The item most closely associated with treatment for this cancer is the radiation mask. Like brain cancer patients HNC patients need to be clipped to a table with their head held steady by a mesh mask to keep them still for the beams of the LINAC machine.
The mask looks grotesque on first viewing and not many of us like being pinned down, but it is a big part of killing those multiplying cancer cells. We kind of make peace with it as you can see from the decorated mask above. Priscilla, Queen of the Desert, with messages of hope and strength in her hair.
In bygone days radiation was even harsher and the masks were clear Perspex, rigid, compared with today’s light mesh contraptions. The image below is of a Perspex mask at the planning stage.
Treatment lasts from 6 to 7 weeks, 5 days a week and continues through public holidays. This is because the doses are fractionated across time, a steady daily dose instead of one giant dose.
The time under the mask each day is short, but patients do a lot when they go to the treatment centre each day. They might see a nurse, a dietitian, a dentist and an oncologist as well as the radiation therapists who do the treatment.
The 10 to 20 minutes each day under the mask is not a painful experience unless you have to wear an uncomfortable tongue depressor. For anxiety and discomfort, people can take some sort of medication but the main thing I think about the radiation is that the time is quite brief. Thank goodness for that.
Many patients, especially those with HPV-related HNC, avoid major surgery and receive most of their treatment by radiation augmented by chemotherapy, usually Cisplatin. Most people have three lots of chemo spread out through their 6- or 7-week regime while some have a lesser amount of weekly chemo. This is much harsher treatment but very effective. The chemo makes the tumour more receptive to radiotherapy, but it also makes the side effects worse.
Non-HPV patients and some with HPV have long surgeries to remove the cancer and reconstruct the head/neck. These surgeries can go on all day and often involve microsurgery which means flaps of tissue are removed from other parts of the body with blood vessels that are joined in the head and neck – surgery with a microscope. After a tongue or jaw surgery you are likely to need a tracheostomy to assist breathing until tissues have healed. This means a long stay in hospital. At least 10 days and often longer.
The surgeries are successful, though, with people who have had part of their jaw replaced by part of the fibula bone in their leg ending up looking perfectly normal. Another common site for a graft of tissue is the forearm.
I have found these treatments gruesome but also hopeful. A horrible process to go through but what a relief to have the cancer removed. Looking back at our stories and the photographs, you wonder how anyone could bear it. However, when you are IN a situation, it is more bearable than people might think. You tend to take one day at a time. The momentum of treatment carries you through and the bad days reduce until some sort of wellbeing and relief is experienced. There might be a new normal, but the worst rigours of treatment are over.
One common factor in terms of surgery is that both non-HPV and HPV patients commonly have the neck dissection where the neck is opened up and a row or rows of lymph nodes are taken. When we’re sewn up again this wound heals quite nicely and disappears into the folds of our necks. Some patients have their scars reviewed and improved but these are a small number.
Another common factor is that many if not most surgical patients have radiation or even chemoradiation to mop up invisible cancer cells after surgery – especially if there was cancer in the lymph nodes.
This information is not to horrify but to inform. From the image to the left you can see that we get through it with a bit of support. HNC can be cured but the treatment is hard and can be less invasive if the cancer is caught earlier. HPV-related head and neck cancer can be prevented in future generations via the HPV vaccine.