With head and neck cancers, preservation of function and rehabilitation are important parts of the treatment process.  Treatment of head and neck cancer is more than just a medical procedure—it’s a comprehensive treatment program designed to return patients to normal activities as soon as possible and support them in their cancer survivorship.

While seemingly simple in name, head and neck cancers encompass a wide range of cancers, including laryngeal (voice box) and hypopharyngeal (lower throat) cancer, nasopharyngeal (upper throat) cancer, salivary gland cancer, oral cavity (mouth) and oropharyngeal (throat) cancer, and nasal cavity (nose) and paranasal sinuses (sinus) cancer.  And despite what one might expect, brain, eye, esophageal, and thyroid cancers aren’t normally included in this heading, as they require different treatments. 

Diagnosing head and neck cancers often requires several steps to determine the best treatment.  This includes a physical examination of the nose, mouth, tongue, gums, and throat for any irregularities, as well as standard medical history and lab tests to look for markers of cancer.  It also includes imaging tests that may include CT scans, PET scans, or MRI scans to understand what is going on within the patient’s body. 

Biopsies, or the removal of tissue samples for investigation, may also occur, as well as an endoscopy in which an endoscope—a special camera for the nose and throat—is inserted through the nose, mouth, and down the throat to investigate further.

Once cancer is diagnosed, there is some additional testing to see if the cancer has spread to other parts of the body, after which the treatment team will determine which stage the cancer is at.

Cancer stage

Treatment and recovery time depends largely on the stage of cancer.  These stages are usually referred to by the Roman numerals I-IV.

Stage I and II cancers are generally considered early-stage cancers and have a survival rate that ranges from 70% to 90%. Or, put a different way, 70% to 90% of people diagnosed with a head and neck cancer at these stages survive at least five years after diagnosis.

In stage I, the tumor is not more than two centimeters in size, while in stage II the tumor is larger than two centimeters in size but does not exceed four centimeters. In both stage I and stage II, the cancer has not reached the lymph nodes. Effectively, this is localized cancer that has not spread to other locations.

In general, for patients with early-stage head and neck cancers, the medical procedure for treatment will consist of either radiation therapy or surgery.

Past stage I and II, cancer survival rates differ based on the location of the specific tumor.

Stage III and IV head and neck cancer describes cancer that has increased in size and/or has spread further to nearby lymph nodes or surrounding tissue.  This is sometimes called locally advanced cancer. Unlike other cancers, it is not common for head and neck cancer to spread outside of the area where it originated, but it can happen in stage IV cancer.

Patients with locally advanced cancer in these stages are often treated with chemotherapy and radiation therapy together, and some patients receive surgery followed by chemotherapy and radiation therapy.

Tumor Location

Many head and neck cancers can be eliminated, especially if they’re found early, although the specific location of the tumor can make a big difference on the specific treatment and recovery times.  This is because preserving the function of nearby tissues, nerves, and organs is important and is part of the treatment process.

While small cancers of the lip and mouth in early stages may be treated with surgery or radiation, recovery time can increase if the tumor is thick as it increases the possibility that the cancer may have spread to the lymph nodes.  If this happens, or abnormal lymph nodes are observed, the surgeon may also remove the lymph nodes to see if the cancer has spread.

Laryngeal cancers, or cancers of the voice box, are often found early because of changes to the patient’s voice.  As such, they are typically treated with either endoscopic surgery or radiation therapy. Supraglottic cancers (cancers above the vocal cords) are more likely to spread to the lymph nodes and may have more expansive treatment and recovery times. Hypopharyngeal cancers, or those of the lower throat, are often harder to treat as they do not cause symptoms when they are small and often spread to the lymph nodes.  Because surgery of the larynx is common, rehabilitation and recovery times are increased.

Nasopharyngeal cancers, or those of the upper throat, are often treated with radiation therapy along with radiation treatment of the nearby lymph nodes.  Patients at stage II will often also receive chemotherapy to the nasopharynx and neck lymph nodes—which can affect recovery times.

Nasal cavity and paranasal sinus cancers are relatively rare, and sometimes include a maxillectomy to remove bone and mucosa of the maxillary sinus.  Generally, radiation after surgery is often recommended, which can make for a longer treatment and recovery. Salivary gland cancers are also considered rare and difficult to treat, and often involve both surgery and radiation therapy as well.

Treatment type

Most doctors prefer using minimally invasive surgeries when appropriate, but recovery from surgery is highly variable depending on the location of the surgery and whether reconstructive surgery is necessary.  For example, for an early-stage cancer that utilizes an endoscopic approach (often possible for early laryngeal cancer) may allow a patient to go home the same day and only need 2-3 days of recovery. Larger tumors removed the same way may require a hospital stay of several days, while tumors requiring extensive surgery and reconstruction may require a longer hospital stay and a recovery of several weeks.

If radiation therapy is part of the treatment process for head and neck cancers, it will likely consist of an advanced external beam radiation therapy to help the treatment team focus and aim the radiation precisely.  Such advanced techniques include three-dimensional conformal radiation therapy (3D-CRT), or intensity modulated radiation therapy (IMRT), both techniques that use computer-driven images to precisely map the location of the tumor and shape and aim the radiation delivered to the patient to avoid damage to nearby tissues and organs.  Learn more about how radiation therapy is used to treat head and neck cancers.

Most external beam radiation treatments will take place over 6-7 weeks, with daily doses 5 days a week. But the cancer stage or tumor location can change how long radiation treatments take.  Other schedules include:

• Hyperfractionation – a slightly lower dose is given more than once per day
• Accelerated fractionation – a standard dose is given over a shorter overall treatment time (ex: 6 days per week over 5 weeks)
• Hypofraction – a higher radiation dose is given each day to lessen the number of treatments

Recovery After Treatment

No matter which treatment is used, recovery and healing is generally slower than patients would like.  Even after treatment has ended, it will usually take at least four weeks to start to feel better.

In the first several weeks after treatment, patients typically start to heal from the side effects of their treatment.  Mouth sores will start to heal, and the mouth and throat will generally be more sensitive in the morning after waking up.

Most patients are advised to keep up with a careful oral care routine during this period that involves brushing the teeth and tongue after meals, avoiding toothpaste with SLS (which makes toothpaste bubble and froth), and continuing to rinse and moisten their mouth and throat when dry.

After about 4-8 weeks, side effects such as thick saliva and dry mouth will start to taper off, although full recovery for these symptoms can take up to a year after treatment. Pain caused by treatment should also improve during this time, and side effects from radiation skin reactions should begin to see improvement.

At the end of 8 weeks (or about 2 months), fatigue should begin to improve. Patients who experienced taste changes will generally see improvement after about 6 months, although it varies from person to person and can take up to 2 years.

Follow-up care is absolutely necessary in order to gauge individual side effects and recovery, and it’s important for patients to keep a line of communication open with their treatment team to see if additional rehabilitation or reconstruction is necessary.  Problems such as difficulty swallowing or opening the mouth, weakness of the shoulders or neck, and speech changes should be communicated to the treatment team and may involve referral to other specialists.

If you are a patient receiving care at Radiotherapy Centers of Kentuckiana and you have questions, please contact your care team at the location you are receiving treatment.