Treatment for mouth, nose & throat cancer

Monday 31 October, 2011

On this page: Surgery | Changes to appearance | Other side effects | Radiotherapy | Chemotherapy | Complementary and alternative medicines | Prognosis | Information reviewers

Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer.

Your medical team will advise you on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread, your age and general health, and what you want.

Treatment for mouth, nose and throat cancers may involve:

  1. surgery to remove the cancer
  2. radiotherapy with or without chemotherapy to destroy cancer cells
  3. a combination of all three treatments.

The best treatment is one that cures the cancer and allows a person to speak and swallow as normally as possible. If you have your own teeth, get a complete dental check up and have any necessary dental work done before your cancer treatment begins. This is because cancer treatment may make your mouth more sensitive and more easily infected. See our pages on making treatment decisions.

Surgery

The aim of surgery for all types of mouth, nose and throat cancers is to remove the cancer. For some people, the surgeon needs to remove only a small area, and healing is quick, with few long-term side effects. For others, the operation may be more extensive and have longer-lasting side effects.

If there is evidence that the cancer has spread to the lymph nodes in the neck, the surgeon may also remove the nodes on one or both sides of the neck. This is called a neck dissection or lymphadenectomy. 

The surgical team sometimes needs to take skin and other tissue from another part of the body to rebuild the area affected by the surgery. This will be done by a plastic surgeon, who will work with the head and neck surgeon. While the reconstructed areas will not have normal feeling or movement, the cosmetic results are generally good.

Laser surgery may be used to remove cancers of the voice box, mouth and the throat. Laser surgery may be used alone or with radiotherapy or chemotherapy. If the surgeon uses a laser to cut out the cancer, you may have a local anaesthetic.

With most cancers of the mouth, nose and throat, the surgeon will remove the tumour and a section of healthy tissue around it. Surgeons call this section of healthy tissue a ‘clear margin'. This margin makes sure that all the cancer is gone. This border tissue is sent to a laboratory to make sure there are no cancer cells in it. Your surgeon will plan the operation carefully in order to avoid harming healthy tissue.

You may have a major operation, or you may have keyhole (endoscopic) surgery, which means a thin, flexible tube will be inserted into your nose or mouth. This means there will not be any cuts to your face. The surgeon will consider how surgery will affect your appearance and ability to breathe, speak, chew and swallow.

If part or all of your nose is to be removed, the surgeon can form a nose from tissues from other parts of your body or from synthetic materials (this is known as a prosthesis). This will usually happen after all your treatment is complete. This is to allow time for healing and any changes surgery or radiotherapy may cause to the shape of your face. Your doctor will discuss this with you before your surgery.

Many head and neck surgeons are experts in reconstructive surgery, however they often need to work with plastic surgeons. Together they will plan the best surgery to get the best appearance for you as well as still controlling the cancer.

Each situation is unique. It is best to discuss your own situation with your surgeon.

Your medical team will discuss your operation with you. They will be able to answer your questions and explain what will happen after your operation.

Before the operation

For some people, it is very important to know, before the operation, what to expect. Ask your surgeon everything you want to know, and make sure you understand what is involved: which parts will be removed, and how this will affect you afterwards. Call the Cancer Council Helpline on 13 11 20 if you would like help putting together a list of questions to ask your doctor. Take a partner, friend or family member with you to the surgeon's appointment, so that you both understand what to expect after the operation.

"Knowing what to expect has made it easier to adjust." — Joan, 63

If speech and/or swallowing are likely to be affected, a speech pathologist will probably visit you before the operation, to discuss what to expect after the operation and how therapy will help you. The nurses will also talk with you about the operation and what to expect in the days afterwards. You will also be able to talk with a dietitian and social worker if you wish.

After the operation

The healing time and side effects depend on what operation you have. The area may heal by itself or it may be closed with sutures. If your mouth is swollen and this affects your breathing, you will have a temporary breathing tube (tracheostomy) until the swelling goes down.

