The main treatments for head and neck cancers are surgery, radiotherapy and chemotherapy. These treatments may be used on their own, or in combination.
The choice of treatment will depend on:
Oral cancer – is commonly treated with surgery, then radiotherapy if required. Chemotherapy is sometimes used in combination with these treatments.
Salivary gland cancer – is usually treated by surgery, followed by radiotherapy. Chemotherapy is not usually given unless the cancer has spread. Chemotherapy may also be offered as palliative treatment.
Pharyngeal cancer – is usually treated with surgery or radiotherapy, or both. Chemotherapy may also be offered, usually with radiotherapy.
Laryngeal cancer – is treated with either laser surgery or radiotherapy in the early stages. For larger cancers, radiotherapy is usually combined with chemotherapy (chemoradiation). Chemotherapy may be given first to ease the pressure on a person’s airway. For advanced cancer, surgery is used only if the cancer comes back or it’s not all destroyed by radiotherapy. Radiotherapy (with or without chemotherapy) will be given after surgery to reduce the chance of the cancer coming back.
Nasal or paranasal sinus cancer – is commonly treated with surgery, followed by radiotherapy and/or chemotherapy.
Treatment for head and neck cancer, particularly radiotherapy, can cause dental problems. However, these problems can often be prevented.
Before starting cancer treatment it is recommended that you see a dentist or oral medicine specialist for a thorough oral examination and to get an oral health care plan. The plan outlines if any dentistry work is needed to reduce the chance of future dental problems. An oral health care plan also helps you learn good oral health care before, during and after treatment.
The dentist will probably recommend that any teeth that might be affected by radiotherapy are taken out. These teeth may be removed during cancer surgery or before radiotherapy.
If you hold a Pensioner Concession Card or Health Care Card you may be eligible for free or low cost public dental services.
The aim of surgery is to remove cancerous tissue and preserve the functions of the head and neck, such as breathing, swallowing and speech, as much as possible.
Before recommending treatment, doctors determine how easy it is to access a tumour using surgery, the likely success of a surgery, and whether it will cause major side effects. They weigh up the benefits and impacts of all the treatments, while taking into account your wants, and your general health. See more information about making treatment decisions.
If surgery is minor, recovery is usually fast. There are likely to be few long-term side effects. For more advanced cancer, surgery will be more extensive, lasting up to twelve hours and often causing longer-lasting or permanent side effects.
If a head and neck cancer has spread to the lymph nodes in your neck, or if there is a chance it will spread, your surgeon will probably remove the nodes. This operation is called a neck dissection or lymphadenectomy. In some cases, this may be the only surgery you have, as the primary cancer will be treated with radiotherapy. The surgeries for the different head and neck cancers are described below. For more information call Cancer Council 13 11 20 or see our surgery section.
There are two main types of surgery for head and neck cancer: surgery to remove the cancer (resection surgery) and surgery to repair any affected areas (reconstructive surgery).
The surgery used depends on the size of the cancer and its position, and may involve:
After surgery to remove advanced cancer, reconstructive surgery may be required to repair defects or restore function. Reconstructive surgery is either carried out at the same time as the resection, or at a later date. It may involve:
Localised cancers can be treated with simple day surgery to remove part of the tongue or mouth. This will heal without side effects in a few weeks. If the cancer is larger, surgery may be more extensive and may require a reconstruction to help you chew, swallow or speak. You may also need a neck dissection to remove lymph nodes if there is a chance of the cancer spreading.
Different types of oral surgery include:
"My dentist suspected I had a tumour in my oral cavity during a check-up for a painful wisdom tooth in my lower left jaw. A biopsy confirmed a squamous cell carcinoma. An x-ray, CT scan, ultrasound and PET scan showed the cancer had spread to my lower left jaw bone and the lymph nodes in my upper left neck.
"I had surgery to remove the tumour, the affected jaw bone and lymph nodes. Later my jaw was reconstructed with bone from my leg. I also had radiotherapy to my lower jaw and neck for six weeks.
"I recovered well. My only ongoing side effect is a dry mouth."
Most salivary gland tumours affect the parotid gland, which has two parts. Surgery to remove this gland is called a parotidectomy. Surgeons can often cut inside or under the jaw to reach the area but sometimes they need to cut through the jaw. Reconstructive surgery will restore any removed tissue.
The facial nerve, which controls movement and muscle tone in the face, runs through the parotid gland. If the nerve is damaged or removed during the surgery, it may be repaired using a replacement nerve from another part of the body, often the leg (a nerve graft). If successful, this will improve movement and appearance on that side of the face.
