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Andalus Proton Therapy Center - Head and neck Cancer

Introduction

Head and neck cancer is a fairly common cancer. Cancer of the oral cavity, salivary glands, paranasal sinuses and nasal cavity, pharynx, larynx, and lymph nodes are considered cancers of the head and neck.

More than 500,000 people are diagnosed with head and neck cancer each year across the world> Head and Neck cancer may be cured if found early.

The following types of cancer are NOT usually grouped with cancers of the head and neck:

    • Cancers of the brain.
    • Cancers of the eye.
    • Thyroid cancer.
    • Cancer of the scalp, skin or muscles.
    • Cancer of the bones of the head and neck.

This reference summary will help you better understand what head and neck cancer is and what treatment options are available.

Cancer

The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing in an uncontrolled way, causing an abnormal growth called a tumor.

If the tumor does not invade nearby tissues and body parts, it is called a benign tumor, or non-cancerous growth. Benign tumors are almost never life threatening.

If the tumor invades nearby tissues and body parts, it is called a malignant tumor or cancer.

Cancerous cells spread to different parts of the body through blood vessels and lymph channels. Lymph is a clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes.

Cancers in the body are given names, depending on where the cancer started. For example, cancer that begins in the oral cavity will always be called oral cancer, even it spreads to other places.

Cancer that moves from one tissue to other body parts is known as metastatic cancer.

Most head and neck cancers begin in the cells that line the mucosal surfaces in the head and neck area, such as the mouth, nose, and throat. Mucosal surfaces are moist tissues lining hollow organs and cavities of the body open to the environment.

Cancer of the Head and Neck

Cancers of the head and neck are identified by the area in which they begin and include cancers of the oral cavity and nasal cavity. The oral cavity includes the lips, front two-thirds of the tongue, the gums, the inside lining of the cheeks, the floor of the mouth under the tongue, the hard palate and the small area behind the wisdom teeth. The nasal cavity is a hollow space inside of the nose.

Cancers of the oral cavity include:

• Cancer of the salivary glands

• Cancer of the paranasal sinuses

The salivary glands make saliva. Saliva is the watery fluid in the mouth. This fluid moistens food to help digestion. Saliva also protects the mputh against infection. There are many salivary glands but the major ones are in the floor of the mouth near the jawbone.

The paranasal sinuses are small hollow spaces in the bones around the nose.

Cancer of the nasal cavity includes:

• Cancer of the pharynx

• Cancer of the larynx

• Cancer of the lymph nodes

The pharynx is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus and the trachea. The esophagus is the tube that goes to the stomach. The trachea is the tube that goes to the lungs.

The pharynx has three parts:

• Nasopharynx. The nasopharynx is the upper part of the pharynx and is behind the nose.

• Oropharynx. The oropharynx is the middle part of the pharynx and includes the soft palate, base of the tongue and tonsils.

• Hypopharynx. The hypopharynx is the lower part of the pharynx.

The soft palate is the back, muscular part of the roof of the mouth. The tonsils are two small masses of tissue on either side of the throat. The larynx, also called the voice box, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords.

Cartilage is a firm but flexible connective tissue found in many areas of the body.

The vocal cords are two membranes that rest across the larynx. They move and vibrate to produce sound as air moves over them.

Causes and Risk Factors

It is usually impossible to specify the cause of cancer in an individual patient. However, we do know what causes cancer in general.

Doctors also know factors that can increase the chances of getting cancer.

These are known as “risk factors”.

The most important risk factors for head and neck cancers are tobacco and alcohol use. Eighty-five percent of head and neck cancers are linked to tobacco use.

People who use both tobacco and alcohol are at greater risk for developing head and neck cancers than people who use either tobacco or alcohol alone.

Other risk factors are associated with the area in which cancer starts.

Risk factors for cancer that begins in the oral cavity include sun exposure to the lip and possibly infection by the human papilloma virus or HPV. HPV stands for human papilloma virus. It is an infection that can cause abnormal tissue growth and other changes to cells.

Radiation to the head and neck is a risk factor for cancer beginning in the salivary glands. Exposure to radiation can come from x-rays or from radiation therapy for certain medical conditions.

Certain industrial exposures can raise a person’s risk of cancer beginning in the paranasal sinuses and nasal cavity. Examples are breathing in wood or nickel dust.

Tobacco and alcohol use may play less of a role in this type of cancer.

Cancer that begins in the nasopharynx has multiple risk factors. Repeated exposure to wood dust and the consumption of certain preservatives or salted foods increases a person’s risk of cancer beginning in the nasopharynx.

