How is Head and Neck Cancer Treated?

This is the eighth page in the Understanding Head and Neck Cancer Guide. This guide was developed by the HealthTree Education Team and was last updated and reviewed on May 22, 2026.

The treatment for head and neck cancer depends on several factors, including the site of the cancer, the stage, HPV status (for oropharyngeal cancer), the genetic features of the tumor, your age, your overall health, and your preferences regarding speech, swallowing, and appearance.

Most people with head and neck cancer are treated with a combination of surgery, radiation therapy, and chemotherapy. Targeted therapies and immunotherapies play an increasingly important role, particularly for recurrent or metastatic disease. Treatment is best directed by a multidisciplinary team that typically includes a head and neck surgeon (an ear, nose, and throat surgeon with specialized training in head and neck oncology), a radiation oncologist, a medical oncologist, a dentist or oral medicine specialist, a speech-language pathologist, a dietitian, and other specialists. Multiple studies have shown that outcomes are better when head and neck cancer is treated at centers experienced in this disease.

Getting a second opinion from another head and neck oncology team is normal and encouraged.

Surgery for head and neck cancer

Surgery is often the primary treatment for early-stage head and neck cancer, particularly cancers of the oral cavity, larynx, and salivary glands. The type of surgery depends on the location and extent of the tumor:

Resection of the primary tumor

The surgeon removes the tumor along with a margin of healthy tissue around it. For small, accessible tumors, this can sometimes be done through the mouth (transoral surgery). For larger or more complex tumors, an open approach through the neck may be needed.

Transoral robotic surgery (TORS) and transoral laser microsurgery (TLM)

These minimally invasive approaches use specialized equipment to remove tumors through the mouth, particularly for cancers of the tonsil, base of the tongue, and voice box. They can shorten recovery and reduce damage to nearby healthy tissue.

Neck dissection

If cancer has spread to lymph nodes in the neck, or if there is a high risk that it might, the surgeon removes lymph nodes from one or both sides of the neck. The extent of the neck dissection depends on the cancer site, the stage, and wherelymph node spread is most likely.

Reconstructive surgery

After larger surgeries, reconstructive techniques are used to restore appearance and function. This may include skin grafts, local tissue flaps, or free flaps (transferring tissue from another part of the body with its blood supply). Reconstruction is essential for maintaining the ability to speak, chew, and swallow after surgery.

Laryngectomy

For some advanced laryngeal or hypopharyngeal cancers, removal of part or all of the voice box (partial or total laryngectomy) may be needed. After a total laryngectomy, breathing is done through a permanent opening in the neck called a stoma, and patients learn new ways of speaking through voice prostheses, electrolarynx devices, or esophageal speech.

Radiation therapy for head and neck cancer

Radiation therapy uses high-energy beams to destroy cancer cells. It is a cornerstone of head and neck cancer treatment, used as the main treatment for some early-stage cancers, in combination with chemotherapy for more advanced disease, and after surgery to lower the risk of recurrence.

External beam radiation therapy

Radiation is delivered from outside the body using techniques such as intensity-modulated radiation therapy (IMRT), which shapes the radiation beams to closely match the tumor while sparing nearby healthy tissue such as the salivary glands and spinal cord.

Proton therapy

Proton therapy uses protons instead of X-rays to deliver radiation. It can sometimes spare more nearby healthy tissue, which may be useful for tumors near critical structures such as the eye or brain. It is not necessary for all patients.

Brachytherapy

Radioactive sources are placed directly into or near the tumor. Brachytherapy is occasionally used for selected head and neck cancers, often in addition to external beam radiation.

Chemotherapy for head and neck cancer

Chemotherapy uses drugs to kill cancer cells throughout the body. In head and neck cancer, chemotherapy is most often used together with radiation (called chemoradiation) for advanced disease, or before surgery and radiation to shrink tumors (induction chemotherapy):

• Platinum-based drugs. Cisplatin is the most commonly used chemotherapy drug for head and neck cancer. Carboplatin is sometimes used as an alternative for patients who cannot tolerate cisplatin.
• Taxanes. Docetaxel (Taxotere) and paclitaxel (Taxol) are used in combination regimens, particularly for induction chemotherapy or recurrent disease.
• 5-fluorouracil (5-FU). Often used in combination with cisplatin.

