Therapies to shrink head and neck cancer before surgery

Surgery is one of the main treatments for head and neck cancers. In some cases, surgery may be the primary treatment. In many cases, it will be part of a treatment plan that combines several types of therapy. For example, additional therapies may be used before surgery to make tumors easier to remove and improve the chances of success for surgery. This approach is called neoadjuvant therapy.

If you or a loved one has been diagnosed with head and neck cancer, below is an overview of this approach to treatment and how it can fit into a treatment plan.

What is head and neck cancer?

The term "head and neck cancer" can sometimes be confusing because it includes some cancers that occur in the head and neck, but not others.

"Head and neck cancer" refers to cancers that begin in the nose, sinuses, mouth, and other areas in and around the head and neck. Cancers in the esophagus are not included in this category, but cancers in the throat are. Cancers of the brain, eye, thyroid gland, and skin cancers are also considered separate categories.

Most head and neck cancers are squamous cell carcinomas, cancers that begin in the squamous cells that line passages and hollow organs throughout the body.

When is surgery used to treat head and neck cancer?

It’s important to remember that there is no best treatment for all head and neck cancers, only the treatment that is right for an individual person. But surgery is commonly used to treat head and neck cancers, especially early-stage cancers and locally advanced cancers (cancers that have spread into nearby tissues or lymph nodes but have not metastasized).

The decision to treat with surgery will depend on multiple factors, including the type of cancer, the size of the tumor, the location, and if the cancer has spread. It will also depend on the age, overall health, and preferences of the person being treated.

What therapies can be used to shrink tumors before surgery?

Like many aspects of cancer treatment, neoadjuvant therapy for head and neck cancers has evolved significantly over the past decade. Chemotherapy and radiation therapy (sometimes used in combination) remain important components of treatment. Newer approaches such as immunotherapy and targeted therapies are increasingly being used or studied to help shrink tumors before surgery.

Neoadjuvant therapies for head and neck cancer:

• Chemotherapy. Drugs or combinations of drugs that destroy cancer cells or stop cancer cells from growing. Chemotherapy with immunotherapy is a newer approach to neoadjuvant therapy.
• Immunotherapy. Immunotherapy drugs do not act on cancer cells directly but help the immune system recognize and attack cancer cells. Immune checkpoint inhibitors are a type of immunotherapy used in the treatment of head and neck cancers. Immune checkpoint inhibitors work by blocking immune checkpoints, proteins that cancer cells use to evade the immune system.
• Radiation therapy. The use of high-energy radiation to target specific tumors and destroy cancer cells. Radiation may be delivered as a beam aimed at a tumor using a machine, or as a small piece of radioactive material placed on, inside, or as close to a tumor as possible.
• Targeted therapy. Drugs that target specific molecules or processes that cancer cells need to grow and spread.

Some treatments may also be used as adjuvant therapy (treatment given after surgery) to help kill off any cancer cells that were not removed and to prevent the cancer from recurring.

It's important to remember that treatment for head and neck cancer is different for everyone, and everyone's treatment plan is somewhat unique. Your best source of information will always be your healthcare provider.