Knowing all your options will help you find the best treatment.
Head and neck cancer is a collective term for several types of cancers that may start in the moist lining of the mouth, nose, and throat. Usually, though not always, the cancer affects the flat squamous cells that line these mucosal surfaces (this is called squamous cell carcinoma of the head and neck). Learn more about the different types of head and neck cancer here.
Because of this, treatment for head and neck cancer can vary as well. “There's no one way to treat these types of cancers,” says Mark Persky, MD, an otolaryngologist and head and neck surgeon at NYU Langone Health in New York City.
Cancer treatment is split into two categories: local and systemic.
Local treatments treat only the cancer (surgery + radiation) and often do not affect the rest of the body.
Systemic treatments are medications that go through whole body (chemo + targeted therapy) and can reach all cells in the body.
Treatment for head and neck cancer may include surgery, radiation, chemotherapy, targeted therapy, or immunotherapy. “Treatment of head and neck cancer can vary depending upon the site, the type of tumor, whether it's HPV-positive or not, and the staging of the tumor,” says Dr. Persky. Learn more about how head and neck cancers are diagnosed.
Some of the newer medications available are targeted therapies and immunotherapies.
Targeted therapy “targets” and kills the mutations in cancer cells that help them grow. Unlike chemotherapy, which aims to kill any rapidly dividing cell, target therapy affects mainly cancer cells and preserves normal cells.
Epidermal growth factor receptor (EGFR) inhibitors are so far the only targeted agents that have been approved for head and neck cancer. Anti-EGFR drugs are a man-made version of an immune system protein, called a monoclonal antibody. These drugs target a protein on the surface of EGFR that helps cells grow and divide. By blocking EGFR, it helps slow or stop cell growth.
Immunotherapy is a type of therapy that stimulates the immune system to combat cancer cells “in a very effective way,” says Dr. Persky. Immunotherapies that treat head and neck cancer are called checkpoint inhibitors, more specifically, PD-1 inhibitors.
Here’s how checkpoint inhibitors work: The immune system uses a “checkpoint” system, in which proteins on an immune cell can be switched on or off to trigger—or inhibit—the immune response. Cancer cells can manipulate this checkpoint system to turn off the immune response, allowing rapid and uninhibited cancer growth.
That’s where checkpoint inhibitors come in. They block those proteins on the immune cell, signaling to the immune system to recognize and attack the cancer cells. PD-1 inhibitors target a protein on the immune cells called PD-1. Learn more about how immunotherapy treats cancer.
Another option patients have is to participate in a clinical trial. Clinical trials are research studies that test new drugs or other treatments in people. Clinical trials are one way to get state-of-the art cancer treatment.
“There are many, many institutional studies, multi-institutional studies, that are now focusing on improving the cure for head and neck cancer,” says Dr. Persky.
Ask your doctor if there are any clinical trials that may be of benefit to you.
“Every patient should be aware of the options of treatment,” says Dr. Persky. “The doctor hopefully will present ... the best option of treatment, but the patient has the final decision.”
Remember: You and your doctor are a team. It’s important to be open with your doctor and bring up any questions or concerns you may have when considering different treatment options.
“A good doctor will always be there for the patient throughout the evaluation process, the treatment process, and the follow-up process,” says Dr. Persky. “That's important for the patient to realize and to expect from any physician treating him, no matter whether it's head and neck or any other type of tumor.”
Dr. Persky is an otolaryngologist and surgeon at NYU Langone Health in New York City.
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Treatment of head and neck cancer can
vary depending upon the site, the type of
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tumor, whether it's HPV-positive or
not, and the staging of the tumor.
00:00:11,696 --> 00:00:18,018
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There are many, many institutional
studies, multi-institutional studies that
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are now focusing on improving the cure for
head and neck cancer.
00:00:26,830 --> 00:00:30,880
There's been a marked improvement
in the effectiveness of
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drugs in the treatment of head and
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The traditional form of drug is the
chemotherapy, where the tumor is directly
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affected by the drug given, and
the drug goes everywhere in the body.
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So when patients heard about this,
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we think very ominous thoughts that
perhaps the tumor is widespread and
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perhaps that their prognosis is
significantly altered because of that.
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Chemotherapy now, in addition to affecting
the tumor, also radiosensitizes the tumor.
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Meaning that often it's given in
combination with radiation therapy.
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And it sensitizes the tumor cells
to the effect of the radiation,
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therefore making the radiation much more
effective in destroying the tumor cell.
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A second form of therapy is
something called biological therapy.
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Where the tumor produces
certain substances, and
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these biologics can alter those
substances to decrease, and
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perhaps even sometimes eliminate
the tumor by directly affecting it.
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And then the third type of
drug therapy is immunotherapy.
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Where there's an effect on stimulating
the immune system of the body
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to combat the cancer cells
often in a very effective way.
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The patient has to realize that the
healthcare team is always available for
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them when it comes to questions,
or support, or
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any addressing of
complications of treatment.
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That we'll always be there for them
throughout the entire treatment process,
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as well as the follow-up process.
Targeted Therapy of Head and Neck Cancer. Berlin, Germany: Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, 2016. (Accessed on March 29, 2019 at https://www.karger.com/Article/Abstract/452432)
How is Immunotherapy Changing the Outlook of Patients with Head and Neck Cancer? The Cancer Research Institute. (Accessed on March 29, 2019 at https://www.cancerresearch.org/immunotherapy/cancer-types/head-neck-cancer)
Head and neck cancers. Bethesda, MD: National Cancer Institute. (Accessed on March 29, 2019 at https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet)
If you have head or neck cancer. Atlanta, GA: American Cancer Society, 2018. (Accessed on March 29, 2019 at https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/if-you-have-head-or-neck-cancer.html)
Overview of the diagnosis and staging of head and neck cancer. Waltham, MA: UpToDate, 2019. (Accessed on March 29, 2019 at https://www.uptodate.com/contents/overview-of-the-diagnosis-and-staging-of-head-and-neck-cancer)
Treating oral cavity and oropharyngeal cancer. Atlanta, GA: American Cancer Society. (Accessed on March 29, 2019 at https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/treating.html)