If the cancer begins under the jaw or tongue, the entire gland will be removed, along with some surrounding tissue. Nerves controlling the tongue and lower part of the face may be damaged, causing some loss of function. If the cancer is in a minor salivary gland, in a paranasal sinus or the larynx, it may be removed with endoscopic surgery.
Some tumours found in the salivary glands are benign, but surgery is the same as for malignant tumours.
"I was diagnosed with cancer after I felt recurring pain in my front left jaw. I had intrusive surgery, which meant my facial nerve was cut, causing paralysis in my face, but I am currently free of the cancer." – Geoff (salivary gland cancer)
Early pharyngeal cancers may be treated with either surgery or radiotherapy. If you have surgery, the surgeon will cut out the tumour and a margin of tissue, which is checked by a pathologist to make sure all the tumour has come out.
If the cancer is large or advanced, the surgery is often combined with radiotherapy and possibly chemotherapy. The surgery is more likely to be extensive and may require reconstruction.
Often, lymph nodes will be removed from your neck (neck dissection or lymphadenectomy) to prevent the cancer spreading. This may affect the movement and appearance of your neck or shoulder.
Different types of pharyngeal surgery include:
If the cancer is at an early stage, you may be offered transoral surgery using standard surgical techniques (cold steel surgery) or laser surgery. The time it takes for your voice to recover will depend on the extent of the surgery and may take up to six months.
In some cases, there may be long term or permanent changes to the pitch, loudness or quality of your voice. The surgeon will work with a speech pathologist to preserve as much of your ability to speak and swallow as possible.
If the cancer has advanced, you may need open laryngeal surgery. This will involve either a partial or total laryngectomy:
If you have a total laryngectomy, your thyroid gland will be removed during surgery (thyroidectomy). Once the thyroid is removed, you will no longer produce thyroxine (T4), the hormone that maintains your metabolism. After surgery, you will be prescribed an oral hormone tablet. You will need to take this hormone replacement daily for the rest of your life. This can be distressing, but talking to someone about how you feel may help.
Your doctor may advise you to have surgery if the tumour isn’t too close to your brain, eyes or major blood vessels. The aim of surgery is to remove all of the tumour and a small area of normal tissue.
The type of surgery depends on the location of the tumour and, in the case of paranasal sinus cancer, the affected sinuses.
Different types of surgery for nasal cancer include:
Some people also have surgery to remove lymph nodes in the neck (neck dissection or lymphadenectomy).
Your surgeons will plan carefully to avoid damaging healthy tissue. You may have open surgery, or you may have endoscopic surgery or midface degloving so that no cuts are made to the face.
The surgeons will consider how the operation will affect your appearance, and your ability to breathe, speak, chew and swallow. If your nose, or a part of it, is removed, you may get an artificial nose (prosthesis). This will be synthetic or made of tissue from other parts of your body.
After surgery for localised cancer, side effects are often minor, and generally temporary. Short-term side effects vary depending on the surgery, but may include:
After surgery for localised or early stage cancer, there are generally few long-term side effects. However, after more extensive surgery, many people have to adjust to significant changes. You may also see a speech pathologist and/or dietitian before surgery to discuss these issues. Talk to your doctor about what to expect. Long-term side effects may include:
For detailed information about adapting to and managing side effects from surgery and other cancer treatments, see managing side effects.
"It was good to be prepared about what all the tubes were and why they were there when I woke up from the operation." – Peter (nasopharyngeal cancer)
Radiotherapy uses x-rays or electrons to kill or harm cancer cells so they can’t grow and multiply. It can be used alone or with other treatment. Radiotherapy can be given externally or internally.
External beam radiotherapy is common for oral, salivary gland, laryngeal, pharyngeal, nasal and paranasal sinus cancers.
Treatment is often given using a machine called a linear accelerator. You will lie on a treatment table while radiation is directed from a machine into your body. Treatment itself is painless and is usually given daily (Monday–Friday) as outpatient treatment for 6–7 weeks. You will be monitored by the radiation therapist team throughout. Many people are able to return to their usual activities 4–5 weeks after treatment ends.
Specialised forms of external beam radiotherapy used to treat head and neck cancers include intensity modulated radiation therapy (IMRT), Volumetric Modulated Arc Therapy (VMAT), and TomoTherapy. These techniques allow multiple radiation beams to be delivered from a variety of angles. This reduces the treatment time, and limits the impact of radiation on normal tissues.
Radiotherapy to the throat area may cause an underactive thyroid. Some people may need to take thyroid medication after radiotherapy.
Also known as brachytherapy, this treatment is occasionally used for oral cancers. Small tubes containing radioactive material are inserted into and around the tumour. Your doctor will give you more information about this treatment.
Before radiotherapy you may need to be fitted for a plastic mask. Wearing the mask will assist you to keep very still during the treatment. This ensures that the radiotherapy is targeted to the correct area, and the same location is treated at each session.
