Head and Neck Cancer

Overview of Advances in Head and Neck Cancer

Journal of Clinical Oncology, October 2015

*This issue focuses on H&N Cancers, 16 articles

HPV + Cancer – has different clinical features, different molecular features have different therapeutic regimens

Virus specific cancer prevention

HPV+ has better overall prognosis, regimens may not need to be as intense

Neck dissection – a surgical procedure for control of neck lymph node metastasis

Surgery and XRT are primary modalities for mgmt. of early and regionally advanced head and neck squamous cell cancer

Immunotherapy may play future role in both HPV+ and HPV- cancers

Neglected areas: Survivorship, QOL, supportive care.

                Currently greater than 60% have unmet needs

Help for Speech and Swallowing Difficulties After Head and Neck Cancer
COPING, March/April 2015

• Base of tongue and throat (pharynx) tumors can hinder swallowing.
• Larynx cancer has potential for swallow issues
• Surgery to lips or tongue can affect oral stage of swallow.
• Nasal regurgitation when eating or drinking a concern after treatment for tumors on roof of mouth
• Radiation therapy directed at head and neck area can produce both short-term and long-term changes in swallow function.
• Effects of chemo on swallow tend to be short-term.

Good oral hygiene is important when threat of aspiration exists.

Survivorship:  American Cancer Society Survivorship Care Guidelines for Head and Neck Cancer

Summary of Potential Long-Term and Late Effects of Head and Neck Cancer and its Treatment

Surgery:

• Long-Term Effects:
• Xerostomia
• Dysphagia
• Oral Infections
• Trismus
• Late Effects:
• Lymphedema
• Neuropathy

Radiation:

• Long-Term Effects:
• Xerostomia
• Dysphagia
• Trismus
• Oral infections
• Radiation dermatitis
• Lymphedema
• Late Effects
• Xerostomia
• Dysphagia
• Dysarthria
• Trismus
• Altered or loss of taste
• Lymphedema
• Osteonecrosis

Chemotherapy:

• Long-Term Effects
• Weight gain, abdominal obesity  *Diet and Exercise
• Fatigue/Decreased activity
• Anemia
• vertigo
• Late Effects:
• Osteoporosis
• Metabolic syndrome
• Cardiovascular disease
• Diabetes
• Increased cholesterol
• Increased fat mass and decreased lean muscle mass

Additional Comments:

• Are there any psychosocial barriers to swallow recovery in survivors
• Be sure to assess dental status after treatment, esp denture fittings, hygiene, how to avoid cavities - encourage regular dental visits
• Monitor for developing or worsening GERD - prevents healing of irradiated tissue and may increase risk of recurrence or SPC (*PPI, antacids)
• Fatigue - consider also anemia, thyroid dysfunction, cardiac dysfunction, depression/anxiety
• New or ongoing financial challenges that interfere with nutrition