Other risk factors are infection from the Epstein-Barr virus and an Asian, particularly Chinese, ancestry.

Epstein-Barr virus is a common virus that remains dormant in most people. It causes infectious mononucleosis, which can cause fever, fatigue, sore throat, swollen lymph glands, liver inflammation, and spleen enlargement.

The risk factor for cancer beginning in the oropharynx is poor oral hygiene. Other possible risk factors are HPV infection and the use of mouthwash that has high alcohol content.

Exposure to airborne particles of asbestos, especially in the workplace, increases a person’s risk of larynx cancer. Asbestos fibers breathed in or swallowed can cause several serious diseases. Asbestos has been used as insulation against heat and fire in buildings.

People who are at risk of developing head and neck cancers should talk with their doctor about ways to reduce their risk.

Symptoms

General symptoms of head and neck cancers include:

• A lump or sore that does not heal

• A sore throat that does not go away

• Difficulty swallowing

• A change or hoarseness in the voice

Other symptoms are associated with where the cancer begins.

Oral Cavity

Symptoms of cancer that begins in the oral cavity include:

• A white or red patch on the gums, tongue, or lining of the mouth

• A swelling of the jaw

• Unusual bleeding or pain in the mouth

Nasal Cavity

Symptoms of cancer that begins in the nasal cavity include:

• Sinuses that are blocked and do not clear

• Chronic sinus infections that do not respond to treatment with antibiotics

• Bleeding through the nose

• Frequent headaches

• Swelling or trouble with the eyes

• Pain in the upper teeth

• Problems with dentures

Salivary Glands

Symptoms of cancer that begins in the salivary glands include:

• Swelling under the chin or around the jawbone

• Numbness or paralysis of the muscles in the face

• Pain that does not go away in the face, chin, or neck

Oropharynx and hypopharynx

Symptoms of cancer that begins in the oropharynx and hypopharynx include:

• Ear pain

Nasopharynx

Symptoms of cancer that begins in the nasopharynx include:

• Trouble breathing or speaking

• Frequent headaches

• Pain or ringing in the ears

• Trouble hearing

Larynx

Symptoms of cancer that begins in the larynx include:

• Pain when swallowing

• Ear pain

The symptoms of cancer are similar to symptoms of other diseases. It is important to check with a doctor or dentist about any of these symptoms.

Diagnosis

The best way to treat head and neck cancer is by finding it very early. It is sometimes possible to find this type of cancer even before it causes any symptoms.

If you have symptoms of head and neck cancer, your doctor will try to find out if cancer is the cause of your symptoms or if there is another cause.

The doctor may perform a physical exam to look at your oral and nasal cavities, neck, throat, and tongue using a small mirror and light. A physical exam may also include the doctor feeling for lumps on the neck, lips, gums, and cheeks.

An endoscopy may be used to examine larynx, esophagus, nasal cavity, and nasopharynx. During an endoscopy, the doctor uses a thin, lighted tube called an endoscope to examine areas inside the body.

Laboratory tests may examine samples of blood, urine, or other substances from the body.

X-rays create images of areas inside the head and neck on film.

Another test to diagnose head and neck cancer is called a CAT scan. A CAT scan takes detailed pictures of areas inside the head and neck. A CAT scan, also known as a CT scan, is an x-ray machine linked to a computer. CT stands for computerized tomography.

An MRI is also used to make detailed pictures of areas inside your body. MRI is a large machine with a strong magnet. MRI stands for magnetic resonance imaging.

A PET scan uses safe radioactive sugar that is modified in a specific way so it is absorbed by cancer cells and appears as dark areas on the scan. The sugar is injected into a vein and a scanner makes detailed pictures of where cancer cells are located in the body.

A biopsy is the only sure way to know if a person has cancer. A biopsy is the removal of tissue. A pathologist studies the tissue under a microscope to look for cancer cells.

If you have head and neck cancer, your doctor will determine the stage of the cancer. Staging is an attempt to find out if the cancer has spread and, if so, to which parts of the body.

Stages are usually described using the numbers 1 - 4; a lower number indicates an earlier stage. Staging is helpful in deciding the best course of treatment. Staging head and neck cancer may involve surgery, x-rays and other imaging procedures, and laboratory tests.

Treatment and Supportive Care

Treatment for head and neck cancer depends on the location of the tumor, the stage of cancer, and the person’s age and general health. Talk to your doctor about each treatment option and the side effects associated with them.

Head and neck cancer can be treated with surgery. The surgeon may remove the cancer and some of the healthy tissue around it. Surgery may be followed by radiation.

