Hi The treatment of squamous cell carcinoma consist of surgery, the goal is to remove the cancerous tumor and some surrounding healthy tissue during an operation. Types of surgery for head and neck cancer include: Laser technology. This may be used to treat an early-stage tumor, especially if it was found in the larynx. Excision. This is an operation to remove the cancerous tumor and some surrounding healthy tissue, known as a margin. Lymph node dissection or neck dissection. If the doctor suspects the cancer has spread, the doctor may remove lymph nodes in the neck. This may cause stiffness in the shoulders afterward. This may be done at the same time as an excision. Reconstructive (plastic) surgery. If cancer surgery requires major tissue removal, such as removing the jaw, skin, pharynx, or tongue, reconstructive or plastic surgery may be done to replace the missing tissue. This type of operation helps restore a person’s appearance and the function of the affected area. For example, a prosthodontist may be able to make an artificial dental or facial part to help restore the ability to swallow and speak. A speech pathologist may then be needed to help the patient relearn how to swallow and communicate using new techniques or special equipment. Depending on the location, stage, and type of the cancer, some people may need more than 1 operation. Sometimes, it is not possible to completely remove the cancer, and additional treatments may be necessary. For example, surgery may be followed by radiation therapy, chemotherapy, or both to destroy cancer cells that cannot The most common type of radiation therapy is called external-beam radiation therapy, which is radiation given from a machine outside the body. A specific type of external-beam radiation therapy is intensity-modulated radiation therapy (IMRT). IMRT uses advanced technology to accurately direct the beams of radiation at the tumor. This helps reduce damage to nearby healthy cells, potentially causing fewer side effects. Proton therapy is another type of external-beam radiation therapy that uses protons rather than x-rays. At this time, proton therapy is not a standard treatment option for most types of head and neck cancer. See the Latest Research section for more information. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. Before beginning radiation therapy for any type of head and neck cancer, patients should be examined by an oncologic dentist or oral oncologist. Because radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning treatment. Learn more about dental and oral side effects. People should also receive an evaluation from a speech pathologist who has experience treating people with head and neck cancer. Patients may experience short- and long-term pain or difficulty swallowing, changes in voice because of swelling and scarring, and loss of appetite due to a change in their sense of taste. It is important that patients begin speech and swallowing therapy early, before radiation therapy begins, to help prevent long-term problems with speaking or eating. In addition, radiation therapy to the head and neck may cause redness or skin irritation in the treated area, swelling, dry mouth or thickened saliva from damage to salivary glands, bone pain, nausea, fatigue, mouth sores, and sore throat. Many of these side effects go away soon after treatment has finished. Other side effects may include hearing loss due to a buildup of fluid in the middle ear, a buildup of earwax that dries out because of the radiation therapy’s effect on the ear canal, and fibrosis (scarring). Radiation therapy also may cause a condition called hypothyroidism in which the thyroid gland (located in the neck) slows down and causes the patient to feel tired and sluggish. This may be treated with thyroid hormone replacement medication. Every patient who receives radiation therapy to the neck area should have his or her thyroid function checked regularly. Patients are encouraged to talk with their health care team about what side effects of radiation therapy to expect before treatment begins, including how these side effects can be prevented or managed. Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs given at the same time. The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. For head and neck cancers, treatments that target a tumor protein called epidermal growth factor receptor (EGFR) may be recommended. Researchers have found that drugs that block EGFR help stop or slow the growth of certain types of head and neck cancer. Immunotherapy, also called biologic therapy, is designed to boost the body s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Pembrolizumab (Keytruda) and nivolumab (Opdivo) are 2 immunotherapy drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of people with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) that has not been stopped by platinum-based chemotherapy (see below for information in metastatic cancer and recurrent cancer). Both are immune checkpoint inhibitors that are also approved for the treatment of some people with advanced lung cancer or melanoma. Regards Dr De