Head and Neck Cancer
Head and neck cancers begin in mouth (oral cavity), nasal cavity (passage behind the nose), paranasal sinuses (spaces around the nose), salivary glands (glands that make saliva), throat (pharynx), and voice box (larynx). There are several treatment options available such as Surgery (tumour removal), Radiation Therapy, Targeted Therapy, Immunotherapy, Chemotherapy, Restoration of swallowing, eating and speaking functions, and Plastic surgery and speech therapy after surgical removal of head and neck tumours.
Signs and Symptoms
Each type of head and neck cancer may be associated with specific type of symptoms. Please consult neck surgeon if you notice the following symptoms:
Head and neck cancer symptoms include:
- a ulcer in the mouth that does not heal or that bleeds on touch
- a persistent red or white patch in the mouth
- inability to open the mouth completely (sub mucous fibrosis ) have high risk of development of cancer
- multiple episodes of bleeding from nose, nasal congestion, or chronic sinus infections that do not respond to treatment
- a lump or swelling in the neck
- persistent sore throat not responding to treatment
- persistent hoarseness or a change in the voice(slurring of speech)
- persistent pain in the neck, throat, or ears
- blood in the sputum
- difficulty chewing, swallowing, or moving the jaws or tongue
- numbness in the tongue or other areas
- loosening of teeth
- dentures that no longer fit
Causes of Head and neck cancer
In India, most common type of head and neck cancer (H & N) seen is mouth and oral cancer. An increased consumption of tobacco in the form of jarda, ghutka, different forms of smokeless tobacco as well as betel nut with or without paan is the major risk factor for causing mouth cancer. It is often observed that several people have the habit of keeping tobacco quid against the cheek and gums, which has led to serious cancer cases of gums, cheeks, and inner side of cheeks.
Common symptoms are:
- Alcohol consumption
- Tobacco chewing
- Cigar smoking
- Exposure to textile fibers
- Poor dental and oral hygiene
- constant irritation of the gums or cheek by sharp teeth or dentures
- poor nutrition,
- infections due to the human papilloma virus (HPV)
Treatment depends on the stage of cancer:
For early cancer with size <4cm without spread to lymph glands in the neck, the treatment is surgery , radiation is added if other risk factors of cancer coming back are identified in the final histopathology report.
For locally advanced cancers size >4 cm or involving adjoining structures or spread to lymph glands in the neck,the treatment is surgery, radiation with or without chemotherapy.
For very advanced cancers where it has spread near brain or involving vitals structures or spread to other parts of the body, then treatment is not aimed at cure. Life span and quality of life can be improved with palliative radiation therapy+ chemotherapy or immunotherapy depending on the general health of the patient.
The overall focus is to improve patient’s quality of life and preserving functions such as swallowing, speech, taste and hearing. If these cancers are diagnosed early they are curable. The three modalities of head and neck cancer are Surgery, Chemotherapy and Radiation Therapy. Surgery/ or Radiotherapy are the primary modalities while Chemotherapy is used as adjuvant/adjunct treatment. However, the treatment plan may vary from patient to patient depending upon stage of tumour, location of tumour, patient’s age, general condition and occupation of patient.
- Surgery – When surgery is the main option for cure, the whole tumour and the lymph nodes are removed. Depending on the afflicted area, a Wide Excision is done like in some cases, a rim or segment of jaw may be removed so that there is no compromise in getting a microscopic clean margin. We are equipped with advanced minimally invasive endoscopic instrumentation (Co2 laser with microscope for vocal cord surgery, Da Vinci Robot for TORS (trans oral robotic surgery ) for early tonsil and base of tongue cancers .This sophisticated method of treatment preserves the organ function, reduces the hospital stay as well as side effects of open surgery.
- Radiation Therapy – Entails use of high energy X-rays to kill cancer cells. The source of radiation may be from a machine outside the body (external beam radiotherapy) or from radioactive materials inserted into the involved organ.
- Neck Dissection – H & N Cancers generally spread to lymph glands in the neck. Even if the neck glands are not involved, these might have to be removed for control of cancer. Today, selective or a modified neck dissection is done so that the appearance and shoulder function are well preserved. It, however, causes some swelling of the face which comes down in 2-3 months, more so in patients undergoing post surgery radiation therapy.
- Chemo-Radiation: Many locally advanced H & N Cancer are treated with combination of Radiation and Chemotherapy. This treatment takes advantage of both the modalities of treatment for improving the cure rates and conserving the organ affected by the disease. It gives hope of conserving larynx to allow patient to have near normal speech and swallowing.
- Chemotherapy: Many patients with H & N Cancer will require chemotherapy or biological therapy (includes monoclonal antibodies). A combination of drugs is usually used. The Medical Oncologist will plan therapy according to your individual case.
Chemotherapy may be administered as:
- Neoadjuvant chemotherapy – prior to definitive treatment (surgery)
- Adjuvant chemotherapy – following surgery
- Chemo-radiotherapy – with radiotherapy
- Palliative chemotherapy – in advanced setting
Chemotherapy is intended to:
- Decrease the chances of recurrence following surgery
- Shrink cancer before surgery if it is large to downstage the cancer
- Control the disease when it has spread to the other areas of body
It slows the growth of cancer cells or kills them. Chemotherapy is given in cycles spread over a few weeks or months. It is usually administered in the day care area of the hospital. You will be required to undergo frequent physical examinations and blood tests to ensure everything is going well.