| Mouth, nose & throat cancers | Diagnosing mouth, nose & throat cancer | Treatment for mouth, nose & throat cancer |
| Deciding on treatment | Recovery & follow-up care |
This information has been reviewed by:
Stephen Kleid (MB,BS FRACS); Otolaryngology/Head & Neck Surgical Oncology
Peter MacCallum Cancer Centre & Western Hospital
Jacqui Frowen (B.SpPath. Hons), Speech Pathologist, La Trobe University
Radioactive iodine treatment for thyroid cancer
Side effects of radioactive iodine treatment
PrognosisMany 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 doctor 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 may involve surgery to remove the cancer, or radiotherapy with or without chemotherapy to destroy cancer cells, or a combination of all 3 treatments. Cancers in the mouth are usually treated with surgery, and may also require radiotherapy (with or without chemotherapy) after the operation. Cancers of the throat and voice box may be treated by surgery or by radiotherapy (with or without chemotherapy). 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 natural teeth, it is usually recommended that you have a complete dental check and any necessary dental work before your cancer treatment begins. This is because cancer treatment may make your mouth more sensitive and more easily infected.
The aim of surgery is to remove the cancer. In 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.
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.
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 is used where appropriate to remove cancers of the voice box, mouth and the throat. Laser surgery may be used alone or with radiotherapy or chemotherapy.
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: what exactly will be removed, and how it will affect you afterwards. Take a partner, friend or family member to the surgeon's appointment as well, so that you both know what to expect after the operation.
‘I did not realise that I would have to learn to swallow again after the operation.' Mario, aged 47
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 can help you. The nursing staff 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.
Surgery may alter your appearance in some way. It can also affect feeling in the mouth, face, neck or shoulder. For some people, swallowing will be affected, or speech may be distorted or different. This can happen even with a very small operation because of the close connections between all the parts in the mouth and throat. Some of the changes will be temporary, due to swelling and bruising. Other changes will be permanent.
‘Knowing what to expect has made it easier to adjust.' Joan, aged 63
Most operations to the mouth or throat make eating and drinking difficult or uncomfortable for a time. You will wake up from the operation with an intravenous drip: a tube inserted into a vein in your arm to take fluids and nutrients directly into your bloodstream. You will need this for a couple of days after the operation.
If eating is likely to be difficult for longer than this, the surgeon will do one of two things while you are under the anaesthetic. You may have a nasogastric tube: a thin tube which passes through your nose or neck down the throat to the stomach. Or you may have a tube that passes directly through the skin into your stomach, near your waist.
This is known as gastrostomy or percutaneous endoscopic gastrostomy (PEG) feeding. Either way, a dietitian will assess your nutritional needs and the nurses will feed you through the tube with special, high nutrient liquid. The tube will stay in place until you are able to eat normally. For a few people, PEG feeding may be permanent.
‘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, aged 58)
There will also be a drain tube from the operation site, and possibly other tubes for a few days. All these tubes are normal and necessary, although they can look a little frightening. They will be removed as you recover.
Many people find that operations to the mouth and throat cause surprisingly little pain. If you do have pain, it can be controlled by pain-killing drugs. If these don't work well at first, it is important to let the doctors and nurses know so they can change the dose or give you a different drug.
Depending on your operation, you may also have a tracheostomy. This is an opening into your windpipe (the trachea) at the base of your neck, to provide a clear airway. The tracheostomy is held open by a small plastic tube a few centimetres long. After a few days or weeks, when swelling goes down and the airway is clear again, the tube is removed and the opening heals over.
You may not be able to talk with a tracheostomy, because air will not pass through your voice box to produce voice. This can be frustrating, but the nursing staff and speech pathologist will ensure that you always have some way to communicate. You might:
For people having their voice box removed (a total laryngectomy), this new airway is permanent. A few people will need a permanent tracheostomy even if they do not have a laryngectomy. If this is the case for you, there are a number of different types of tracheostomy tubes and other devices that will help you to talk.
Radiotherapy treats cancer by using radiation to destroy or injure cancer cells. The radiation can be targeted onto cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissues.
Radiotherapy for cancers of the mouth, nose and throat is usually given as external radiotherapy.
In external radiotherapy, rays from a large machine are directed towards the part of the body where the cancer is. You will need to visit the hospital or clinic daily for treatment. External radiotherapy may be given 5 days a week for 5 to 7 weeks.
The treatment is not painful. You will not see, hear or feel the rays. External radiotherapy does not make you radioactive. It is quite safe for you to be with other people.
