The two major modalities for treating head and neck cancer are radiation therapy and surgery. The treatment of choice depends on the site, extent, and cell type (histology) of the cancer. Most cancers of the head and neck region are squamous cell carcinomas.
In general, early-stage cancers are best treated by one modality (either surgery or radiation therapy) 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, sometimes 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 given initially to try to cause tumor regression to facilitate complete removal of the malignancy.
Usually, cases of head and neck cancer are presented to the Head and Neck Tumor Board, and the patient is examined by several head and neck cancer specialists. A treatment plan is recommended jointly by the Board. Before any treatment is started, the recommended treatment, the reasons it is recommended, the procedures to be carried out, the expected or possible side effects or complications, and the expected benefits are all explained to the patient and family. The patient must give permission for treatment, based on this knowledge (“informed consent”), before treatment is given.
Following are some general guidelines for treatment of head and neck cancers according to specific tumor site. In general, the chance of cure is in the range of 90% or better for patients with stage I disease, approximately 80% for those with stage II disease, 60% to 70% for those with stage III disease, and 40% to 50% for patients with stage IV cancers.