Head and neck cancer involves a team approach in the management of the disease. Cancers of the head and neck include areas involving the oral cavity, larynx (voice box), pharynx, salivary glands and nasal cavities. Treatment involves specialists like ENT (head and neck) surgeons, medical oncologists, radiation oncologists, and many others to help in this team approach.
Head and neck cancer accounts for an estimated 3 percent of all cancers in the United States. However, there are an increasing number of patients being diagnosed in their 30’s and 40’s due in part to the association of human papillomavirus (HPV)-linked cancers. With improved treatments, including chemotherapy, these patients are surviving longer than ever before.
Patients most commonly present with swelling, neck masses, or a sore/lesion which does not heal on its own. Other common symptoms include change in voice — including hoarseness, a sore throat that doesn’t respond to routine antibiotics, coughing up blood, trouble swallowing or breathing, ear pain or trouble hearing, headaches and frequent coughing.
Most head and neck cancers are treated with surgery, radiation therapy, chemotherapy, immunotherapy or targeted therapy, either alone or in combination.
Surgery is generally considered the first-line treatment for head and neck cancer. The goal of surgery is to remove the tumor and affected surrounding tissue. Surgical techniques have become state-of-the-art — with some patients having no visible incisions for tumors in certain areas. Such modern techniques have led to less recovery time, reduced pain and cause less damage to tissues and muscles that help with eating and other daily activities.
Radiation therapy may be recommended as the main treatment for head and neck cancer, or in certain cases it may be used after surgery to potential residual cancer cells that can not be seen with even modern imaging scans.
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Chemotherapy may be recommended if the cancer has metastasized to other parts of the body. It may also be used in combination with radiation to reduce the risk of recurrence for head and neck cancers.
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One of the newest forms of treatment to attack head and neck cancers is immunotherapy. Two approved treatments by the FDA (Food and Drug Administration) include pembrolizumab (Keytruda®) and nivolumab (Opdivo®). These drugs work by a mechanism called checkpoint inhibitors to treat patents with recurrent or metastatic head and neck cancer that hasn’t responded to chemotherapy: pembrolizumab (Keytruda®) and nivolumab (Opdivo®). Both of these medications block a protein called PD-1 found on immune cells. PD-1 acts like a brake on the immune system, which inhibits the body’s immune system to recognize cancer cells. Nivolumab and pembrolizumab release this brake, allowing the immune system to recognize and attack cancer cells.
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Another type of chemotherapy option for some patients uses targeted therapy against epidermal growth factor receptor (EGFR). For some patients studies have shown that drugs which target and block the EGFR may help slow or stop cancer progression for select patients with head and neck cancer.