Head & Neck Cancer

Symptoms of head and neck cancer vary according to the site of origin of the cancer. Because of this characteristic, patients with H&N cancer often present with advanced diseases - a fact that makes annual cancer screening important in people over 40 years of age, especially if they are addicted to tobacco and/or alcohol. The presence of any of the following, if present for more than four weeks mandates a visit to the Head & Neck surgeon:

• A non-healing sore/ulcer in the mouth/tongue or lip
• A white or red patch on the gums, tongue or lining of the mouth
• Inability to protrude the tongue
• Inability to open the mouth properly
• Swelling of the gums that prevents dentures from fitting properly
• Unusual bleeding, pain or numbness in the mouth or cheek
• Thickening of the cheek
• Loose teeth
• Earache/headache
• Feeling of something getting stuck in the throat/ a sore throat that does not go away
• Slurred speech
• Change in voice/ hoarseness
• Painful and/or difficulty in swallowing
• Difficulty in breathing
• Swelling around and/or under the jaw which may be accompanied by numbness or paralysis of one side of the face Weight loss
• Swelling in the midline of the lower neck which moves with swallowing
• Progressively enlarging lumps in the neck
• Streaking of blood in sputum

If a patient has symptoms suggestive of a head and neck cancer then the doctor will first of all take a detailed history, and ask other relevant questions. After this the patient will undergo a detailed physical examination. In addition to this the following tests may be required to diagnose head and neck cancer:

• Endoscopy
• Biopsy
• Molecular testing of the tumour
• X-ray/barium swallows
• Panoramic radiograph
• Ultrasound
• Computed Tomography Scan (CT Scan)
• Magnetic Resonance Imaging Scan (MRI Scan)
• Positron Emission Tomography–Computed Tomography Scan (PET-CT Scan)

Surgery

The goal of cancer surgery is to remove the tumour with a good margin all around it. Along with this, we also remove the associated lymph nodes. Any surgery on the head and neck region is associated with functional incapacitation with regards to swallowing and speech. Our team of highly skilled surgeons endeavour to remove such tumours with great precision and provide suitable reconstruction to help the patient attain excellent functional outcomes.

The surgeries performed include minimally invasive, endoscopic & open skull base surgeries, and microlaryngoscopic surgery. The department has to its disposal the newest gadgets like laser and nerve monitoring. Additionally, it is equipped with an advanced Da Vinci XI Robot, which is the next-frontier technology for minimally invasive surgery.

Radiotherapy

Radiotherapy (a form of high energy X-rays) is used for treatment of head and neck cancers. Nearly 300 new head & neck cancers patients are treated by the department of Radiation Oncology at Max Saket. The department is very well equipped with advanced technologies having a wonderful team of trained doctors, physicists and radiation technologists.

We were the first facility in the Northern India to acquire Novalis Tx for high precision radiotherapy provided by Intensity Modulated Radiotherapy (IMRT), Image-Guided Radiation Therapy (IGRT) VMAT, SBRT and Stereotactic Radiosurgery/Radiation Therapy (SRS/SRT) routinely. This helps in providing better tumour control and also helps in limiting impact on surrounding normal tissues, thus providing better functional outcomes and quality of life. Ours is also one of the few centres in the country which practices intra-operative brachytherapy and SBRT for recurrent head and neck cancers.

Chemotherapy

Chemotherapy has a huge role to play in the management of head neck cancers. For locally advanced diseases it’s used together with Radiation and leads to improvement in survival. Sometimes, it is given before definitive surgery or radiation (called as Neoadjuvant Chemotherapy) particularly in the management of cancers of voice box (larynx) nasopharyngeal cancers and extensive oral cancers. It also has a huge role to play in the management of patients with more advance diseases not amenable to surgery or radiation therapy.

The Head Neck Cancer Medical Oncology team at Max Institute of Cancer Care is one of the most experienced in the country. They have one of the highest number of patients treated with targeted therapy in the localised stages and targeted therapy, chemotherapy and immunotherapy for advanced stages. Personalised therapy where treatment is modified as per the patient’s stage, fitness, needs and as per the molecular characteristics (particularly in salivary gland cancers) is also done here.

The immense experience of the team, usage of the most modern international treatment protocols and personalised medicine go a long way in ensuring improved outcomes for patients suffering with head neck cancers.

Radionucleotide Therapy

This highly specialized therapy with radioactive compounds is used to evaluate and treat thyroid cancers and also rare neuroendocrine tumours.

At Max Institute of Cancer Care, we provide the most advanced cancer treatments using cutting edge technology, based on International Standards. We firmly believe in delivering quality care, support and reassurance to our patients. Cancer care requires medical professionals from different specialities to execute an individualized patient care plan for best results collectively. Accordingly, the Max Institute of Cancer Care has a Head and Neck DMG (Disease Management Group) led by a dedicated and expert team of doctors who deals with head and neck cancers.

This team includes head and neck surgeons, radiation oncologists, medical oncologists, plastic and reconstructive surgeons, maxillofacial surgeons, radiologists, pathologists, nuclear medicine specialists, speech and swallowing therapists, occupational therapist, nutritionists, prosthodontics, dentists, rehabilitation specialists who provide targeted and personalized treatment for patients with benign and malignant head and neck tumours.

The Team sits together in a Head and Neck Tumor Board meeting and discuss each case in detail to ensure the best treatment is provided to the patient, keeping in mind the specific requirement of each patient. The team meets on a regular interval to analyse treatment and patients' response to the given treatment.

Having experts from all these disciplines ensures that a patient's treatment plan is comprehensive and coordinated, and not just in the treatment phase, but even after the treatment is over, for better recovery and rehabilitation for a smooth life ahead. The treatment involves surgery, chemotherapy, radiation therapy etc.

The treatment plan varies from patient to patient depending on a number of factors like the stage of the tumour, location of the tumour, patient's age, general condition, occupation of the patient etc.

• For early-stage cancer - the treatment is surgery or radiation, further therapy may be considered if other risk factors of cancer coming back are identified in the final histopathology report.
• For locally advanced cancers - the treatment is surgery, radiation with or without chemotherapy.
• For very advanced cancers - where it has spread to vitals structures or spread to other parts of the body, then treatment is not aimed at cure. Lifespan and quality of life can be improved with palliative therapy along with radiation therapy and chemotherapy or immunotherapy depending on the general health of the patient.

Max Institute of Cancer Care believes that each patient and their disease is unique. Hence, our team of Oncology experts prepares a 'personalized treatment plan' based on the discussions in Tumor Board. Tumor Board includes experts from Surgical Oncology, Radiation Oncology, Medical Oncology, Pathology, Imaging and related disciplines; working together to provide the best possible treatment plan. We constantly review and improve our protocols and encourage the participation of our patients as well as caregivers, to understand the disease and its treatment process.

When a patient is suspected with Head & Neck Cancer, the examining clinician evaluates the medical history and performs a detailed physical examination. Other diagnostic tests are performed depending upon the area of suspicion. A biopsy (study of a tissue sample from the suspected area under the microscope) / FNAC is mandatory to confirm the diagnosis of cancer.

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