Management of symptoms and treatment-related toxicities of head and neck cancers

Malignancies of the head and neck can be challenging to manage due to frequent involvement of the mucosal surfaces of the aerodigestive surfaces causing bleeding, airway obstruction, pain, malnutrition, and impaired communication abilities. Toxicity and impairment caused by invasive neoplasms can result in severe morbidity and can significantly affect a patient’s quality and length of life. Radiation therapy is an essential component in the management of head and neck cancer in the definitive, adjuvant, and palliative settings, but likewise can cause severe acute and late morbidity, even after successful treatment. Tumor-related morbidity and treatment-related toxicity are frequent in head and neck cancers due to the many vital organs-at-risk (OARs) within a compact anatomic space—including the serial neural structures (brainstem, spinal cord, brachial plexus), salivary glands (parotid, submandibular), mucosa (oral cavity, oropharynx), pharyngeal constrictors, larynx, major vasculature, endocrine organs (thyroid, pituitary), functional soft tissue, and the mandible. For instance, the rapidly proliferating mucosa of the oral cavity and oropharynx are sensitive to radiation, and together with associated muscles and soft tissues provide crucial functionality for speech, swallowing, and nutritional intake. In the acute term, effects on OARs may be dose-limiting, and result in significant weight loss requiring feeding tube placement or compromised disease control. Late toxicity, including soft tissue fibrosis, chronic feeding tube dependence, and increased stroke and aspiration risk may involve profound quality of life changes and even portend mortality. Due to the potentially serious nature of tumor infiltration, and both acute and late toxicities, efforts must be made to prevent and actively manage these complications. This chapter will summarize the acute and late effects of treatment as well as major principles of management for tumor-related complications.