUIT-NOW

– American Cancer Society Quit for Life:  866-QUIT-4-LIFE

CDC’s: How to Quit Smoking

Substance Abuse and Mental Health Services Administration

Alcoholics Anonymous