Management and prevention of complications during initial treatment of head and neck cancer
- Thomas Galloway, MD
Thomas Galloway, MD
- Assistant Professor
- Department of Radiation Oncology
- Fox Chase Cancer Center
- Robert J Amdur, MD
Robert J Amdur, MD
- Department of Radiation Oncology
- University of Florida College of Medicine
- Section Editors
- Marshall R Posner, MD
Marshall R Posner, MD
- Section Editor — Cancer of the Head and Neck
- Professor of Gene and Cell Medicine
- The Tisch Cancer Institute
- Icahn School of Medicine at Mount Sinai
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Daniel G Deschler, MD, FACS
Daniel G Deschler, MD, FACS
- Section Editor — Otorhinolaryngology
- Professor of Otology and Laryngology
- Harvard Medical School
Toxicity from cancer therapy is classified as acute or late based upon its temporal relationship to treatment. Acute toxicity develops during or shortly after the completion of treatment and is usually temporary. Late toxicity presents months to years after the completion of treatment and is often permanent. The term "complication" is used for a treatment toxicity that causes an important medical problem.
This topic will review the care of patients with head and neck cancer during their initial therapy, both to treat acute toxicity and to prevent late complications. The management of late complications is discussed separately. (See "Management of late complications of head and neck cancer and its treatment".)
Spectrum of issues — Cancers of the upper aerodigestive tract are in close proximity to organs vital to a patient's quality of life (eg, tongue, larynx, mandible), and they often emanate from such organs. The involvement of these structures with cancer and the steps needed to eradicate the malignancy can cause a wide spectrum of toxicities.
The most basic toxicities are the impairment in the ability to breathe, communicate, and maintain an adequate oral intake. Oral intake is compromised by swallowing problems (dysphagia and odynophagia), poor taste (dysgeusia), trismus, xerostomia, and mucositis. Respiration and communication can be compromised by bulky tumors, neuromuscular impairment secondary to tumor growth, or an edematous pharynx and/or larynx. In addition to toxicity limiting the ability to speak, eat, and breathe, patients can experience cutaneous toxicity from both radiation and targeted therapy (cetuximab), neurotoxicity from both commonly used chemotherapy agents (cisplatin) and radiation, and dental complications from the effects of radiation dose to the mandible/maxilla and salivary glands.
The treatment of these tumors is complex and best handled by a coordinated team involving surgeons, radiation oncologists, medical oncologists, dentists, oral surgeons, speech pathologists, physical/occupational therapists, nutritionists, and skilled nurses.
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- GENERAL PRINCIPLES
- Spectrum of issues
- - Surgery
- - Radiation therapy
- - Chemotherapy
- Smoking cessation
- SALIVARY GLAND DAMAGE AND XEROSTOMIA
- Acute injury
- - Highly conformal RT technique
- - Amifostine
- - Submandibular gland transfer
- - Pilocarpine
- - Bethanechol
- - Hyperbaric oxygen
- - Acupuncture
- Management and prevention
- - Doxepin rinse
- - "Miracle" mouthwashes
- - Mucoadhesive hydrogel
- - Benzydamine
- - Palifermin
- Laser therapy
- Other approaches
- DENTAL ISSUES
- RADIATION DERMATITIS
- OROFACIAL PAIN
- WEIGHT LOSS AND MALNUTRITION
- ANXIETY AND DEPRESSION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS