Head and Neck Cancer FAQ : Part 3

by National Cancer Institute

(Page 3 of 3)

Chemotherapy, also called anticancer drugs. This treatment is used to kill cancer cells throughout the body. The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect rapidly growing cells, including blood cells that fight infection, cells that line the mouth and the digestive tract, and cells in hair follicles. As a result, patients may have side effects such as lower resistance to infection, sores in the mouth and on the lips, loss of appetite, nausea, vomiting, diarrhea, and hair loss. They may also feel unusually tired and experience skin rash and itching, joint pain, loss of balance, and swelling of the feet or lower legs. Patients should talk with their doctor or nurse about the side effects they are experiencing, and how to handle them. The NCI booklet Chemotherapy and You: A Guide to Self-Help During Treatment has more information about this type of treatment.

• Hypopharyngeal Cancer
• Laryngeal Cancer
• Lip and Oral Cavity Cancer
• Nasopharyngeal Cancer
• Oropharyngeal Cancer
• Paranasal Sinus and Nasal Cavity Cancer
• Salivary Gland Cancer

9. Are clinical trials (research studies) available for patients with head and neck cancers?

Clinical trials are research studies conducted with people who volunteer to take part. Participation in clinical trials is an option for many patients with head and neck cancers.

Treatment trials are designed to find more effective cancer treatments and better ways to use current treatments. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and standard therapy to another group. Doctors are studying new types and schedules for delivering radiation therapy, new anticancer drugs, new drug combinations, and new ways of combining treatments. They are also studying ways to treat head and neck cancers using biological therapy (a type of treatment that stimulates the immune system to fight cancer) by itself or in combination with anticancer drugs or radiation therapy.

Scientists are also conducting clinical trials to find better ways to reduce the side effects of chemotherapy and radiation therapy for head and neck cancers. These clinical trials, called supportive care trials, explore ways to improve the comfort and quality of life of cancer patients and cancer survivors.

People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the CIS (see below) and the NCI booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know. This booklet describes how research studies are carried out and explains their possible benefits and risks. In addition, the NCI's Web site, http://www.cancer.gov on the Internet, provides information about clinical trials. It also offers detailed information about specific ongoing studies by linking to PDQ, a cancer information database developed by NCI. The CIS also provides information from PDQ.

10. What rehabilitation or support options are available for patients with head and neck cancers?

Rehabilitation is a very important part of treatment for patients with head and neck cancer. The goals of rehabilitation depend on the extent of the disease and the treatment a patient has received. The health care team makes every effort to help the patient return to normal activities as soon as possible.

Depending on the location of the cancer and the type of treatment, rehabilitation may include physical therapy, dietary counseling, speech therapy, and/or learning how to care for a stoma after a laryngectomy. A stoma is an opening into the windpipe through which a patient breathes after a laryngectomy.

Sometimes, especially with cancer of the oral cavity, a patient may need reconstructive and plastic surgery to rebuild the bones or tissues of the mouth. If this is not possible, a prosthodontist may be able to make a prosthesis (an artificial dental and/or facial part) to restore satisfactory swallowing and speech. Patients will receive special training to use the device.

Patients who have trouble speaking after treatment, or who have lost their ability to speak, may need speech therapy. Often, a speech-language pathologist will visit the patient in the hospital to plan therapy and teach speech exercises or alternative methods of speaking. Speech therapy usually continues after the patient returns home.

Eating may be difficult after treatment for head and neck cancer. Some patients receive nutrients directly into a vein (IV) after surgery, or need a feeding tube until they can eat on their own. A feeding tube is a flexible plastic tube that is passed into the stomach through the nose or an incision (cut) in the abdomen. A nurse or speech-language pathologist can help patients learn how to swallow again after surgery. The NCI booklet Eating Hints for Cancer Patients: Before, During, and After Treatment contains many useful suggestions and recipes.

11. Is follow-up treatment necessary? What does it involve?

Regular follow-up care is very important after treatment for head and neck cancer to make sure the cancer has not returned, or that a second primary (new) cancer has not developed. Depending on the type of cancer, medical checkups could include exams of the stoma, mouth, neck, and throat. Regular dental exams may also be necessary. From time to time, the doctor may perform a complete physical exam, blood tests, x-rays, and CT, PET, or MRI scans. The doctor may continue to monitor thyroid and pituitary gland function, especially if the head or neck was treated with radiation. Also, the doctor is likely to counsel patients to stop smoking. Research has shown that continued smoking may reduce the effectiveness of treatment and increase the chance of a second primary cancer (see question 12). The NCI fact sheet Follow-up Care: Questions and Answers has more information about this topic.

12. What can people who have had head and neck cancer do to reduce the risk of developing a second primary (new) cancer?

People who have been treated for head and neck cancer have an increased chance of developing a new cancer, usually in the head and neck, esophagus, or lungs. The chance of a second primary cancer varies depending on the original diagnosis, but is higher for people who smoke and drink alcohol. Patients who do not smoke should never start. Those who smoke should do their best to quit. Studies have shown that continuing to smoke or drink (or both) increases the chance of a second primary cancer for up to 20 years after the original diagnosis. Information about smoking cessation is available from the CIS (see below) and in the NCI fact sheet Questions and Answers About Smoking Cessation.

Some research has shown that isotretinoin (13-cis-retinoic acid), a substance related to vitamin A, may reduce the risk of the tumor recurring (coming back) in patients who have been successfully treated for cancers of the oral cavity, oropharynx, and larynx. However, treatment with isotretinoin has not yet been shown to improve survival or to prevent future cancers.

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