Treatment and care of people with cancer is usually provided by a team of health professionals called a multidisciplinary team. This is especially important for people affected by head and neck cancer.

Treatment for head and neck cancer depends on:

• the stage of the disease
• the location of the cancer
• the severity of symptoms
• your general health and wishes.

Treatment may involve the following.

Surgery

Surgery is a common treatment for all stages of head and neck cancer. Depending on what part of the head and neck is affected, it may involveremoval of all or part of the larynx, all or part of the pharynx, the tongue, all or part of the jaw bone, lymph nodes and other tissues in the neck, the vocal cords, the thyroid gland or the affected salivary gland.Wide local excision (removal of the cancer and some of the healthy tissue around it) may also occur. Occasionally, surgery for cancer of the nasal cavity and paranasal sinuses may require removal of an eye.

Surgery may affect your ability to chew, swallow or speak.If a facial nerve is damaged during surgery (e.g. for salivary gland cancer), you might lose control of the muscles on that side of your face.

If the larynx is removed in surgery, a stoma will be created.This is an opening in the windpipe that enables breathing. You will need to learn how to take care of the stoma.

A gastrotomy tube might be needed, often as a temporary measure, during treatment for some types of head and neck cancers, because the treatment can prevent you from swallowing enough food to maintain adequate nutrition. Nutrition is provided through the gastrotomy tube, which is inserted in the wall of the abdomen, directly into the stomach.

Reconstructive or plastic surgery may be needed to rebuild bones or tissues after surgery – for example, for surgery involving the oral cavity or throat.Another possibility is use of a prosthetic device to restore the function and appearance of the part of the face or mouth that was affected.

If your larynx has been removed, you will not be able to speak using your vocal cords, and you will need speech therapy to teach you to speak in a different way; your voice will be different from before the surgery.

For metastatic squamous neck cancer with occult primary that has spread widely in the neck, surgery may remove tissues in the neck (1 or both sides) between the jawbone and the collarbone, including nerves and possibly muscles.Physiotherapy may be needed after this surgery.

Chemotherapy

Chemotherapy is most often delivered at the same time as radiation treatment, as concurrent chemoradiation. In some instances, it may be given both before and during radiation treatment. In people with cancers of the nasopharynx, chemotherapy may also be given after completing chemoradiation.

Chemotherapy may be used to shrink the tumour before surgery or radiation therapy.It may also be used after surgery to kill any remaining cancer cells (this would be very uncommon).It can be used to relieve symptoms of advanced cancer.

Chemotherapy is not often used to treat salivary gland cancers.

Radiotherapy

Along with surgery, some people may receive radiotherapy.

For some types of head and neck cancer, radiation therapy may be the main treatment. Chemotherapy may be given at the same time to enhance the effect of radiation treatment. Radiation therapy may also be used after surgery to kill any remaining cancer cells.It can be used to relieve symptoms of advanced cancer.

Targeted therapy

Targeted therapy refers to treatment with medicines that are designed to specifically attack cancer cells without harming normal cells. These types of medicines affect the way that cancer cells grow, divide, repair themselves or interact with other cells.

Cetuximab is a targeted medicine that is sometimes used to treat cancers of the head and neck.It is a monoclonal antibody that binds to a protein on the surface of cancer cells and stops them growing and dividing. Cetuximab is usually given in conjunction with radiation therapy.

Follow-up

After treatment, you will need regular follow-up examinations of the head and neck by appropriate specialists. These may involve some of the tests that were used to diagnose the cancer or to find out the stage of the cancer.

If you were treated with radiation, it might affect the functioning of the thyroid gland (which is in the neck), and you may need regular checks to text your thyroid function.

Advanced disease

Treatment of advanced head and neck cancer may involve surgery, chemotherapy and/or radiotherapy. Some types of advanced head and neck cancer may not be treatable with surgery. Treatment of these cancers may involve chemotherapy and/or radiotherapy.The goal of treatment of advanced cancer of the head and neck is often to slow the growth of the cancer and to relieve symptoms.

Recurrent cancer

Head and neck cancer can recur (come back) after treatment. The cancer can recur in the head or neck or somewhere else in the body, and is classified as local or distant.

Treatment options for recurrent head and neck cancer include surgery, chemotherapy, radiotherapy and targeted therapy.