Chemotherapy and its Role in Head Neck Cancer

Good health is one of the biggest assets of life and everybody has a deep longing for it but with changing lifestyle, being healthy has become a strenuous task. Ailments like Cancer leave patients highly despondent and their families distressed.

Timely detection of Cancer can improve the cure and survival rates for patients. Treatment options depend on the type of cancer and how advanced it is. Apart from surgery and radiotherapy, Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, one will have chemotherapy and other cancer treatments, depending on the type of cancer you have, if it has spread and where, and if you have other health problems.Chemotherapy can be indicated as the standard therapy for a very limited range of advanced head and neck cancers.

What is Chemotherapy ?

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to kill cancer cells.Chemotherapy is used to treat cancer and lessen the chance for cancer to return, or stop or slow its growth. It also eases the cancer symptoms by shrinking the tumors that are causing pain and other problems.

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly.

Chemotherapy can be employed with other treatment methods:

  • Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant
  • Destroy cancer cells that may remain after treatment with surgery or radiation therapy. This is called adjuvant Adjuvant chemotherapy is most useful in patients who have a high risk of relapse.

WHEN CHEMOTHERAPY IS USED?

For oral or mouth cancer ,induction chemotherapy is used for locally advanced disease which cannot be considered for surgery to shrink the tumor and then perform surgery.

Concurrent chemotherapy and radiation therapy treatment means radiation therapy is given along with weekly chemotherapy. This used for locally advanced stage III &IVa  oropharynx cancer (tonsil and base of tongue) and stage 3 larynx or voice box cancer and for cancer of nasopharynx( area behind nose)

and first-, second-, and third-line chemotherapy is used for metastatic (already spread to lungs, bone etc.)or recurrent disease which cannot be operated.

TYPES

  1. INDUCTION (neoadjuvant) CHEMOTHERAPY:

It is typically given to patients with stage III-IVB disease in order to shrink a primary tumor to reduce its bulkiness in preparation for future surgery or radiation therapy. Decision to treat the patient with induction chemotherapy rather than concurrent chemo-radiation or surgery, radiation, or chemotherapy alone is made by our multidisciplinary tumor board ( A radiation therapist, an ENT surgeon along with best head and neck surgeon in India- Dr. Mudit Aggarwal).

  1. FIRST-LINE CHEMOTHERAPY:
  • It is practised for metastatic or recurrent disease (oral cavity, pharyngeal, and laryngeal cancers) with cancer of Stage IV. It includes the use of single-agent or combination chemotherapy.
  • Platinum-based chemotherapy regimens are preferred if these agents can be tolerated by the patient; if they cannot be tolerated, single agents have been used.
  1. SECOND- AND THIRD-LINE CHEMOTHERAPY
  • It is for metastatic or recurrent disease (oral cavity, pharyngeal, and laryngeal cancers) with Stage IV cancer.
  • Second-line chemotherapy is given after disease progression or recurrence following completion of first-line therapy
  • Third-line therapies are given after disease progression or recurrence following completion of first-line and second-line therapies
  • Second- and third-line regimens are similar to regimens used as first-line therapy but usually offer lower response rates and survival benefits
  • Patients should be treated with platinum-based chemotherapy regimens if they have not previously received a platinum-based drug

METHODS FOR GIVING CHEMOTHERAPY

Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over

Some other common ways include:

  1. Oral

The chemotherapy comes in pills, capsules, or liquids that you swallow

  1. Intravenous (IV)

The chemotherapy goes directly into a vein

  1. Injection

The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly

  1. Intrathecal

The chemotherapy is injected into the space between the layers of tissue that cover the brain and spinal cord

  1. Intraperitoneal (IP)

The chemotherapy goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver

  1. Intra-arterial (IA)

The chemotherapy is injected directly into the artery that leads to the cancer

  1. Topical

The chemotherapy comes in a cream that you rub onto your skin

WHICH CHEMOTHERAPY DRUGS TO BE GIVEN?

There are many different chemotherapy drugs. Dr. Mudit Aggarwal carefully decides which to be included in your treatment plan depends on the basis:

  • The type of cancer you have and how advanced it is
  • Whether you have had chemotherapy before
  • Whether you have other health problems, such as diabetes or heart disease

 

The most common side effect is fatigue, which is feeling exhausted and worn out.

SIDE-EFFECTS OF CHEMOTHERAPY

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.

 

The most common side effect is fatigue, which is feeling exhausted and worn out.

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