Head and Neck Cancer

Head and Neck Cancer

It is the abnormal growth of cells in different parts of the head and neck including the mouth, throat, salivary glands, nose, sinuses and the lymph nodes. And even though the cancer types are different, the form of treatment given to them is the same, therefore they can be considered as one entity.

In India, Head and neck cancers are one of the most common cancers and account for about 18% of all diagnosed cases of cancer, with an overall five year survival rate of 70%.

What Are the Symptoms of head and neck Cancer?

Because this group comprises of different sites, the exact symptoms you develop will depend on the site of the cancer, but some common symptoms that all patients can develop include:

  • Non healing ulcer in mouth/ tongue
  • Bleeding from mouth
  • Loosening of teeth
  • Difficulty in swallowing
  • Changes in voice or hoarseness of voice
  • Pain or swelling in any of the regions mentioned above
  • Persistent bad breath
  • Unexplained swelling of face

If you have developed any of these symptoms and you are worried, then you should definitely see your doctor at the earliest.

What causes head and neck cancer?

Although an exact cause for the development of head and neck cancer cannot be pointed out, there have been several risk factors associated with increased chances of developing head and neck cancer. These include:

  • Tobacco consumption – is by far one of the biggest risk factors for the development of head and neck cancers, including cancer of the oral cavity, oropharynx and larynx. It is the cause for about 75% of all head and neck cancers diagnosed. Tobacco can be consumed in two major forms – smoked or smokeless. Smokeless involves tobacco chewing in form of pan masala, khaini and sniffing of tobacco.
  • Alcohol consumption – is the second biggest risk factor for the development of head and neck cancer, and in combination with tobacco smoking, the risk is multiplied several fold.
  • Human Papilloma Virus – infection with this cancer causing virus is said to increase the risk of oropharyngeal cancers involving the tonsils and base of the tongue.
  • Cancers of the head and neck are four times more common in males than in females.
  • Age over 40 is another identified risk factor for the development of head and neck cancer.
  • Cancers of the oral cavity have been linked to poor oral hygiene.
  • Increased consumption of preserved and salted foods have shown to increase the risk of nasopharyngeal cancer.

What tests are used to diagnose head and neck cancer?

Diagnosis of head and neck cancers are done through evaluation of the patient’s medical history, a complete physical examination and diagnostic investigations. The tests performed may depend on the symptoms that the patient complains of. But the most common investigations performed for this group of cancers include:

  • Imaging   - such as X-ray, CT or MRI, which will help your doctor visualize the different parts of your head and neck and, identify the exact location and size of the tumor, as well as assess the spread of cancer to adjacent tissue.
  • Biopsy – a sample of tissue is taken from the tumor in form of a punch biopsy or if the tumor is very small then a complete excision may be performed.

What is the treatment for head and neck cancer?

The most important factor upon which the treatment modality depends on is the staging or extent of the head and neck cancer. It is determined by the size of the cancer which tells about the local extent of tumor. Regional extension refers to spread of the tumor to regional nodes in the neck which is determined by clinical examination and may require a FNAC for confirmation. When the disease spreads to other organs of body like lungs or bones, then it is labeled as Metastatic Disease.

The treatment options available for cancer of the head and neck include:

  • Surgery – which is the mainstay of treatment for head and neck cancers. Surgery entails removal of the main tumor with an adequate margin ensuring no tumor is left behind. This is confirmed with pathologic examination of the specimen during surgery itself (FROZEN SECTION). Along with the main tumor, we also address the nodes in the neck at the same time. This ensures complete treatment.
  • Radiotherapy – is either used in combination with surgery, or alone, when you don’t want to surgically remove the tumor because of the high risk of damage to nerves and vocal cords. Radiation ensures the cancer cells, that are not visible to naked eye, are addressed.
  • Chemotherapy – anti-cancer medication are given intravenously which ensures disease spread systematically is addressed. Many times chemotherapy is given along with radiotherapy to increase the effects of radiotherapy.

Of all these therapies, any one or combination of all or any may be required for the best management of your cancer. And this requires individualized approach. Although treatment is protocolised, it may need to be personalized. And this decision needs to be taken by a team of Surgical Oncologist, Medical Oncologist and Radiation Oncologist.

What is the Prognosis of head and neck cancer?

The outcome of head and neck cancer is dependent on many factors such as the type of cancer, the exact location, the stage of the disease, as well as general health conditions such as your age, level of fitness and medical history

Screening for and prevention of head and neck cancer

Although there are no specific screening methods available for the early detection of head and neck cancers, the development of white plaques anywhere in your oral cavity, should prompt immediate investigation, because they are known to precede the development of cancer of the oral cavity.

Reducing consumption of alcohol, quitting smoking and betel chewing have all shown to reduce the risk of developing head and neck cancers.

Routine inspection of oral cavity is required for early detection. Small complaints like change in character of voice and difficulty in swallowing should not be ignored. Dental hygiene and regular check up is required.