Reirradition for Head and Neck Cancer

neck cancer hpvA new set of guidelines published by the American College of Radiology suggest that reirradiation for head and neck cancer is the only potential cure for cancer cases where further surgery is not an option. Head and neck cancer usually begins in the squamous cells that line the mucosal surfaces in the head and neck and are normally associated with smoking or chewing tobacco, and alcohol consumptions. Initial neck cancer symptoms and signs include a lump in the neck, or a sore in the mouth or nose that does not heal, a chronic sore throat, huskiness or other persistent change in the voice, and problems swallowing. Not all symptoms arise in all cases however and patients should get any potential metastatic squamous neck cancer symptoms investigated straight away.

What is Head and Neck Cancer?

Treatment for head and neck cancer depends on the location of the tumor as some can be too close to vital structures to operate comfortably. The stage and spread of the cancer will also affect treatment decisions, as will a patient’s general health, age, and quality of life. In some cases the side-effects of cancer treatment may be considered too risky and likely to be of little benefit in extending a patient’s life or improving daily living for them. Early intervention has the best chance of success for most patients, with smaller neck cancer tumors usually easier to remove without damaging the normal anatomy of the neck too profoundly. Avoiding risk factors, such as tobacco and alcohol, after neck cancer diagnosis is vital to improve cancer prognosis. Where a tumor reoccurs in the neck or head it is often in the same location as the initial tumor, which can leave oncologists in a difficult position as neck surgery may then not be possible without extreme risk of damage to surrounding tissues.

Treatment of Head and Neck Cancer

Radiology treatment of neck and head cancers is an option for patients who cannot have the tumor surgically removed, but the complexity of the treatment, particularly in cases where a patient has already undergone neck surgery with irradiation, presents unique challenges to surgeons. The new guidelines from the American College of Radiology specifically advise that tertiary care centers are equipped with a well-resourced oncology team with plentiful experience so as to face the challenges of retreatment.

Retreatment of neck cancer has been shown to improve survival rates overall but patients should undergo careful evaluation before operating again. The use of positron emission tomography (PET), with computed tomography (CT) or magnetic resonance imaging (MRI) is recommended by the panel in order to assess whether metastatic squamous neck cancer has spread to the chest or elsewhere in the body. Most head and neck cancers begin in the cells that line the insides of the mouth, nose, and throat but other types of neck and head cancers occur in glandular cells and are called adenocarcinomas rather than squamous cells carcinomas. The difficulty in diagnosing many of these head and neck cancers early is that the cellular changes are often hidden inside the body and lumps in the neck, or enlarged lymph nodes in the neck are only apparent once the cancer has grown quite large.

Head and Neck Cancer Symptoms

Cancerous growth in the salivary glands may create jaw pain, and squamous cell cancer in the pharynx may lead to ear ache, headaches, and neck pain along with difficulties in breathing and swallowing. Other symptoms of head and neck cancers, which account for around 3-5% of all cancers in the US, include:

  • White or red patches on the gums, tongue, or inside of the mouth
  • Swelling of the mouth or jaw or unusual bleeding or mouth pain
  • Chronic sinus infections, nose bleeds, and headaches
  • Eye pain, tooth ache, dentures no longer fitting properly
  • Chin swelling, numbness in the face or neck
  • Ear ache, ringing in the ears, or hearing loss/change
  • Breathing or speaking difficulties and problems swallowing

Not all of these symptoms are signs of neck or head cancer however, but they should be investigated so as to rule it out as a cause of neck pain. The highest incidence of these types of cancers is in men over the age of fifty, although symptoms of neck cancer in women do not usually vary significantly from symptoms of neck cancer in men. Around 40,000 Americans are diagnosed with head and neck cancer each year, with those that smoke or drink most at risk. Some 85% of head and neck cancers are thought connected to tobacco use, whether smoking or chewing the substance and the cumulative effect of tobacco use and alcohol consumption is bigger than either alone.

Who is at Risk of Neck Cancer?

neck cancer tumor

Neck lumps and cancer - when should you be worried?

Other risk factors for head and neck cancer include radiation, whether from previous x-rays or radiation therapy for cancer or noncancerous conditions. Certain viruses and environmental toxins are also considered risk factors for head and neck cancer, such as wood chips, asbestos, and Human Papilloma Virus (HPV). The popular health drink mate has also been associated with an increased risk in such cancers.

Diagnosing Neck Cancer

Patients diagnosed with head and neck cancer require, therefore, a detailed assessment so as to try to establish any potential contributing factors present and attempt to eradicate these risks where possible. Retreatment of neck and head cancer may include surgical resection and chemotherapy as the usual care strategy, except in cases where more surgery is not an option for a patient. In such a case, the new guidelines are clear that reirradiation is the only possible cure for the disease and is superior to chemotherapy alone. Patients who can still undergo neck surgery to remove a secondary or recurring tumor may also be given radiation therapy to improve their prognosis. Head and neck pain can also be a consequence of neck cancer treatment, especially where cervical spinal nerves have had to be cut during surgery or where lymph tissue has been removed, thus affecting mobility and lymph drainage. Recognizing that a pain in the neck may be more than just tight muscles or stress can mean the difference between radical neck cancer surgery, an inoperable neck tumor, and early intervention with minimal side-effects and risks.


McDonald, M.W., Lawson, J., Garg, M.K., Quon, H., Ridge, J.A., Saba, N., Salama, J.K., Smith, R.V., Yeung, A.R., Yom, S.S., Beitler, J.J., ACR appropriateness criteria® retreatment of recurrent head and neck cancer after prior definitive radiation: Expert panel on radiation oncology-head and neck cancer. International Journal of Radiation Oncology Biology Physics, Volume 80, Issue 5, 1 August 2011, Pages 1292-1298.

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