BREAST CANCER Treatment Options - DOC by stephan2


									              HEAD AND NECK CANCER: Treatment Options
How is it treated?
        As with any other cancer, treatment of Head and Neck Cancers is best undertaken at the earliest stage.
This maximizes chances of successful treatment. Smaller areas may be treated by radiation or surgery while
larger areas will often necessitate combined therapy. Radiation therapy and/or Surgery are the most common
types of treatment for Head and Neck Cancers. Treatment options are different for each individual case, but
there are several common procedures listed below. In some cases, the patient is referred to a team of
specialists, including a surgeon, ENT specialist, radiation oncologist, medical oncologist, speech pathologist,
nurse, and dietitian. A dentist may also be an important member of the team, especially for patients who will
receive radiation therapy. The information presented is intended to provide patients with treatment information
that they can use in discussing treatment options with their physician.

Surgical Treatments

        When a patient needs surgery, the type of operation depends mainly on the size and exact location of
the tumor. Surgery or surgery combined with radiation therapy and/or chemotherapy is commonly used for
Head and Neck Cancers. A surgical treatment plan that combines radiation therapy and/or chemotherapy has
a definite advantage. Radiation and chemotherapy reduce the amount of tissue that needs to be surgically
removed. This allows for a greater amount of organ preservation. In other words, a larger portion of the
affected structure (the larynx, tongue, jaw, etc.) can be saved and will remain functional. Speech, breathing,
eating, and appearance are often less affected when radiation and chemotherapy are added to a surgical


   Primary Tumor Resection: The entire tumor along with some normal surrounding tissue is removed to
    assure the adequate margins. Smaller tumors can be removed through the mouth without cutting the
    jawbone. Larger tumors may require splitting the jawbone with a saw (mandibulotomy) to get access to the
   Mandible Resection or Maxillectomy: If the tumor invades the jawbones (mandible: lower jaw bone;
    maxilla: upper jawbone), a full or partial resection of jawbone may be required dependent upon the
    extension of the tumor.
   Mohs’ Micrographic Surgery: Skin cancer involving the lip can be removed by Mohs’ chemosurgery. This
    method removes the tumor in thin slices, which will be examined under microscope immediately. The
    surgeon continues to remove more slices until no more cancer cells can be seen under the microscope.
   Neck dissection: The surgeon removes the lymph nodes from the neck. It is performed to remove
    cancerous lymph nodes from the neck and possibly cancerous lymph nodes from the body.
   Some cancers of the tongue, tonsils, or other parts of the mouth can be cured by radiation alone or with


   Total Laryngectomy: The whole voice box is removed. With the removal of the voice box, the windpipe is
    then brought up to the skin of the neck as a stoma (or hole) through which the patient will breathe. This is
    called a tracheostomy. In total laryngectomy, the stoma is permanent.
   Partial Laryngectomy: The surgeon removes only part of the voice box with preservation of the voice.
    Smaller cancers of the larynx can often be removed without taking out the entire voice box. If a stoma is
    performed during a partial laryngectomy, it is normally only temporary. After a brief recovery period, the
    tracheostomy tube is removed, and the stoma closes up.
   Laser surgery: When the tumor on the vocal cord is very small, the surgeon may use a laser to remove
   Neck dissection: The surgeon removes the lymph nodes from the neck. It is performed to remove
    cancerous lymph nodes from the neck and possibly cancerous lymph nodes from the body.
   Some laryngeal cancers can be cured by radiation alone without loss of the voice box.

        When the entire voice box is removed, patients must learn to speak in a new way. There are various
ways of talking after a total laryngectomy. Some patients can swallow air into the esophagus and create a
belching type of speech (esophageal speech). The patients may also use electrical devices to produce a
mechanical voice (electrolarynx). One of the most significant advances in restoring speech has been the
development of the tracheoesophageal puncture (TEP). The surgeon creates a small opening between the
trachea and the esophagus. A plastic or silicone valve is inserted into this opening through the stoma. The
valve keeps food out of the trachea. After this operation, patients can cover their stoma with a finger to force air
out of their mouths, producing sustained speech.
        It takes practice and patience to learn new ways of speech after total laryngectomy. Speech therapists
help in this regard. There is a “New Voice” club for people with permanent tracheostomies who share
experiences and give each other support.


