Head and neck cancer treatment

Treatment for head and neck cancers, particularly radiation therapy, can affect your mouth, gums and teeth. Before treatment starts:

See a dentist or oral medicine specialist – Have a thorough check-up and ask for an oral health care plan. The plan outlines any dental work you need before treatment starts, and also provides guidance on appropriate care before, during and after treatment. The dentist may recommend taking out any unhealthy teeth that might be affected by radiation therapy. These teeth may be removed during cancer surgery or before radiation therapy.

Start an exercise program – This will help build up the strength needed for recovery. Talk to your doctor about this.

Stop smoking before you have surgery – If you continue to smoke, you may not respond to treatment as well as people who don’t smoke. Also, smoking may make side effects worse and increase the chance of a second primary cancer. See your doctor or call the Quitline on 13 7848 for support to quit.

Mouth (oral) cancer

• Commonly treated with surgery.
• May be followed by radiation therapy alone or combined with chemotherapy (chemoradiotherapy).

Pharyngeal cancer

• Treatment will depend on the type of pharyngeal cancer you have: nasopharyngeal, oropharyngeal or hypopharyngeal.
• The options may include surgery, radiation therapy, chemotherapy, or a combination.

Laryngeal cancer

• Early laryngeal cancer is treated with surgery or radiation therapy.
• Advanced laryngeal cancer is sometimes treated with surgery first. Radiation therapy (with or without chemotherapy) is usually given after surgery to reduce the chance of the cancer coming back.
• Surgery may be offered to people who have had radiation therapy if the cancer comes back or is not all destroyed by radiation therapy.

Salivary gland cancer

• Surgery is the main treatment. This may include removing some lymph nodes.
• Surgery may be followed by radiation therapy alone or in combination with chemotherapy (chemoradiotherapy).

Nasal or paranasal sinus cancer

• Commonly treated with surgery, including removal of some lymph nodes.
• Surgery may be followed by radiation therapy.

Sometimes it is difficult to decide on the type of treatment to have. You may feel that everything is happening too fast. Check with your doctor how soon your treatment should start, and take as much time as you can before making a decision.

Understanding the disease, the available treatments and possible side effects can help you weigh up the pros and cons of different treatments and make a well-informed decision that’s based on your personal values. You may also want to discuss the options with your doctor, friends and family.

You have the right to accept or refuse any treatment offered. Some people with more advanced cancer choose treatment even if it only offers a small benefit for a short period of time. Others want to make sure the benefits outweigh the side effects so that they have the best possible quality of life.

A second opinion

You may want to get a second opinion from another specialist to confirm or clarify your doctor’s recommendations or reassure you that you have explored all of your options. Specialists are used to people doing this.

Your doctor can refer you to another specialist and send your initial results to that person. You can get a second opinion even if you have started treatment or still want to be treated by the first doctor. You might decide you would prefer to be treated by the doctor who provided the second opinion.

Taking part in a clinical trial

Your doctor or nurse may suggest you take part in a clinical trial. Doctors run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods. For example, if you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment.

Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer.

It may be helpful to talk to your specialist or clinical trials nurse, or to get a second opinion. If you decide to take part, you can withdraw at any time. For more information, call Cancer Council 13 11 20 and ask for a free copy of Understanding Clinical Trials and Research, or visit australiancancertrials.gov.au.

When your doctor first tells you that you have cancer, you may not remember the details about what you are told. Taking notes or recording the discussion may help. Many people like to have a family member or friend go with them to take part in the discussion, take notes or simply listen.

If you are confused or want clarification, you can ask your doctor questions – see below for a list of suggested questions. If you have several questions, you may want to talk to a nurse or ask the office manager if it is possible to book a longer appointment.

• What type of head and neck cancer do I have?
• Has the cancer spread? How fast is it growing?
• What treatment do you recommend and why?
• Do I have a choice of treatments?
• What are the risks and possible side effects of each treatment?
• How long will treatment take? Will I have to stay in hospital?
• Who will be my primary specialist coordinating my care?
• How much will treatment cost?
• Will I have a lot of pain with the treatment? What will be done about this?
• Are the latest tests and treatments for this type of cancer available in this hospital?
• Are there any clinical trials or research studies I could join?
• What kind of rehabilitation will be available to me afterwards?
• When can I return to work or my usual activities?
• Will my face or neck have significant scarring or will I look different? What can be done to minimise this?
• Will I need to have a stoma?
• Will my speech be affected?
• How frequently will I need check-ups after treatment?
• Who should I go to for my check-up appointments?
• Are there any complementary therapies that might help me?
• Should I change my diet during or after treatment?
• If the cancer comes back, how will I know?