"It was good to be prepared about what all the tubes were and why they were there when I woke up from the operation. It would have been a shock otherwise, for me and the family." — (Peter, 58)

Call the Cancer Council Helpline on 13 11 20 and ask for our Cancer Connect program, to speak to someone about how they coped with surgery.

The side effects of surgery depend on the operation you have. This section describes some of the side effects of the different surgeries for mouth, nose and throat cancers. You may have some, or none, depending on the type of operation you have.

Changes to appearance

Some surgery can cause big changes to the way you feel, look and function. It can take time to find the best way to cope with these changes. You will be helped by experienced health professionals. So talk to your doctor about exactly what to expect.

Talk to your doctors about how surgery and reconstruction might affect your appearance. Scarring from surgery is usually visible at first, but generally these scars will fade. If part of your jaw or skin is removed, your face will look different.

Changes to speech and swallowing

Some types of surgery affect your ability to speak and eat. You will be helped to adapt to changes. For example, if some of your tongue is affected, a speech pathologist will work with you to retrain the remaining portion of your tongue so you can speak and swallow.

"I did not realise that I would have to learn to swallow again after the operation." — Mario, 47

Your ability to swallow may be affected by the insertion of a skin flap in your mouth, or by other side effects such as dry mouth or teeth extractions. A speech pathologist will help you to re-learn how to swallow. If the cancer is in the hypopharynx or larynx, your voice box may need to be removed. If this happens, you will need speech therapy and you will have a tracheostomy.

Changes to sense of smell, taste and sight

Your sense of smell and taste may be affected. For example, a tracheostomy may mean a temporary or permanent loss of your sense of smell. Some people are affected by cancer in or near the eye. Surgery in this area can affect vision.

Prostheses

A prosthesis is a specially designed, soft plastic replacement for a part of the body that may be removed during surgery. Some people who have surgery to the face have a prosthesis. These prostheses are fitted permanently and blend extremely well with your own skin and features. While they can never feel like your own tissue, they generally look very good.

If you are likely to need a prosthesis, the doctor will discuss this with you before the operation. You could also ask to see a prosthodontist before surgery. Your doctor or speech pathologist may also be able to put you in touch with someone who has a prosthesis.

Other side effects

Other side effects, which can affect people who have all types of surgery, can include:

  • Stiffness, scarring, numbness and pain. Talk to your doctor or nurse if you have pain; this can always be relieved.
  • Fatigue can persist for several months, depending on the extent of your treatment. Ask your health care team how to cope with this side effect.
  • Effects on other aspects of your life, such as your relationships and sex life.

Radiotherapy

Radiotherapy is the use of high-energy x-rays or electrons to destroy or damage cancer cells. It can be used alone or with another treatment.

"My biggest problem after radiotherapy has been a very dry mouth." — Maria, 64

Before radiotherapy, you usually will require a visit to a dentist or oral medicine specialist. This is because radiotherapy can cause dental health problems that can sometimes be prevented with good dental health prior to treatment. Your specialist may try to prevent future problems by removing teeth or giving you a fluoride tray to wear at night. Oral hygiene is very important after the completion of your treatment, to maintain dental health. Radiotherapy can cause damage to your teeth and bones involved in the mouth. You will probably need to see a dentist regularly.

Before treatment begins, the staff will see you to plan the treatment. You will probably be fitted for a mask to wear during treatment so that the same area is always treated. You will only wear it for about 10-30 minutes at a time during treatment.

If you have external radiotherapy, you will lie on a table under a machine that will send radiation into your body. This painless procedure is usually given as outpatient treatment, daily, Monday to Friday, for 6-7 weeks.

Some people have internal radiotherapy (brachytherapy). This is when small radioactive seeds are placed internally, near the cancer.

