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University of Florida Proton Therapy Institute

Since cancers begin in different ways, are located in different parts of the body, and have different ways of spreading, cancer treatments come in several different forms. Some new cancer treatments, like Proton Therapy, eradicate tumors with fewer cancer treatment side effects.

Florida Proton Therapy Cancer Patients
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Head and Neck Cancer

In 2005, approximately 39,000 cases of head and neck cancer were diagnosed, with about 11,000 deaths, making it a relatively uncommon cancer. The majority of head and neck cancers begin in the lining (mucosa) of the mouth, throat and sinuses, and are squamous cell carcinomas. Using tobacco and alcohol increases the risk of developing squamous cell carcinoma in the mouth and throat areas. Other malignancies, such as salivary gland cancers, can also occur, but are rare and the risk factors are not well understood.

Since the anatomy of the head and neck is complex, treatment is determined by the tumor's location, its extent and the medical condition of the patient. The main parts of the head and neck include the oral cavity, oropharynx, nasal cavity, paranasal sinuses, nasopharynx, hypopharynx, and larynx. Squamous cell carcinomas often spread to the lymph nodes in the neck, with the chance of developing lymph node metastases related to the location and extent of initial cancer. Blood-borne metastases to other parts of the body (usually the lungs) are uncommon, and are related mostly to the extent the cancer has spread to the lymph nodes.

The chance of curing a head and neck cancer is relatively good. The two main ways of treatment are radiotherapy and surgery. Small tumors that have not spread to the lymph nodes in the neck (cervical nodes) are usually treated with one method (radiotherapy or surgery). More advanced cancers are usually treated with a combination of radiotherapy and surgery - with or without chemotherapy. Radiotherapy alone, or combined with chemotherapy, is the preferred cancer treatment for squamous cell carcinomas of the oropharynx and nasopharynx, as well as early to medium size cancers of the larynx and hypopharynx. Surgery alone, or combined with radiotherapy, is generally the preferred treatment for cancers of the oral cavity, nasal cavity, and paranasal sinuses, as well as for advanced cancers of the larynx and hypopharynx.

One of the advantages radiotherapy has over surgery is that no tissue is removed, so function and quality of life after treatment may be better. The side effects and potential complications of head and neck radiotherapy may be significant, and include dry mouth, sore throat, difficulty swallowing, and loss of taste. The dry mouth (xerostomia) may be permanent. Many structures may be damaged by radiotherapy, including the jawbone, eyes, and spinal cord. The chance of developing treatment complications depends on the amount of tissue that is irradiated and the radiation dose. Many head and neck cancers may be well treated with conventional radiotherapy, which consists of either high-energy X-rays or electrons. Recent developments, such as intensity modulated radiation therapy (IMRT) may be used to produce a tighter dose distribution, thereby reducing the dose to normal tissues and the risks of treatment side effects and complications.

Proton radiotherapy alone - or combined with conventional radiation treatments - may be employed to reduce the dose to normal tissues even further, and is particularly useful for treating cancers near the skull base (including cancers arising in the nasopharynx, nasal cavity, and paranasal sinuses). Proton therapy may also be used to treat moderate to advanced oropharyngeal malignancies (tonsil and base of tongue) to reduce the dose to the jawbone and salivary glands. This lowers the risk of bone injury and permanent dryness of the mouth.

The University of Florida Department of Radiation Oncology has a 30-year history of clinical research with significant contributions in head and neck cancers. Head and neck cancer is one of the target areas for proton therapy at Florida Proton.

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