Medical Oncology for Head and Neck Cancers
Medical oncology is the specialty that is responsible for giving “systemic therapy”. These are medications that go throughout the body, unlike radiation or surgery that only targets a specific area. Systemic therapies for head and neck cancer include chemotherapy and targeted therapy. These therapies are most often used in advanced head and neck cancers. They may be given before or after surgery, and/or before, during or after radiation therapy.
Treatment can be with one medication or with a combination of medications, which is referred to as a regimen. A regimen is like a recipe and your oncology providers choose the recipe of medications that is best for your cancer and follow it during treatment. The regimen tells the provider how much of each medication and how often you will receive it. The head and neck is made up of several areas and cancers in different areas may be treated with different regimens.
Most regimens will include a chemotherapy medication called cisplatin. Other commonly used chemotherapy medications include: carboplatin, 5-FU, docetaxel, and paclitaxel. Cetuximab is a targeted therapy medication that is often used in head and neck cancer treatment. This medication targets the EGFR receptor, which is found on many head and neck cancer cells.
In many cases, chemotherapy is given along with radiation. This is called chemoradiation. The chemotherapy is serving two purposes; to kill the cancer cells and to make them more sensitive to the effects of radiation (called radiosensitization).
The following list includes some of the most common side effects of systemic therapy for head & neck cancers. Remember that the treatment can affect each patient differently, and you may not experience these particular side effects. Talk with your oncologist and health care team about what you can expect from your specific treatment.
- Fatigue is very common with treatment and tends to begin a few weeks into therapy. Fatigue typically resolves slowly over the weeks and months following treatment.
- Nausea and vomiting can occur with many systemic therapies. Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting.
- Peripheral neuropathy is a side effect that is caused by damage to the nerves. It causes a tingling or numbness in the hands and/or feet. Let your care team know if this occurs, as they may need to adjust the dose of your medication.
- Your hair may become thin, brittle, or fall out. This typically starts a few weeks after your first treatment.
- Your appetite may decrease and the taste of things may change. People often report a metallic taste in their mouth or an aversion to foods they used to like. A dietitian can help you manage these changes in the hopes of maintaining your weight during treatment. Although the problem of taste changes typically resolves over time after therapy ends, it can persist for a year or longer.
- Chemotherapy can damage blood cells, leading to low levels of white blood cells, red blood cells, and platelets.
- Targeted therapies have different side effects, which can include skin and nail changes and changes to your hair.
Many of these side effects will resolve in the weeks and months following treatment, but some can persist over time. Talk with your care team about the side effects you are experiencing.