Side effects of radiotherapy

The side effects of radiotherapy are mostly temporary, and they will probably ease 1-3 weeks after treatment. However, some side effects may be present for a longer period of time, or permanently. Side effects can include:

  • dry mouth
  • thick mucus (phlegm) instead of saliva
  • difficulty swallowing, or difficulty opening the mouth fully
  • changes in sense of taste and appetite, and nausea
  • skin soreness, redness or ulceration, or sores in the mouth or throat
  • dental problems
  • damage to the jaw bone
  • blocked or swollen salivary glands
  • fatigue
  • hair loss (e.g. facial hair)
  • weight loss
  • an underactive thyroid gland (hypothyroidism).

Our booklet Coping with Radiotherapy discusses ways of managing side effects.

Chemotherapy

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells.

Chemotherapy can be given during the course of radiotherapy (chemoradiation). In other cases, chemotherapy is given to try to shrink a tumour before surgery or radiotherapy. This treatment is called neoadjuvant chemotherapy.

You may receive chemotherapy by injection into a vein (intravenously). You will probably have treatment sessions over several weeks.

Side effects of chemotherapy

Side effects of chemotherapy depend on the drugs that you have. They may include:

  • tiredness and lethargy
  • nausea and vomiting
  • diarrhoea
  • hair loss
  • hearing loss
  • mouth sores
  • nerve or muscle damage
  • anaemia
  • an increased risk of infection.

Cancer Council Victoria's booklet Coping with Chemotherapy discusses ways of managing side effects.

Complementary and alternative medicines

It's common for people with cancer to seek out complementary and alternative treatments. Many people feel that it gives them a greater sense of control over their illness, that it's ‘natural' and low-risk, or that they just want to try everything that seems promising.

"During my treatment I did a daily meditation to help keep my emotions under control. I also had weekly massages which made me feel more relaxed." — Jane, 59

Complementary therapies include massage, meditation and other relaxation methods that are used along with medical treatments.

Alternative therapies are unproven remedies, including some herbal and dietary remedies that are used instead of medical treatment. Some of these have been tested scientifically and found to be not effective or even to be harmful.

Some complementary therapies are useful in helping people to cope with the challenges of having cancer and cancer treatment. However, some alternative therapies are harmful, especially if:

  • you use them instead of medical treatment
  • you use herbs or other remedies that make your medical treatment less effective or more toxic
  • you spend a lot of time and money on alternative remedies that don't work.

Be aware that a lot of unproven remedies are advertised on the Internet and elsewhere without any control or regulation. Before choosing an alternative remedy, discuss it with your doctor or a cancer nurse at the Cancer Council Helpline.

You can find out about what scientific research has been done into specific herbs, supplements and other products on the Memorial Sloan-Kettering website. The US National Center for Complementary and Alternative Medicines (NCCAM) and Quackwatch are also reliable websites.

Prognosis

‘Prognosis' means the likely outcome of a person's illness. For people who have been treated for cancers of the mouth, nose and throat, the likely outcome depends on how advanced the cancer is when it is diagnosed. The earlier that a cancer is diagnosed and treated, the more likely it is that a person will be cured.

Cancers that are more advanced when diagnosed are more difficult to successfully treat. If you would like to know about your own prognosis, speak to your doctor, who knows your full medical history.

When cancer can't be cured

If your cancer has spread and it is not possible to cure it by surgery, your doctor may still recommend treatment. In this case, treatment may help relieve any symptoms, can make you feel better and may help you to live longer.

Whether or not you choose to have anti-cancer treatment, symptoms can still be controlled. For example, if you have pain, there are effective treatments for this. General practitioners, specialists and palliative care teams in hospitals all play important roles in helping people with cancer. For further information, contact the Cancer Council Helpline on 13 11 20 or Palliative Care Victoria on 9662 9644.

Information reviewed by: Dr Annette Lim, Medical Oncology Fellow, Peter MacCallum Cancer Centre; Members of the Western and Central Melbourne Integrated Cancer Service Head and Neck Tumour Group. 

 

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