Head and neck cancer: why you may need treatment after surgery

Head and neck cancers are a group of cancers that begin inside the mouth, sinuses, throat, and other surfaces inside the head and neck. Like other cancers, these begin when normal cells undergo mutations and begin to grow and divide uncontrollably. This type of cancer most often begins with mutations to cells called squamous cells, and most head and neck cancers are a type of cancer called squamous cell carcinoma.

You may see head and neck cancers referred to as head and neck squamous cell carcinoma (HNSCC) or squamous cell carcinoma of the head and neck (SCCHN).

Surgery to remove the primary tumor is the preferred treatment approach for this type of cancer whenever possible.

However, surgery is often used in combination with other therapies, either before or after treatment, or both. Many people begin treatment for head and neck cancer therapies to help shrink a tumor and make it easier to remove. In many cases, a healthcare team will recommend a person receive additional therapies following surgery.

Why you may need additional treatment after surgery

When a tumor is removed with surgery, the goal is to remove a small margin of healthy tissue around the tumor, to ensure that all cancer cells were removed. However, this may not always be possible, and some cancer cells can remain. This can be cells near where the primary tumor was removed or micrometastasis, which are small clusters of cancer cells that have spread beyond the primary tumor but are too few in number to be detected with screenings.

Even small numbers of cancer cells that remain in the body can form new tumors and cause a cancer to return.

After surgery, a healthcare team may recommend additional therapy to lower the risk of the cancer recurring. This is known as adjuvant therapy. If you or a loved one received treatment before surgery, you may have encountered the term neoadjuvant therapy, which refers to therapies used to shrink tumors.

Adjuvant therapy is a recommended part of treatment for many cancers, including many cases of head and neck cancer.

Different therapies can be used as adjuvant therapy

Like other aspects of treating head and neck cancer, adjuvant therapy will vary from person to person. The recommendation to use adjuvant therapy and what therapy to use will depend on numerous factors about the cancer and the person being treated. These factors include:

• The type of cancer
• The location
• The result of the surgery (was the tumor removed completely, was a margin of healthy tissue removed)
• How the person being treated has responded to previous treatments (for example, side effects and recovery)
• The biology and genetics of the cancer
• The overall health of the person being treated
• The personal preferences of the person being treated

Based on these and other factors, a healthcare team may recommend adjuvant therapy that includes one or several treatments.

Radiation therapy

Radiation has been a mainstay of adjuvant therapy for head and neck cancers. Also called radiotherapy, this involves the use of high-energy radiation that can kill cancer cells and shrink tumors. This can help clean up cancer cells that were missed when a tumor was removed with surgery.

Chemotherapy

Chemotherapy drugs work by stopping cancer cells from growing or having a cytotoxic effect on cancer cells (meaning they kill cancer cells). In head and neck cancer, chemotherapy is often combined with other treatments, mainly radiation therapy and immunotherapy.

Immunotherapy

Options for adjuvant therapies have also expanded in recent years and now include at least one immunotherapy drug. This drug is an immune checkpoint inhibitor. It works by helping the body’s immune system (specifically white blood cells called T cells) identify and destroy cancerous cells. This drug can be combined with radiation and/or chemotherapy. It may also help some people avoid needing chemotherapy after surgery.

What can you do with this information?

People living with cancer are encouraged to take an active role in treatment decisions, and it helps to understand the different treatment options you may discuss with your healthcare team and how these treatments might be used together.

Remember that each case of head and neck cancer is somewhat unique. Your healthcare team will be your best source of information about your diagnosis and your treatment options.