Head and Neck Cancer is a common form of cancer in India and other developing countries. More than one lakh Head and Neck Cancer cases are diagnosed in India, every year. Head and neck cancer types include ear cancers, nose cancers, throat cancers, tongue cancers, thyroid cancer, oral cancers as well as cancer of the larynx. Typically, the cells lining these organs experience a cancerous growth and affect the entire organ. Most head and neck cancers are squamous cell carcinomas, which are cancerous growths that begin in the flat squamous cells, that form the inner lining of many parts of the head and neck. Invasive squamous cell carcinoma is a tumour that moves into deeper tissues and adenocarcinomas arise in the glandular cells, such as those found in the salivary glands. Alcohol and tobacco are the key etiological factors and their use increases the risk of developing Head and Neck Cancers.
The signs and symptoms vary with the location of the primary site and the stage of the cancer. The early warning signs of head and neck cancer could lead to an early diagnosis and a high probability of better outcome in many cases. For example, hoarseness frequently occurs in the earliest stage of voice box cancers. Persistent sore throat for longer than two weeks is a possible symptom of cancer in the voice box and/or the pharynx. Though not limited to, other symptoms often are:
- Pain and changes in the fit of dentures (if the patient is using one) in case of cancer in the oral cavity
- A non-healing ulcer, difficulty in swallowing or nasal blockage could also be warning signs of potential carcinomas
- Although not an early sign, a neck mass may be the first presenting symptom
- Nasal problems may also indicate possibility of nasopharyngeal cancer
- Red or white patch in the mouth
- Foul mouth odour not explained by hygiene
- Hoarseness or change in voice
- Difficulty in breathing
- Double or weak vision
- Numbness or weakness in the head and neck region
- Pain or difficulty in chewing, swallowing, or moving the jaw or tongue
- Jaw pain
- Blood in the saliva or phlegm, discharged via the mucus into the mouth from respiratory passages
- Loosening of teeth
- Ear pain or infection
Oral cancer is the uncontrolled multiplication of cancerous cells in the mouth and surrounding regions. They are most commonly seen in people who chew tobacco, but it is also seen in smokers. In addition to tobacco, trauma due to sharp teeth and Human Papilloma Virus are emerging as causes of these cancers. This type of cancer may affect the tongue, lips, palate, floor of the mouth, pharynx, minor salivary glands and sinuses. If not treated when the disease is at an early stage, it can potentially be life threatening.
Throat cancer refers to cancerous tumours that develop in the throat. Throat cancer includes cancers of the air pipe, food pipe and those arising from the glands in the neck. Throat cancer includes cancer of the nasopharynx (the upper part of the throat behind the nose), the oropharynx (the middle part of the pharynx) and the hypopharynx (the bottom part of the pharynx). Cancer of the larynx (voice box) may also be included as a type of throat cancer.
Different cancers can develop from each kind of cell in the paranasal sinuses and nasal cavity. The nasal cavity and paranasal sinuses are lined by a layer of mucus-producing tissue with the following cell types: squamous epithelial cells, minor salivary gland cells, nerve cells, infection-fighting cells and blood vessel cells. Symptoms may include nasal blockage, nosebleed, swelling in the eyes and partial or complete loss of vision.
Cancers of the ear usually begin as skin cancers on the outer ear, ear canal or skin around the outer ear. The most common types are squamous cell carcinoma and basal cell carcinoma. If they are neglected, they may grow into the:
- Ear canal
- Middle ear
- Deep into the temporal bone, which consists of the ear canal
- Facial nerve
- Organs for hearing and balance
Head and neck Cancer diagnosis can be done through cancer screening exams. Some of the commonly used diagnostic tests are:
- Physical Examination: During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. The nose, mouth, throat, and tongue are also inspected for abnormalities. Blood and urine tests may be advised to help diagnose cancer.
- Endoscopy: This allows the doctor to examine inside the body via a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is gently inserted through the nose into the throat and down the oesophagus to examine inside the head and neck.
- Biopsy: A biopsy is the removal of a small amount of tissue for examination under a microscope. During this procedure, cells are withdrawn using a thin needle inserted directly into the tumour or lymph node. The cells are examined under a microscope for cancer cells, which is called a cytological examination.
- Molecular testing of tumour: It may be recommended to run laboratory tests on a tumour sample to identify specific genes, proteins, and other factors unique to the tumour. This will determine if the treatment options include a type of treatment called targeted therapy.
- Imaging: Ultrasound, MRI, CT scan or PET-CT scan could be recommended to get detailed images of the affected region.
Head and neck cancer treatment is dependent on the stage of the cancer. While there is a different staging system for each type of head and neck cancer, the doctors use the diagnostic tests to answer the following aspects in the staging system:
- Tumor: How large is the primary tumour and where is it located
- Node: Has the tumour spread to any of the lymph nodes? If so, where and how many
- Metastasis: Has the cancer metastasized to other parts of the body? If so where and how much?
The combined result of the above determines the stage of the cancer basis which a treatment plan is determined for each patient. Many cancers of the head and neck can be overcome, especially if they are detected early. Although eliminating the cancer is the primary goal, preserving the function of the nearby nerves, organs, and tissues is also equally crucial. When planning the treatment, how it might affect a person’s quality of life needs to be considered, such as how a person feels, looks, talks, eats, and breathes.
Multi-disciplinary approach is known to have improved the quality of cancer care and ensure that the patient has access to the best current thinking on cancer management. Surgery or radiation therapy by themselves or a combination of these therapies may be part of the treatment plan.
Here the goal is to remove the cancerous tumour and some surrounding healthy tissue. Types of surgery for head and neck cancer include:
- Laser surgery: This is commonly used to treat an early-stage tumour, especially if it is found in the larynx.
- Excision: This is a surgery to remove the cancerous tumour and some surrounding healthy tissue, known as a margin.
- Lymph node dissection or neck dissection: If it is suspected that the cancer has spread, removal of lymph nodes in the neck maybe necessary. This could be done at the same time as an excision.
- Reconstructive (plastic) surgery: If cancer surgery requires major tissue removal, such as jaw, skin, pharynx, or tongue removal, reconstructive or plastic surgery may be done to replace the missing tissue. This helps restore a person’s appearance and the function of the affected area.
Depending on the cancer staging, some people may need multiple surgeries. Sometimes, it is not possible to completely remove the cancer and it may have to be followed by radiation and/or chemotherapy.
Chemotherapy for Head and Neck Cancer
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is also given in combination with radiotherapy and before surgery to shrink the tumour and make it easier to remove, sometimes chemotherapy is given to relieve symptoms and improve quality of life.
Radiotherapy for Head and Neck Cancer
Radiation Therapy uses high-energy particles or waves (like x-rays, gamma rays, electron beams) to destroy or damage cancer cells. For advanced head and neck cancer radiation therapies are used along with chemotherapy and surgery. Radiation therapies are painless and are aimed at destroying cancer cells in a specific area. It can either come from a high energy x-ray machine or from a small source of radioactive material placed close to or on the tumour.
Targeted Therapy for Head and Neck Cancer
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer’s growth and survival. This treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.
Recent findings show that all tumours do not have the same targets. To find the most effective treatment, tests are done to identify the genes, proteins, and other factors in the tumour. This helps identify the most effective treatment whenever possible.
For head and neck cancers, treatments that target a tumour protein called epidermal growth factor receptor (EGFR) may be recommended. Researchers have found that drugs that block EGFR help stop or slow the growth of certain types of head and neck cancer.
Immunotherapy for Head and Neck Cancer
Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defences to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.