Head and Neck Squamous Cell Carcinoma (HNSCC) is a type of cancer originating in the squamous cells lining moist surfaces of the head and neck, such as the mouth, throat, and voice box. HNSCC is prevalent globally, with an estimated 890,000 new cases and 450,000 deaths annually, accounting for approximately 4.5% of cancer diagnoses and deaths worldwide. Managing HNSCC is complex because affected areas are vital for functions like speaking, swallowing, and breathing. Treatment is often multidisciplinary and tailored to each patient’s needs.
Core Treatment Approaches
Treating HNSCC involves several primary modalities, used alone or in combination to eliminate cancer cells.
Surgery removes the tumor and sometimes surrounding tissues. This can involve removing parts of the affected area, such as a portion of the tongue or larynx. Reconstructive surgery often follows to restore function and appearance.
Radiation therapy uses high-energy rays to target and destroy cancer cells. This treatment works by damaging the DNA within cancer cells, preventing them from growing and dividing. External beam radiation therapy delivers radiation from a machine outside the body. Brachytherapy, or internal radiation, places radioactive sources directly into or near the tumor for a concentrated dose. Radiation treatments are administered daily over several weeks.
Chemotherapy uses drugs to kill cancer cells throughout the body. These drugs are given intravenously or orally. Chemotherapy is often combined with radiation therapy (chemoradiation) to enhance effectiveness or used before/after surgery to shrink tumors or eliminate remaining cancer cells. For example, cisplatin is a common chemotherapy drug used in HNSCC treatment.
Targeted therapy uses drugs that specifically attack certain molecules or pathways involved in cancer cell growth. For instance, some targeted therapies block the activity of the epidermal growth factor receptor (EGFR), which is frequently overexpressed in HNSCC cells and contributes to tumor growth. These therapies often have fewer side effects than traditional chemotherapy.
Immunotherapy harnesses the body’s own immune system to fight cancer cells. These treatments enable immune cells to mount a stronger attack against the tumor. Programmed cell death protein 1 (PD-1) inhibitors, such as pembrolizumab and nivolumab, are examples of immunotherapies approved for HNSCC.
Personalized Treatment Planning
Treatment for HNSCC is highly individualized, reflecting each patient’s unique characteristics and cancer. The selection of therapies is a carefully considered process.
Factors influencing treatment decisions include the cancer’s stage (size and spread), tumor location, patient’s overall health, age, and personal preferences.
A multidisciplinary team develops the most appropriate treatment plan. This team typically includes surgical, radiation, and medical oncologists, pathologists, and radiologists. Specialists like speech therapists, nutritionists, and social workers also contribute. This collaborative effort ensures all aspects of the patient’s condition are considered.
Often, therapies are combined for optimal results. For instance, surgery might be followed by radiation therapy, possibly with concurrent chemotherapy, to reduce the risk of recurrence. The specific sequence and combination are determined by the multidisciplinary team based on influencing factors.
Supportive Care and Rehabilitation
Managing treatment side effects and supporting quality of life are integrated aspects of care. Treatment can lead to various physical and emotional challenges requiring proactive management.
Patients may experience common side effects such as difficulty swallowing (dysphagia), voice changes, dry mouth (xerostomia), skin reactions, fatigue, limited mouth opening (trismus), neck swelling (lymphedema), and altered taste.
Supportive therapies alleviate these side effects. Pain management controls discomfort. Nutritional support, which may involve feeding tubes if severe swallowing difficulties arise, ensures adequate nourishment. Speech therapy addresses voice and swallowing problems, while physical therapy aids in regaining mobility. Psychological support helps patients cope with the emotional impact.
Rehabilitation helps patients regain function and improve overall quality of life during and after treatment. This approach aims to minimize long-term impairments and enable patients to return to daily activities.
Long-Term Follow-Up
After active HNSCC treatment, ongoing monitoring and care ensure long-term well-being. This phase focuses on preventing recurrence and addressing lingering effects.
Regular check-ups, imaging scans, and examinations monitor for cancer recurrence or new cancers. The majority of HNSCC recurrences typically occur within the first two to three years after treatment, with 95% of asymptomatic recurrences detected within 24 months. This surveillance aids early detection.
Some treatment side effects can be long-lasting or appear months or years later. These late effects include persistent dry mouth, swallowing difficulties, neck stiffness, and changes in taste or voice. Managing these effects involves continued supportive therapies.
Survivorship care addresses physical, emotional, and social needs after treatment. This includes ongoing support for managing late effects, promoting healthy lifestyle choices, and addressing psychosocial challenges. Survivorship programs provide comprehensive care to help patients navigate their post-treatment journey.