What is the prognosis for head and neck cancer? The statistics for cancer prognosis are usually described in terms of 5 year disease-free survival. So, a 50% 5-year survival would mean that 50% of patients diagnosed with a particular type of cancer would be alive and cancer-free in 5 years.
For head and neck cancers, the average 5-year survival is about 50%. That number takes into account all new diagnoses, regardless of stage. The stage of a cancer is a term that describes how advanced the cancer is at the time of diagnosis. For early stage cancers, particularly those on the vocal cords or inside the mouth, the 5-year survival can be over 90%. For more advanced stage cancers (especially those which have spread elsewhere in the body), the 5 year survival is poor.
Staging for all cancers is described by the TNM classification. Head and neck cancers are classified as well based on the location of the primary tumor. You can read more about staging here if you are interested. (http://emedicine.medscape.com/article/2007181-overview)
How are head and neck cancers treated? For any type of cancer, there are 3 broad treatment options:
1. Surgery to remove the cancer
2. Radiation to kill the cancer cells
3. Chemotherapy (medicines given by mouth or through an iv line) to kill the cancer cells
For head and neck cancers, chemotherapy plays a relatively minor role. It is generally only given in conjunction with radiation therapy to make the radiation work better.
So, the main current treatments for H+N cancer are either surgery or radiation (plus or minus chemotherapy).
If radiation is given to a patient and the cancer is not completely eradicated or it recurs in the future, surgery is still an option at that point. Also, patients frequently have radiation after they have surgery. Radiation can usually not be given more than once to the same spot though.
So, how are head and neck cancers usually treated? Whether surgery or radiation is the first treatment depends on the location of the primary tumor and patient preference.
As a general rule, cancers in the mouth are treated with surgery first to remove the primary tumor and the lymph nodes in the neck. The mouth (or oral cavity) is defined as the inner lips and cheek, the gums, the floor of mouth under the tongue, the front ⅔ of the tongue, the hard palate, and the retromolar trigone (the back part of the jawbone behind the wisdom teeth. The main reason is that radiation can be dispersed by the mandible (jawbone) and cannot be precisely targeted into the oral cavity.
Cancers in the oropharynx or hypopharynx can be treated with surgery first or radiation first. In my experience, the vast majority of patients with pharyngeal cancers choose radiation (with chemotherapy if the cancer is larger or there are metastatic lymph nodes in the neck). The reason is that surgery for these throat cancers is generally a very major operation that can have serious side effects including inability to swallow.
Cancers in the larynx (voice box) can also be treated with surgery first or radiation first. Some of these cancers are small and are amenable to minimally-invasive laser resection or partial removal of the voice box, thus preserving voice and swallowing function. Larger laryngeal cancers require total removal of the voice box if surgical removal is desired. For this reason, the majority of patients in my experience want to try chemo + radiation as a first line treatment in hopes of preserving their voice. Surgery can be done after chemoradiation if the cancer has not been eradicated.
I hope this was an informative (and quick) overview of the prognosis and treatment options for head and neck cancer. The next post will discuss a hypothetical cancer patient and walk you through the process of diagnosis, staging, and treatment for him.