NECK CANCER TREATMENTS

The cancers can be treated successfully if diagnosed early. The choice of treatment depends on the size of the tumor, its location, and whether it has spread to other parts of the body.

In the case of lip and mouth cancers, sometimes surgery is performed to remove the cancer. Radiation therapy, which destroys the cancerous cells, is also one of the primary modes of treatment, and may be used alone or in combination with surgery. If lip surgery is drastic, rehabilitation cosmetic or reconstructive surgery may have to be considered.

Cancers of the nasal cavity are often diagnosed late because they have no specific symptoms in their early stages, or the symptoms may just resemble chronic sinusitis. Hence, treatment is often complex, involving a combination of radiotherapy and surgery. Surgery is generally recommended for small tumors. If the cancer cannot be removed by surgery, radiotherapy is used alone.

Treatment of oropharynx cancers (cancers that are either in the back of the tongue, the throat, or the tonsils) generally involves radiation therapy and/or surgery. After aggressive surgery and radiation, rehabilitation is often necessary and is an essential part of the treatment. The patient may experience difficulties with swallowing, chewing, and speech and may require a team of health care workers, including speech therapists, prosthodontists, occupational therapists etc.

Cancers of the nasopharynx are different from the other head and neck cancers in that there does not appear to be any association between alcohol and tobacco use and the development of the cancer. In addition, the incidence is seen primarily in two age groups: young adults and 50-70 year-olds. The Epstein-Barr virus has been implicated as the causative agent in most patients. While 80-90% of small tumors are curable by radiation therapy, advanced tumors that have spread to the bone and cranial nerves are difficult to control. Surgery is not very helpful and, hence, is rarely attempted. Radiation remains the only treatment of choice to treat the cancer that has metastasized (traveled) to the lymph nodes in the neck.

In the case of cancer of the larynx, radiotherapy is the first choice to treat small lesions. This is done in an attempt to preserve the voice. If the cancer recurs later, surgery may be attempted. If the cancer is limited to one of the two vocal cords, laser excision surgery is used. In order to treat advanced cancers, a combination of surgery and radiation therapy is often used. Because the chances of a cure in the case of advanced laryngeal cancers are rather low with current therapies, the patient may be advised to participate in clinical trials so they may get access to new experimental drugs and procedures, such as chemotherapy, that are being evaluated.

When only part of the larynx is removed, a relatively slight change in the voice may occur-the patient may sound slightly hoarse. However, in a total laryngectomy, the entire voice box is removed. The patients then have to re-learn to speak using different approaches, such as esophageal speech, tracheo-esophageal (TE) speech, or by means of an artificial larynx.

In esophageal speech, the patients are taught how to create a new type of voice by forcing air through the esophagus (food pipe) into the mouth. This method has a high success rate of approximately 65% and patients are even able to go back to jobs that require a high level of verbal communication, such as telephone operators and salespersons.

In the second approach, TE speech, a small opening, called a fistula, is created surgically between the trachea (breathing tube to the lungs) and the esophagus (tube into the stomach) to carry air into the throat. A small tube, known as the "voice prosthesis," is placed in the opening of the fistula to keep it open and to prevent food and liquid from going down into the trachea. In order to talk, the stoma (or the opening made at the base of the neck) must be covered with one's thumb during exhalation. As the air is forced out from the trachea into the esophagus, it vibrates the walls of the esophagus. This produces a sound that is then modified by the lips and tongue to produce normal sounding speech.

In the third approach, an artificial larynx, a battery driven vibrator, is placed on the outside of the throat. Sound is created as air passes through the stoma (opening made at the base of the neck) and the mouth forms words.