Chemoradiation

Combining chemotherapy with radiation makes the radiation more effective. Concurrent chemoradiation, usually with cisplatin, is a standard treatment for many locally advanced head and neck cancers.

Induction chemotherapy

In selected cases, chemotherapy is given first to shrink the tumor before definitive treatment with surgery or chemoradiation. This is most often used for very advanced disease, including some nasopharyngeal cancers.

Targeted therapy for head and neck cancer

Targeted therapies are drugs that attack specific proteins or pathways in cancer cells:

EGFR inhibitors

Cetuximab (Erbitux) is an antibody that blocks the epidermal growth factor receptor (EGFR), a protein found in high levels on many head and neck cancer cells. Cetuximab is used in combination with radiation for selected patients with locally advanced head and neck cancer who cannot tolerate cisplatin, and in combination with chemotherapy or immunotherapy for recurrent or metastatic disease.

Targeted therapies for specific genetic changes

For recurrent or metastatic head and neck cancers with specific genetic features, targeted therapies may be considered. Examples include larotrectinib or entrectinib for cancers with NTRK fusions, and other targeted therapies matched to specific molecular findings.

Immunotherapy for head and neck cancer

Immunotherapy helps the immune system find and destroy cancer cells. Its role in head and neck cancer has grown rapidly in recent years:

• Checkpoint inhibitors such as pembrolizumab (Keytruda) and nivolumab (Opdivo). These drugs block proteins (PD-1 or PD-L1) that some cancers use to hide from the immune system. They are approved for recurrent or metastatic head and neck squamous cell carcinoma, and pembrolizumab is also used as a first-line treatment alone or with chemotherapy depending on PD-L1 status. Clinical trials are evaluating their role earlier in treatment, including with chemoradiation.

Treating recurrent and metastatic head and neck cancer

When head and neck cancer returns, treatment depends on the location and timing of recurrence, prior treatments, HPV status, and individual patient factors. Options may include additional surgery, re-irradiation in selected cases, chemotherapy, targeted therapy, immunotherapy, and clinical trials. For some patients with limited recurrence, treatment can still aim for cure. For others, treatment focuses on controlling the cancer, extending life, and maintaining quality of life. Many patients with recurrent or metastatic head and neck cancer live for years with treatment.

Supportive and palliative care for head and neck cancer

Treating the symptoms of cancer and side effects of treatment is called supportive and palliative care. This is an important part of cancer treatment at every stage, not just at the end of life. Head and neck cancer treatment can significantly affect speech, swallowing, taste, saliva production, and appearance, so supportive care is especially important. Palliative care can include:

• Pain management
• Management of treatment-related side effects (such as mouth sores, dry mouth, taste changes, fatigue, skin changes, and difficulty swallowing)
• Speech and swallowing therapy with a speech-language pathologist
• Nutritional support from a registered dietitian, including feeding tube management when needed
• Dental and oral care, including management of dry mouth
• Physical and occupational therapy, particularly for shoulder and neck stiffness after surgery or radiation
• Mental health support and counseling
• Smoking cessation support

There is a common misconception that palliative care is only given at the end of life. Palliative and supportive care can be given at any time during cancer treatment.

Follow-up care after treatment

After head and neck cancer treatment ends, regular follow-up appointments are essential to watch for signs of recurrence, monitor for side effects of treatment, and support recovery of speech and swallowing. Follow-up typically includes physical examinations, endoscopy of the throat, imaging as clinically indicated, and dental care. Thyroid function is monitored after radiation to the neck. Follow-up appointments are frequent in the first two years, when most recurrences happen, and continue at decreasing intervals for at least 5 years.