Radiotherapy can cause a number of side effects, most of which tend to gradually disappear after the treatment has finished. Tiredness is a common short-term side effect.
‘My biggest problem after radiotherapy has been a very dry mouth.' (Maria, aged 64)
After about two weeks of treatment, your mouth may become dry and sore and develop ulcers, and your voice may become hoarse. Regular mouthwashes, cool drinks, artificial saliva or sucking ice chips can help a dry mouth. Tobacco and alcohol will make the problem worse.
Eating may become uncomfortable and swallowing difficult. It will be easier to eat soft, moist food and avoid hot, spicy foods. A speech pathologist can recommend the best types of foods and drinks to make swallowing safer and more comfortable. Try not to miss meals: good nutrition will help your recovery.
It may be easier to have small meals often through the day. A dietitian can suggest appropriate foods, fluids and methods of preparation to ensure adequate nutrition. They will be able to provide you with recipes for high energy and high protein drinks. Nutrition supplements can be bought from hospitals and supermarkets. Ask your doctor for something to relieve any pain - certain mouthwashes and medicines can help.
‘The 6 weeks of radiotherapy were a bit of an endurance test, but things got better after that.' Barney, aged 71.
If swallowing becomes too difficult, you may temporarily need some other way of taking food. A nasogastric tube (a thin tube that goes down your nose and into your stomach) or a tube that goes directly into your stomach, through the skin (a percutaneous endoscopic gastrostomy or 'PEG' tube) may be used for 'high-nutrient meals in a drink' to bypass your sore throat.
Side effects may get worse as the treatment continues, but once it finishes, your mouth will heal. After radiotherapy, swallowing usually returns to normal over the next month. The Cancer Council's booklet Coping with Radiotherapy discusses ways of managing side effects. Telephone 13 11 20.
Some people find that their sense of taste is affected. Try different foods or different ways of preparing food if this happens. It may take several months for your taste to return to normal. Skin in the treatment area may become red and sore after 2 or 3 weeks of treatment. If so, you will need to avoid harsh soaps and perhaps use an electric shaver. Check with your doctor before using any lotions. Ask a member of your radiotherapy treatment team for a cream or gel to ease the burning sensation.
There may also be some permanent changes. The tissues that have received radiotherapy may remain slightly swollen and, particularly if you have had surgery as well, lose softness and flexibility. They can become quite hard and you may lose feeling in them. Some people also find that swallowing remains slower and a little difficult. Long-term changes to diet may be required.
Radiotherapy to the mouth can make teeth decay. If you have your own natural teeth, talk this over with your doctor and, if possible, with your dentist before your treatment. Your dentist may want to see you during the radiotherapy, and may give you instructions about caring for your mouth and teeth to help prevent problems. It is very important to follow this advice.
Thyroid cells take up radioactive iodine, which can destroy them, so radioactive iodine is an effective treatment for some thyroid cancers. The combination of surgery and radioactive iodine treatment achieves high cure rates even when the cancer has spread beyond the thyroid gland. Radioactive iodine is taken as a drink, in a capsule or in an injection into a vein in the arm.
Treatment with radioactive iodine generally involves a hospital stay for a few days, with limited visitors, while the level of radiation falls to safe levels for the people around you.
Radioactive iodine treatment can cause discomfort around the thyroid gland and/or parotid salivary gland (which is near the mouth, in front of the ear) for a short time, due to swelling caused by the radiation. Nausea can also occur.
Chemotherapy is the treatment of cancer with anti-cancer drugs. The aim is to destroy all cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing themselves.
Chemotherapy is sometimes given as tablets, but people most often have it through a needle inserted into a vein. A course of treatment usually lasts a few days, followed by a rest period of a few weeks. During treatment you may need to stay in hospital or you may be treated as a day patient, depending on the drugs you are given and how you are feeling. The number of courses will depend on the type of cancer you have and how well it is responding to the drugs.
The side effects of chemotherapy vary according to the drugs used. They may include feeling sick (nausea), vomiting, feeling unwell and tired, and some thinning or loss of hair from your body and head. These side effects are all temporary and steps are always taken to prevent or reduce them.
The Cancer Council's booklet Coping with Chemotherapy discusses ways of managing side effects. Telephone 13 11 20.
People who have been treated for cancers of the mouth, nose and throat can have a lifestyle that is similar to their lives before diagnosis. 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 information about your own prognosis, you need to speak to your doctor, who knows your full medical history.
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 allow 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. The Cancer Council has a booklet on advanced cancer for people with cancer and a booklet for carers. Telephone 13 11 20.
