Head and neck cancers treatment overview

Head and neck cancers are treated differently depending on their location and size. Surgery, radiotherapy or chemotherapy, or a combination of these treatments are used to treat the cancer.

Before recommending treatment, doctors determine how easy it is to access a tumour using surgery; the likely success of an operation; and whether surgery will cause major side effects. They weigh up the benefits and impacts of all the treatments, and also consider a person’s general health.

Surgery

  • An advantage of surgery is that after the tissue is removed, it can be examined under a microscope to make sure all the tumour has been taken out and is surrounded by normal tissue (clear margins). This is done by a pathologist.
  • The tissue can also give information about the stage of the cancer which helps doctors decide on further treatment.
  • Surgery is generally the fastest treatment and can be repeated if the cancer comes back.
  • Recovery usually depends on how large the cancer is when diagnosed.

Radiotherapy and chemotherapy

  • Radiotherapy may be given on its own or after surgery with/without chemotherapy, if the cancer is more likely to recur without these treatments.
  • Usually, a course of radiotherapy can only be given once, and it takes about six weeks to recover.
  • See the Understanding Radiotherapy and Understanding Chemotherapy pages for more information.
  • Your medical team will help you decide what treatment to have.

How different cancers are treated

  • Oral cancer –  Cancers of the oral cavity are commonly treated with surgery, then radiotherapy if required. Chemotherapy is sometimes used in combination with these treatments.
  • Salivary gland cancer -  Surgery is done in most cases. This is usually followed by radiotherapy. Chemotherapy is not usually given unless the cancer has spread, and it may be offered as palliative treatment.
  • Pharyngeal cancer -  This is usually treated with surgery or radiotherapy. If radiotherapy does not destroy all the cancer cells or if the cancer comes back, surgery may be performed. If surgery is done first, radiotherapy may be used afterwards to destroy any remaining cancer cells. Chemotherapy may also be offered, usually with radiotherapy.
  • Laryngeal cancer -  Where possible, early laryngeal cancer is treated with either laser surgery or radiotherapy. For larger cancers, radiotherapy is usually combined with chemotherapy (chemoradiation). For advanced cancer, surgery is only used if the cancer comes back or it’s not all killed by radiotherapy. Chemotherapy may be given first to ease the pressure on a person’s airway while chemoradiation is being planned. Radiotherapy (with or without chemotherapy) will be given after surgery to reduce the chance of the cancer coming back.
  • Nasal or paranasal sinus cancer -  These are commonly treated with surgery, followed by radiotherapy and/or chemotherapy.

Before treatment starts

Dental check-ups

Head and neck cancer treatment, particularly radiotherapy, can cause dental problems, but these can often be prevented.

Before starting cancer treatment you must 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. A plan also helps you learn good oral health care before, during and after treatment.

The dentist will probably recommend that decayed or damaged teeth, and healthy teeth that will be affected by radiotherapy, are taken out. These teeth may be removed during cancer surgery or before radiotherapy.

Radiotherapy permanently affects tissue healing in the treatment area. In rare cases, it can cause scarring of the jaw, leading to the bone being exposed in  the mouth (osteoradionecrosis or ORN). ORN can cause problems if you later need a tooth extraction or surgery to the mouth or jaw.

  • Check if you are eligible to receive free or low cost public dental services provided by state and territory governments to Pensioner Concession Card and Health Care card holders.
  • Have regular six-monthly dental appointments  after your cancer treatment.

Palliative treatment

Palliative treatment helps to improve people’s quality of life by reducing symptoms of cancer without trying to cure the disease. It is not just for end-of-life care and can be used at different stages of cancer. Often treatment is concerned with pain relief and stopping the spread of cancer, but it also involves the management of other physical and emotional symptoms. Treatment may include radiotherapy, chemotherapy or other medications.

Call the Helpline 13 11 20  for more information about palliative care, advanced cancer and cancer pain.

This information was last reviewed in Content updated June 2012

This information has been reviewed by: Dr Tim Iseli, ENT Surgeon, Royal Melbourne Hospital; Katrina Blyth, Senior Speech Pathologist, Royal Prince Alfred Hospital, NSW; Dr David Boadle, Staff Specialist, Medical Oncology, Royal Hobart Hospital; Geoffrey Booth, Consumer; Teresa Brown, Team Leader, Royal Brisbane and Women’s Hospital; Marty Doyle, Co-founder and Facilitator, Head and Neck Cancer Support Group, Brisbane; Dr Peter Foltyn, Dental Department, St Vincent’s Hospital, NSW; Noelene Hunt, Consumer; Dr Michael Jackson, Director, Radiation Oncology Department, Prince of Wales Hospital, NSW; Len McDowall, Consumer; and Cancer Council SA Helpline Consultant.

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