    Because the nasopharynx is close to vital nerves and blood vessels and not easy to reach, it is very difficult
to remove the entire tumor with an adequate margin. Most patients require radiation therapy with or without
chemotherapy. Surgery can be used for patients with recurrent disease who have received a maximal dose of
radiation. Neck dissection is sometimes performed in conjunction with radiation therapy for patients with a neck
lump or mass.

Other Treatments

        There are several non-surgical treatment options that may be combined with surgery or used in place of
surgery. These treatment options are applicable to all types of Head and Neck Cancers. For Head and Neck
Cancer, alternate treatments are important to reduce the need for extensive surgical procedures resulting in
loss of function or disfigurement.

    Radiation Therapy – Radiation therapy uses high-energy radiation to kill cancer cells. External beam
    radiation therapy uses radiation from outside the body to focus on the cancer. Radiation can also come
    from radioactive materials placed directly into or near the tumor. This is called brachytherapy. Radiation
    therapy can be given either in daily fractions, five days per week or two treatments per day (altered
    fractionation). Radiation treatment can be used in conjunction with surgery and/or chemotherapy for
    selected group of patients. You should discuss these options with your doctor to explore different treatment

    Chemotherapy – Drugs are administered by mouth or injection to kill the cancer cells. The drugs enter the
    blood stream and can, therefore, reach areas of the body where the cancer may have spread. Some recent
    studies have demonstrated the advantage of combining radiation therapy and chemotherapy for patients
    with advanced Head and Neck Cancers.

    Clinical Trials – With the introduction of many new drugs that affect Head and Neck Cancers and
    combinations with radiotherapy, there are new experimental treatments being tested that have promising
    results. The effectiveness and side effects of clinical trials are not always known, but they can sometimes
offer hope of survival especially for end-stage cancer patients. Consult your physician or the Rhode Island
Cancer Council to find out what clinical trials are going on near you and if you are eligible.
What are the side effects of the treatments?
Possible Side Effects from Surgical Treatment

Surgery to remove a small tumor in the mouth usually does not cause any lasting problems. More extensive
surgery, such as mandible resection and maxillectomy, is likely to change the patient’s ability to swallow, chew,
or talk. The patient may also look different. Reconstruction surgery may be needed to repair defects in the
mouth, throat, or neck caused by removal of larger tumors.

   Total Laryngectomy – The patient will permanently have a hole in the neck (stoma) from which to breathe
    for the rest of his/her life. Like any surgeries, wound infection and bleeding may occur.

   Partial Laryngectomy – The stoma is temporary. As soon as the skin around the stoma heals, the
    tracheostomy tube is removed. The voice may change after partial laryngectomy.

 Neck Dissection – There are a number of important structures in the neck (blood vessels, nerves, other
    structures) that are at risk of injury during a neck dissection. The top of the lungs actually enter the neck
    and the lining of the lung can be injured during a neck dissection resulting in a collapsed lung requiring a
    tube in the chest for a short time to reinflate the lung. All of these risks occur in just a small minority of
    cases but must be understood by the patient before agreeing to undergo a neck dissection.

Possible Side Effects from Non-Surgical Treatments
           *Most side effects are temporary and can often be relieved with medication.

       Radiation Therapy
           o Skin problems, looks like sunburn
           o Dry mouth (may persist and even be permanent)
           o Sore throat
           o Worsening of hoarseness, especially at beginning
           o Difficulty swallowing
           o Decreased taste
           o Fatigue
           o Difficulty breathing

       Chemotherapy
           o Nausea and vomiting -Loss of appetite
           o Loss of hair
           o Mouth sores
           o Decreased blood count
           o Increased susceptibility to infection

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