Improvements in diagnosis and local management, as well as targeted therapy, have led to improvements in quality of life and survival for people with<unk> . After a histologic diagnosis has been established and tumor extent determined, the selection of appropriate treatment for a specific cancer depends on a complex array of variables, including tumor site, relative morbidity of various treatment options, concomitant health problems, social and logistic factors, previous primary tumors, and the person's preference. Treatment planning generally requires a multidisciplinary approach involving specialist surgeons and medical and radiation oncologists. Surgical resection and radiation therapy are the mainstays of treatment for most<unk> s and remain the standard of care in most cases. For small primary cancers without regional metastases (stage I or II), wide surgical excision alone or curative radiation therapy alone is used. More extensive primary tumors, or those with regional metastases (stage III or IV), planned combinations of pre- or postoperative radiation and complete surgical excision are generally used. More recently, as historical survival and control rates are recognized as less than satisfactory, there has been an emphasis on the use of various induction or concomitant chemotherapy regimens. Surgery Surgery as a treatment is frequently used in most types of<unk> . Usually the goal is to remove the cancerous cells entirely. This can be particularly tricky if the cancer is near the larynx and can result in the person being unable to speak. Surgery is also commonly used to resect (remove) some or all of the cervical lymph nodes to prevent further spread of the disease. CO2 laser surgery is also another form of treatment. Transoral laser microsurgery allows surgeons to remove tumors from the voice box with no external incisions. It also allows access to tumors that are not reachable with robotic surgery. During the surgery, surgeon and pathologist work together to assess the adequacy of excision (“margin status”), minimizing the amount of normal tissue removed or damaged. This technique helps give the person as much speech and swallowing function as possible after surgery. Radiation therapy Radiation mask used in treatment of throat cancer Radiation therapy is the most common form of treatment. There are different forms of radiation therapy, including 3D conformal radiation therapy, intensity-modulated radiation therapy, particle beam therapy and brachytherapy, which are commonly used in the treatments of cancers of the<unk>  and<unk> . Most people with<unk>  who are treated in the United States and Europe are treated with intensity-modulated radiation therapy using high energy photons. At higher doses,<unk>  and<unk>  radiation is associated with thyroid dysfunction and pituitary axis dysfunction. Radiation therapy of<unk> s can also cause acute skin reactions of varying levels of severity, which can be treated and managed with topically applied creams or specialist films. Chemotherapy Chemotherapy in throat cancer is not generally used to cure the cancer as such. Instead, it is used to provide an inhospitable environment for metastases so that they will not establish in other parts of the body. Typical chemotherapy agents are a combination of paclitaxel and carboplatin. Cetuximab is also used in the treatment of throat cancer. Docetaxel-based chemotherapy has shown a very good response in locally advanced<unk> . Docetaxel is the only taxane approved by US FDA for<unk> , in combination with cisplatin and fluorouracil for the induction treatment of inoperable, locally advanced squamous cell carcinoma of the<unk>  and<unk> . While not specifically a chemotherapy, amifostine is often administered intravenously by a chemotherapy clinic prior to IMRT radiotherapy sessions. Amifostine protects the gums and salivary glands from the effects of radiation. There is no evidence that erythropoietin should be routinely given with radiotherapy. Photodynamic therapy Photodynamic therapy may have promise in treating mucosal dysplasia and small<unk>  and<unk>  tumors. Amphinex is giving good results in early clinical trials for treatment of advanced<unk> . Targeted therapy Targeted therapy, according to the National Cancer Institute, is "a type of treatment that uses drugs or other substances, such as monoclonal antibodies, to identify and attack specific cancer cells without harming normal cells." Some targeted therapy used in squamous cell cancers of the<unk>  and<unk>  include cetuximab, bevacizumab and erlotinib. The best quality data are available for cetuximab since the 2006 publication of a randomized clinical trial comparing radiation treatment plus cetuximab versus radiation treatment alone. This study found that concurrent cetuximab and radiotherapy improves survival and locoregional disease control compared to radiotherapy alone, without a substantial increase in side effects, as would be expected with the concurrent chemoradiotherapy, which is the current gold standard treatment for advanced<unk> . Whilst this study is of pivotal significance, interpretation is difficult since cetuximab-radiotherapy was not directly compared to chemoradiotherapy. The results of ongoing studies to clarify the role of cetuximab in this disease are awaited with interest. Another study evaluated the impact of adding cetuximab to conventional chemotherapy (cisplatin) versus cisplatin alone. This study found no improvement in survival or disease-free survival with the addition of cetuximab to the conventional chemotherapy. However, another study which completed in March 2007 found that there was an improvement in survival. A 2010 review concluded that the combination of cetuximab and platin/5-fluorouracil should be considered the current standard first-line regimen. Gendicine is a gene therapy that employs an adenovirus to deliver the tumor suppressor gene p53 to cells. It was approved in China in 2003 for the treatment of<unk>  and<unk>  squamous cell carcinoma. The mutational profile of HPV+ and HPV-<unk>  has been reported, further demonstrating that they are fundamentally distinct diseases. Immunotherapy Immunotherapy is a type of treatment that activates the immune system to fight cancer. One type of immunotherapy, immune checkpoint blockade, binds to and blocks inhibitory signals on immune cells to release their anti-cancer activities. In 2016, the FDA granted accelerated approval to pembrolizumab for the treatment of people with recurrent or metastatic HNSCC with disease progression on or after platinum-containing chemotherapy. Later that year, the FDA approved nivolumab for the treatment of recurrent or metastatic HNSCC with disease progression on or after platinum-based chemotherapy. In 2019, the FDA approved pembrolizumab for the first-line treatment of metastatic or unresectable recurrent HNSCC. Treatment side effects Depending on the treatment used, people with<unk>  may experience the following symptoms and treatment side effects: *Eating problems *Pain associated with lesions *Mucositis *Nephrotoxicity and ototoxicity *Xerostomia *Gastroesophageal reflux *Radiation-induced osteonecrosis of the jaw *Radiation-induced acute skin reactions Psychosocial Programs to support the emotional and social well-being of people who have been diagnosed with<unk>  may be offered. There is no clear evidence on the effectiveness of these interventions or any particular type of psychosocial program or length of time that is the most helpful for those with<unk> .
Head and neck cancer
Laryngeal cancer
Oral cancer
Paranasal sinus and nasal cavity cancer
Oropharyngeal cancer
Hypopharyngeal cancer
Nasal polyp
Nasal glioma