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Rajiv Gandhi Cancer Institute and Research Centre
New Delhi - 110085
Rajiv Gandhi Cancer Institute and Research Centre
New Delhi - 110085
Person diagnosed with head and Neck cancer should not be disappointed as cure rates over a period of last few decades have improved immensely. Success in cancer therapy is often presented as the probability of individual suffering from cancer to live another 5 years, 10 years or 20 years. Please notice that as we mature our chances of living another 5,10,15,20 years or further falls below 100%. When ever we are talking of 5 years survival post cancer treatment, it should never be compared to an otherwise 100% chance of survival.
1. Do nothing
2. Surgery
3. Radiation + Chemotherapy
4. Surgery + Irradiation
5. Chemotherapy (Only chemotherapy is experimental approach)
For head neck cancer chemotherapy has never been the mainstay of treatment. Its only proven role is along with radiation as a concurrent chemo-radiotherapy approach.
Alternative medicine is not an established modality but still practiced by many. We have no objection to having them considered for cancer patients. The concern is that they will waste time & will later on present with more advanced stage of disease & thus probably no option of cure, only supportive & palliative treatment can be offered.
If nothing is done, these tumors will grow. They will cause local symptoms like difficulty in swallowing, breathing and pain. Swallowing difficulty may require feeding tube placed through nose into the stomach or direct placing the tube surgically into the stomach (gastrostomy). Similarly breathing difficulty requires surgically placing a tube into the trachea bypassing the site of obstruction. Most tumors of the Head & Neck progress slowly. In these cases patients may survive for a period of nine months to a year or more. Patent must ovoid the trap of comparing their initial condition to the condition because of the options we recommend. Initial condition is not going to stay as it was if nothing is done. Chances of five year survival with no treatment is very close to zero. Organ preservation approaches are considered for majority of head neck cancer subsites. Early stage disease where tumor size is small and no lymph node metastasis is present, control rates are excellent irrespective of the treatment modality chosen (radiation versus surgery).
For locally advanced Head & Neck Cancer there are two options. First is surgery followed by radiation or concurrent chemo-radiation (in concurrent chemo-radiation, chemotherapy is given along with radiation treatment). Second option is concurrent chemo-radiation with surgery reserved for residual disease. Benefit of second approach is organ preservation (both anatomy & function) resulting in good quality of life post treatment. Introduction of chemotherapy before surgery or radiotherapy is known as induction chemotherapy. Its role is experimental & situational. Many phase III trials are going on & it will take couple of years to ascertain its role.