If the doctor suspects the cancer has spread, lymph nodes in the neck may also be removed. This is called a lymph node dissection.

Radiation therapy, also called radiotherapy, involves the use of high-energy x-rays to kill cancer cells. Radiation therapy may be done externally or internally. External radiation comes from a machine outside the body. Internal radiation comes from radioactive materials placed directly into or near the area where cancer cells are found.

Chemotherapy is another treatment option for head and neck cancer. This treatment is used to kill cancer cells throughout the body using very strong chemicals, sometimes called anticancer drugs.

There may be clinical trials available for people with head and neck cancer. Clinical trials test new medical approaches and treatments.

Proton Therapy for Head and Neck Cancer Treatment

headneck1

Proton therapy allows for effective treatment of complicated head and neck tumors, while minimizing the radiation dose to vital structures such as the eyes, mouth and brain. Vital physical functions such as vision, smell, taste and swallowing remain virtually untouched when a patient is treated with proton therapy.

The Andalus Proton Therapy Center treats cancers of the:

    • Nasal and sinus cavities
    • Oral cavity, including the salivary glands, tongue and tonsils
    • Larynx
    • Eye
    • Skull base
    • Spine

Many head and neck cancer patients can benefit from the precision of proton therapy. Proton Therapy delivers protons to the most complicated tumors by focusing a narrow proton beam and essentially "painting" the radiation dose onto the tumor layer by layer.

The need to implant a feeding tube during head and neck treatment, which can occur in up to 60% of standard radiation patients, may be avoided in Proton Therapy patients due to less collateral damage to the oral cavity.

Side effects such as nausea, damage to the salivary glands, loss of taste and endocrine disorders are also reduced with proton therapy. This enables patients to better maintain their weight and hydration, contributing to successful treatment outcomes and substantially improving quality of life both during and after cancer treatment.

proton

The gantry rotates 360 degrees around the patient to deliver treatment from different angles, allowing physicians to precisely target the tumor site. It is typically used to treat complex cases, such as those found in pediatric patients and hard-to-reach tumors in adult patients

The benefits of proton therapy for head and neck cancers

With any radiation techniques used for this type of cancer, the potential for serious complications including blindness and brain stem injury can be high. This can lead to a difficult choice between giving:

1. a less-than-optimal dose to the tumor (which reduces the chance of a cure); or

2. an ideal dose to the tumor with a higher risk of radiation to healthy tissues.

Proton therapy is an extremely precise form of radiation treatment that enables us to target cancerous cells within the intricate areas of the head and neck. Because protons deposit their maximum energy directly in the tumor, exposure to your fragile healthy tissues is greatly reduced.

    • Advanced proton therapy allows doctors to more selectively place high-dose radiation on your tumor, while simultaneously reducing the dose to your surrounding critical organs. This has been shown to deliver higher cure rates than X-ray radiation treatment even with some of the most difficult tumor types.

 

    • Many studies have shown an increased rate of secondary cancer in surrounding areas in patients who receive X-ray radiation therapy. Because proton therapy lowers the dose to normal tissue, studies predict a lower risk of secondary cancer with this treatment.

 

    • Because proton therapy can better concentrate its radiation dose to the target and limit it elsewhere, it is ideally suited for treating recurrent tumors in areas that have previously been treated with radiation therapy.

Treating previously radiated areas is challenging and very risky with any radiation therapy. Tissues around the recurrent tumor don’t “forget” the previous radiation dose, and any added dose continues to increase the risk of normal tissue injury. By reducing the radiation dose given to these previously treated tissues, protons can help to reduce, but not eliminate, some of the risks associated with re-irradiation.

What to expect

Each patient’s therapy is precisely tailored to their needs. Patients and clinicians collaborate closely to create a personalized treatment plan. The number and length of treatments will vary, based on the cancer. How patients respond depends on many factors, including the types of treatments they are receiving. Many people tolerate proton therapy well and continue to perform normal activities. However, individual responses vary.

Advantages of Proton Therapy for Head and Neck Cancer

Although proton radiation treatment is relatively new, clinical trials for head and neck cancer have already shown excellent signs of disease control and minimal side effects compared with traditional forms of treatment. Proton therapy also offers a number of other compelling benefits:

    • Treatment is noninvasive and painless
    • Proton therapy is effective for treating early stage head and neck cancers
    • Treatment offers quicker recovery times with minimal side effects
    • It is more accurate and precise than other kinds of radiation
    • Treatment is provided in an outpatient setting
    • Proton radiation has little to no impact on patient energy level