Cancer of the Head and Neck

Cancer of the Head and Neck
by Norman J. Harris, MD
Affiliated Ear, Nose and Throat of Orange county
reprinted with permission from www.ocentdoc.com

A diagnosis of cancer of the head or neck shouldn’t bring despair. Success in cancer therapy is expressed in terms of impact on patient’s expectations to live another 5, 10 or 20 years. Please notice that as we ‘mature’, our odds for living another 5, 10, 20 years and so forth fall below 100%. The impact of a diagnosis of malignancy shouldn’t be compared to an otherwise 100% chance for survival.

In general, there are four practical courses of action available to somebody who has such a diagnosis. The first is to do nothing. The second is to do a surgical procedure. The third is to have irradiation, and the fourth is to have a combination of irradiation and surgery.

Chemotherapy, although effective elsewhere in the body, so far has been disappointing in cancers of the head and neck. There are experimental chemotherapy protocols underway. Little has come of this work so far. Several blood related medications have been shown to make cancer cells vulnerable to certain kinds of laser lights. This promising approach has yet to give reliable results and remains experimental. Combining radiation with chemotherapy has seemed to help in a very short list of advanced tumors. This approach as well is considered to be experimental.

Alternative medicine/holistic cancer treatments are usually variations of therapies used by the medical profession in the past. They failed, and were abandoned. I have no objection to having them considered for my patients. The concern is that they will waste time, and change the treatment from one which might totally control the tumor if started immediately to one which will only slow it down. As we go along, we address the issues of diet and lifestyle on treatment, to the extent they are known.

If nothing is done, these tumors grow. They create local problems of pain, difficulty swallowing or difficulty breathing. The pain usually becomes quite difficult to control. Swallowing difficulty may require either a nasogastric tube or a hole into the stomach for feeding. Most tumors of the head and neck progress slowly. These events will play out over a period of nine months to a year or more. Doing nothing is rarely the best option. Patients must avoid the trap of comparing their initial condition to the options we recommend. They aren’t going to stay as they are. Their chances for a five-year survival with most of these tumor untreated is very close to zero.

Surgical treatment of your tumor alone would consist of removal of the source with a generous margin, together with the lymphatics of the neck if they’re involved. The typical operation is know as a radical neck dissection.

Radiation therapy is the third option mentioned. Radiation therapy with a tumor much larger than ½ inch, with rare exceptions, offers a slightly less satisfactory outcome than surgery alone. The advantage of radiation therapy however is that structures are preserved. This doesn’t meant there is no loss in function or there is less discomfort involved. In fact, in many instances, the discomfort of radiation therapy far exceeds in quantity and duration the discomforts of surgery.

I most commonly recommend combined therapy for the usual squamous cell cancers. Studies over the years have demonstrated that surgery followed by irradiation offers about a 15-20% improvement in five-year survivals compared to either alone. Remember, your five-year survival without the tumor present wasn’t 100% to begin with.

The best advice we offer our patients is, regardless of how you choose to have your tumor treated, write off a year. It’s going to be an uncomfortable, scary, often sloppy experience. After a year, you’ll be in a position to look forward to the rest of your life.

As always, our philosophy is to offer you only what we would accept in your place. We encourage our patients to obtain second opinions. There is always time to make a right decision. We do urge proceeding as rapidly as practical. As the tumor grows, the probable success rates fall.