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Head and Neck Oncology

  • Head & neck oncology is a specialized area of medicine focused on diagnosing and treating cancers arising in the head and neck region. This encompasses malignancies of the:

    • Oral cavity (lips, tongue, floor of mouth, gums, cheeks)

    • Oropharynx (tonsils, base of tongue, soft palate)

    • Hypopharynx & Larynx

    • Nasal cavity and paranasal sinuses

    • Salivary glands

    • Skin of the head and neck

    • Thyroid & Parathyroid glands

    These cancers can vary widely in behavior, aggressiveness, and response to treatment depending on the site, histological type, stage, and patient’s general health.

  • Treatment is often multimodal—that is, using more than one type of therapy. Typical options include:

    1. Surgery
      Removal of the tumor plus a margin of healthy tissue. Sometimes reconstructive surgery is needed to restore form and function (speech, swallowing, appearance).

    2. Radiation Therapy
      High-energy beams are used to kill or damage cancer cells. Can be external beam radiation (most common) or brachytherapy (internal placement).

    3. Chemotherapy
      Drugs to kill cancer or stop its growth. Often used in conjunction with radiotherapy in locally advanced cancers.

    4. Targeted Therapy & Immunotherapy
      Using drugs that specifically attack cancer cells (based on molecular markers) or boosting the immune system to fight cancer.

    5. Supportive / Rehabilitative Care
      Speech and swallowing therapy, nutritional support, psychological support, pain management, etc., are crucial, both during and after treatment.

  • Radiation oncology is a cornerstone in the management of head & neck malignancies. Key aspects include:

    • Primary treatment: For many tumors, especially small or intermediate-stage, radiation alone (sometimes with chemotherapy) can cure.

    • Adjuvant therapy: After surgery, radiation (often with chemotherapy) may be used to reduce the risk of recurrence.

    • Organ preservation: Radiation (plus chemotherapy) can sometimes avoid the need for extensive surgery, preserving voice, swallowing, and appearance.

    • Palliative care: When cure isn’t possible, radiation helps relieve symptoms — pain, bleeding, obstruction.

    • Modern radiation oncology has evolved to reduce toxicity while maximizing effectiveness. Some advanced techniques:

    • Intensity-Modulated Radiation Therapy (IMRT): Allows modulation of dose intensity, sparing normal tissues (e.g. salivary glands) while covering tumor volume.

    • Volumetric Modulated Arc Therapy (VMAT): Delivers IMRT in arcs around the patient; faster treatment, precise shaping.

    • Image-Guided Radiation Therapy (IGRT): Uses frequent imaging to ensure the radiation beam is delivered accurately.

    • Proton & Heavy Ion Therapy: More precise dose distribution, potentially less collateral damage (used in certain centers).

    • Adaptive Radiation Therapy: Monitoring changes (tumor shrinkage, weight loss) during treatment and adjusting plans accordingly.

    • Benefits:

    • Non-invasive (for radiation vs. surgery’s invasiveness)

    • Can preserve anatomical structures and functions

    • Effective against microscopic disease post-surgery

    • Ability to treat areas difficult to reach with surgery

    • Challenges:

    • Acute side effects: mucositis, skin reactions, taste changes, swallowing difficulties

    • Long-term effects: xerostomia (dry mouth), dental issues, risk of secondary cancers, tissue fibrosis, changes in quality of voice

    • Requires highly precise planning and technology

    • Coordination with other treatments (surgery, chemo) to optimize timing

    • Huge tumors with extensive invasion, where surgery is required for removal

    • Certain histologies that are less radiosensitive

    • Patients with contraindications to radiation (prior radiation, comorbidities)

    • Situations needing immediate decompression or removal

    • Head & Neck Oncology encompasses a broad spectrum of cancers that affect vital functions—speech, swallowing, breathing, appearance. Radiation Oncology plays a central, often overlapping role in managing these cancers. Together with surgery, chemotherapy, and newer systemic and supportive therapies, radiation helps achieve the dual aims of oncologic control and preservation of function & quality of life.

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