Head and Neck Cancer: After the Diagnosis

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Something to Sink Your Teeth Into

6 min readSep 17, 2015

So you’ve been diagnosed with cancer affecting the head and neck, now what? What does that mean? As the doctor starts explaining your treatment plan and options, you lose focus and struggle to pay attention. You are inundated with facts, future appointments, medical terms, pamphlets. Have to remember simulation date. Wait simulation, what simulation? Your mind becomes nebulous. Meeting with the medical oncologist and then the radiation oncologist. Hold on, how many types of oncologists do I need to see? Appointment with the physical therapist? Wait what? If this is in my mouth, why do I need to meet a physical therapist? Did I hear that correctly? You leave the office feeling lost and confused.

A cancer diagnosis is indubitably stressful, life-altering and overwhelming. Cancer not only affects individuals physically but it also influences us psychologically. And, in the midst of dealing with a diagnosis, you have to struggle with understanding new medical jargon, learning about seemingly foreign treatment modalities and handling myriad appointments with different specialists. A diagnosis can be exhausting! To potentially make the process a little easier, I have provided a basic guide to understanding radiation therapy as it applies to the head and neck and what to expect when receiving head and neck radiation therapy.

So, the first question you may have is: what type of radiation therapy?

Wait what? Yes, believe it or not, radiation treatment is extremely complicated and your tumor stage and grade will affect the type of radiation therapy you will receive.

To over-simplify this, there are three main types of radiation therapy: external beam, brachytherapy (also known as internal beam) and systemic radiation therapy.

External beam

If you are receiving head and neck therapy, you will most likely be receiving external beam radiation. There are multiple types of external beam radiation treatments, but the most common are 3-D conformal radiation therapy, intensity-modulated radiation therapy (IMRT), and proton therapy. Other types of external beam radiation therapy include: image-guided radiation therapy, tomotherapy, stereotactic radio surgery and stereotactic body radiation therapy.

IMRT

Intensity-modulated radiation therapy (IMRT) is well established and has become the hip treatment in the past 10 to 15 years. Basically, before 1995, conventional radiation therapy was the mainstay which involved radiation being delivered through opposing lateral portals. In other words, everything between the portals was treated with the same dosage of radiation. But, now, IMRT has become extremely popular in treating head and neck cancers.

What is great about IMRT is that it is extremely precise, and with IMRT, the doses of radiation delivered to the area vary depending on the site. So, the tumor receives the highest doses, but the other anatomical structures are spared and receive less.

IMRT is planned with a computer-controlled linear accelerator and allows for extreme accuracy. The planning is complicated and involves multiple types of imaging such as MRI’s or CT’s and complex dose calculations. Do you get side effects with IMRT? Yes, unfortunately, but they are reduced in comparison to conventional radiation. And, the side effects are related to the radiation dosage delivered.

Proton Therapy

The coolest kid on the block, though, when it comes to external beam radiation, is proton therapy. In contrast to IMRT which uses X-rays, proton therapy consists of a beam of protons. It is extremely specific and can be used to treat cancers that have not yet spread. Proton therapy is extremely expensive, though, and not offered at many places.

What is fractionation?

Radiation delivery is usually “fractionated,” or spread out, into small doses over a five to six week period during which one receives radiation daily for five days.

Before you receive your radiation, you will be given an appointment for a ‘simulation’ date. The simulation appointment is the treatment planning session during which your radiation treatment is mapped out. This is an extremely important appointment as the dosage and exact location of the radiation that will be delivered are determined at this time.

During the simulation appointment, you will lie on your back and a mesh face mask may be fabricated to maintain your positioning. If a mask is fabricated, you will wear this mask at every appointment.

Since the treatment planning session is completed during the simulation appointment, it is recommended that you visit a dental oncologist prior to the simulation.

Why? The measurements and planning are based on how you present the day of the simulation so any changes in your mouth such as loss of teeth will result in changes in the measurements and planning of the radiation dosage. Additionally, visiting a dental oncologist before receiving radiation therapy to the head and neck is important, as the dentist may recommend that you wear radiation mouth guards to prevent backscatter and help minimize the risk of developing mouth sores. Whether or not you are a candidate for radiation mouth guards will be determined by the dentist. If your dental oncologist fabricates radiation mouth guards for you, you should bring the mouth guards to the simulation appointment as you will wear them during every session.

After Simulation

After the simulation appointment, you will be given an appointment to return for a set-up appointment as well as treatment sessions.

The side effects of radiation therapy include dry mouth (xerostomia), taste alterations, increased risk for dental decay, mucositis, decreased opening of your mouth, and osteoradionecrosis of the jaw.

The side effects of radiation therapy include dry mouth (xerostomia), taste alterations, increased risk for dental decay, mucositis, decreased opening of your mouth, and osteoradionecrosis of the jaw.

Dental treatment such as tooth extraction(s) may be recommended before beginning treatment depending on where you will be receiving radiation and the dosage that will be delivered.

If extractions are recommended, it is ideal to allow 10–14 days of healing time prior to starting radiation therapy.

It is important to visit a dental oncologist before beginning radiation therapy for a thorough dental evaluation. At this evaluation, the dentist will determine if you need any dental treatment prior to beginning radiotherapy. Dental treatment such as tooth extraction(s) may be recommended before beginning treatment depending on where you will be receiving radiation and the dosage that will be delivered. If extractions are recommended, it is ideal to allow 10–14 days of healing time prior to starting radiation therapy.

Wow that was a lot of reading, what’s the bottom line?

It is important to visit a dental oncologist prior to receiving head and neck radiation therapy to help minimize the risks of developing the side effects associated with head and neck radiation therapy.
If you are given radiation mouth guards, remember to bring them to your simulation appointment and leave them there so that you wear them at every radiation treatment session.
If you have a tooth/teeth extracted, you should ideally allow for 10–14 days of healing time prior to starting radiation therapy.
After receiving radiation therapy to the head and neck, be sure to inform your dentist of your radiation history before any invasive dental procedures as they may not be indicated depending on the dosage and location of your radiotherapy.