Cancer of the Head and Neck
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.