You will wear the mask for up to an hour in the planning session, but only for 5–40 minutes during treatment, depending on the location of the cancer. You can see and breathe through the mask, but it may feel strange and claustrophobic at first. The radiation therapy care team can help you manage this.
Radiotherapy to the head and neck can affect your teeth and bones, possibly causing osteoradionecrosis (ORN). Your health care team should include a dentist who takes measures to prevent this damage before treatment begins. However, if ORN does occur your doctors may treat it with hyperbaric oxygen treatment. This treatment delivers concentrated oxygen to the bone to help it heal. During this treatment, you will sit or lie in a pressurised chamber while oxygen is pumped in for you to breathe.
Side effects vary according to the location of treatment, how long you have treatment for, and the type of radiotherapy you have. Side effects often peak in the final week of treatment, or shortly afterwards, then start to ease 2–3 weeks after treatment ends. Some side effects may last longer or be ongoing.
Possible side effects from radiotherapy
Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. The aim of chemotherapy is to destroy cancer cells while doing the least possible damage to healthy cells. You will probably receive chemotherapy by injection into a vein (intravenously) at treatment sessions over several weeks. Chemotherapy may be given in a number of ways, for a range of reasons:
There are many possible side effects of chemotherapy, depending on the drugs you are given. Many side effects are preventable and treatable. Combined chemoradiation may cause more severe side effects than if you have chemotherapy and radiotherapy separately, but the side effects can be managed. The combined treatment approach is almost always only used when the aim of treatment is cure or prolonged remission.
For more information call Cancer Council 13 11 20 or see our chemotherapy section.
Possible side effects from chemotherapy
Palliative treatment helps to improve people’s quality of life by reducing symptoms of cancer without aiming to cure the disease.
Palliative treatment can assist with managing symptoms such as pain and nausea, as well as slowing the spread of cancer. In rare cases, palliative treatment is offered in an attempt to delay the onset of symptoms. Treatment may include radiotherapy, chemotherapy or other medications and always involves consideration of the potential benefits and side effects.
Palliative treatment may be beneficial for people at any stage of advanced disease, as well as those requiring end-of-life care.
"The treatment from my multidisciplinary team sent the stage 4 cancer in my tonsils, throat and tongue into remission in 2013. My cancer was caused by the HPV virus. I hadn’t drunk alcohol or smoked for over 30 years.
"I have to be honest, the side effects of treatment were tough. My capacity to swallow was limited to liquid food for some time, so I lost 20kg over six to eight weeks. I lost the capacity to talk for quite a few weeks. I used an iPad to communicate.
"For a month I had chemotherapy once a week and radiation every day. I had to wear a special mask to keep me totally still while the radiation treatment took place. It is called an “immobilisation mask”. The mask keeps you safe by ensuring the radiation is delivered to the precise locations necessary.
"I found this aspect of the treatment challenging. I had never seen a mask like this and I had never heard about their purpose. A combination of listening to music, light sedation and support from a psychologist helped a great deal.
"But the result made the rigours of treatment absolutely worth the effort. I can talk, swallow and I am back to work and the joy of daily life.
"I really recommend asking for help from speech pathologists, nutritionists, psychologists and senior nurses, as well as the medical team. Find a dentist who understands the effects of treatment and get advice for the health of your teeth long term. Tell your trusted family members and friends what you need and ask directly for help. Do everything you can to survive because life is precious and sweet."
Reviewed by: Dr Jason Bonifacio, Chief Radiation Therapist, Radiation Oncology Associates & Genesis Cancer Care Pty Ltd, St Vincent’s Clinic, NSW; A/Prof Suren Krishnan, Consultant Otolaryngologist & Head and Neck Surgeon, Royal Adelaide Hospital, SA; Dr David Boadle, Senior Staff Specialist in Medical Oncology, Royal Hobart Hospital, TAS; Dr Debra Phyland, Clinical Research Coordinator, ENT/Head & Neck Dept, Monash Health, VIC; Dana Middleton, Clinical Trials Coordinator – ENT, Princess Alexandra Hospital, QLD; Iwa Yeung, Senior Cancer Physiotherapist, Princess Alexandra Hospital, QLD; Lauren Muir, Accredited Practising Dietitian, Peter MacCallum Cancer Centre, VIC; Dr Peter Foltyn, Dentist, Department Head, Dental Department at St Vincent’s Centre, NSW; Haley McNamara, Social Worker, Royal Brisbane and Women’s Hospital, QLD; Marty Doyle, Co-Founder and Facilitator, Head and Neck Cancer Support Group, QLD; Frank Hughes, 13 11 20 operator, Cancer Council Queensland, QLD.