Although many different cancers can start in the head and neck, the majority are squamous cell carcinomas. These are tumours that begin predominantly in the lining area of the mouth (oral cavity), throat (pharynx), and voice box (larynx). They have the capacity to invade tissue locally and to spread to lymph nodes in the neck. Rarely the tumour may spread to other sites beyond the head and neck such as lung or bone.

There are also some rarer tumours of the skull and facial sinus areas, the nose, and the salivary glands. It is important to appreciate that most cancers of the head and neck have the possibility of permanent cure provided the disease has not already spread beyond the head and neck.

Types of Treatments

The two principal treatment types used for head and neck cancer are radiotherapy and surgery. In some cases, they both need to be used in the same patient. Chemotherapy is often added to augment the effect of radiotherapy in extensive tumours and is especially indicated in patients with many or very large lymph nodes.

Alternatively, in patients with less lymph nodal involvement it may still be possible to use radiotherapy alone even when the primary tumour is extensive. The treatment of choice depends on the site, extent, and cell type (termed the histology) of the cancer.

Head and neck cancers frequently spread to lymph nodes in the neck. The treatment of the neck nodes should be determined in conjunction with the treatment of the primary cancer in the mouth or throat. In general, if the primary cancer is first managed with radiation therapy, the neck nodes are treated with radiation as well. If the nodes resolve completely at the end of treatment, surgery is not necessary. If neck nodes remain at the end of radiation therapy, it is safest to proceed with an operation to remove them.

Choosing Treatments

In general, early-stage cancers are best treated by either surgery or radiation therapy (chemotherapy alone is not an appropriate option) rather than a combination of the two treatments. In contrast, patients with more advanced cancers are often best treated with a combination of radiation and surgery, often combined with adjuvant chemotherapy.

Patients who would benefit from combined-modality treatment are usually treated with surgery followed by postoperative radiation therapy if the cancer is completely removable by an operation. If not, radiation is first given to try to shrink the main cancer mass and kill the cancer cells that may be infiltrating the outer shell of the tumour to facilitate its complete removal.

Active Clinical Trials

Patients who require concurrent radiotherapy and chemotherapy for curable locally advanced head and neck cancer are eligible for the randomized Headstart trial that compares concurrent chemotherapy using tirapazamine and Cisplatin compared to the Cisplatin alone, both with the same 7 week course of radiotherapy.

This important trial is being conducted in approximately 80 centres throughout the world and is designed to examine the value of Tirapazine, a promising drug that selectively kills cancer cell that have insufficient oxygen, and also enhances the effect of Cisplatin in killing cancer cells. Because of this, tirapazamine may be an ideal agent to use with radiotherapy and Cisplatin since cancer cells with insufficient oxygen are less sensitive to radiotherapy. Princess Margaret is one of the top two centers in the world involved in this clinical trial.

A prospective assessment of quantitative volumetric change in primary tumour and in major salivary glands during radiotherapy using MRI assessment.

PET-PREVENT. Assessment of the role of PET scanning in the management of resectable neck disease following radiotherapy in resectable neck disease.

The use of PET scanning in assessing the location of disease in patients with newly diagnosed nasopharynx cancer. This study may help to target the disease more accurately for radiotherapy planning and is also linked to evaluation of the amount of E-B virus found in the patient’s blood. E-B virus is probably the cause of nasopharyngeal cancer in many patients.

A prospective Phase II trial of Intensity Modulated Radiotherapy (IMRT) in the assessment of local control and salivary preservation in the radiotherapy and chemo-radiotherapy of nasopharyngeal cancer.

Assessment of the tolerance and requirements of endogastric feeding tube support in the radiotherapy and chemo-radiotherapy of head and neck cancer.

Cone Bean Image-guidance to assess the accuracy of the delivery of IMRT for nasopharynx cancer.

This page was last updated August 18th, 2010 at 7:47am.