What to Expect

Head and Neck Cancer

Fighting cancer is challenging. To help you prepare for the fight, here is a brief outline of what you can expect during treatment with radiotherapy or radiosurgery. The details of some of the steps may differ, depending on your particular case.

Step 1: The Consultation

First, you'll meet with your doctor, a radiation oncologist, to discuss your treatment. The oncologist may examine you with a fiberscope — a flexible device that uses fiber optics to look at internal organs. Your oncologist will tell you what type of radiation therapy he or she recommends, whether it will be given alone or in conjunction with other treatment methods, what the specific goals of treatment are, and what side effects you may experience. If you have more than one treatment option from which to choose, your doctor will give you the information you need to make a decision.

In addition, you may meet with an ENT (ear, nose, and throat) specialist — also called an otolaryngologist — to learn how to manage side effects and to discuss other issues. You may also have a consultation with a medical oncologist to discuss chemotherapy to be given along with the radiation therapy — a treatment approach called concomitant chemotherapy.

The consultation is an excellent opportunity for you to ask your oncologist whatever questions you may have. Click here for a list of common questions.

Step 2: Imaging

In order for the radiation oncologist to design your treatment, the exact size and location of the tumor must first be determined. This is done typically by using scans to create a detailed 3-D image of the treatment area. The scans usually include a CT scan, but they can also include an MRI, PET scan, and ultrasound scan. Your oncologist can rotate the image on his computer screen in order to view the tumor from every angle.

It is very important that the position in which you are scanned is reproduced at the time of treatment. Sometimes temporary skin marks or even tiny tattoos (about the size of a freckle) are made on your body to help the radiation therapist (RT) position you correctly each day for treatment. Depending on the location of your cancer, the RT may construct a face mask, shoulder mold, or "bite block" for your tongue, to make it easier for you to keep those parts of your body still during treatment.

Step 3: Treatment Planning

After imaging is complete, the radiation oncologist will meet with the medical physicist and dosimetrist to design the details of your treatment plan. After taking into account the location and type of cancer you have, your medical history, lab tests, and other factors, your treatment team will use sophisticated computer software to help them determine the exact area to be treated, the total amount of radiation that will be delivered to the tumor, the desired angles for the radiation beams, how many treatments you should have, and what kind of machine to use.

Step 4: Getting Positioned for Treatment

The radiation therapist will help you get positioned on the treatment "couch" — a platform designed to work with the radiation machine. If a face mask or shoulder mold has been made for you, the RT will place it on you. Depending on the type of machine you’re treated on, your treatment team may take a scan immediately prior to treatment, while you are on the couch. The purpose of this new scan is to show if the tumor has changed in size or position since the first one was created during imaging. If it reveals any changes, the RT will make the necessary adjustments to the position of the couch to ensure that you are properly aligned for treatment.

Step 5: Treatment Begins

The radiation is delivered by a machine called a linear accelerator, or linac. Most linacs have a gantry, which is the head of the machine. The gantry houses a device called a multi-leaf collimator that "shapes" the radiation beam so it conforms to the shape of the tumor from any given angle. During your treatment, the gantry will move around you to deliver the radiation. The radiation beam is not visible to the eye, so you will not see it when it leaves the gantry.

Your first two treatments may take 15 minutes or more, as your radiation therapist helps you get into position and takes images to verify that your setup on the machine is the same as the treatment plan. Subsequent treatments, however, are often shorter. In fact, some treatments — from entering the waiting room to leaving the clinic — can take as little as 12 to 30 minutes.

Step 6: Post-Treatment and Follow-Ups

You may experience some side effects from radiotherapy. If you do, they might not begin until after several sessions because the effects of radiation treatment are cumulative. Talk to your radiation oncologist before and during treatment if you have any questions or experience discomfort. Click here to learn more about possible side effects.

After your treatment has ended, your radiation oncologist will recommend a schedule for periodic checkups to monitor the results. Typically, the first checkup is given in one to three months, and subsequent checkups are scheduled at six-month intervals, but yours may be more or less frequent, depending on your situation. If sypmtoms or clinical circumstances suggest a recurrence, diagnostic tests such as blood tests, ultrasound, CT scans, or MRIs may be needed.