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Head & Neck Oncology
Overview
Head & Neck cancer (H&N cancer) refers to a group of biologically similar cancers that arise in the head and neck region (comprises the lip, oral cavity (mouth), nasal cavity, sinuses, pharynx, larynx (voice box), salivary glands and the thyroid). H&N cancers together ranks sixth amongst all cancers worldwide, and they comprises about 40% of all cancers in South East Asia, including India. Advances made in the last few decades in all the fields of Oncology (surgical, radiation and medical) have made H&N cancer a better understood and better-managed subject today.
Symptoms of H&N cancer vary according to the site of origin of cancer. Initially these may not . 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
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.
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.
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 is the first facility in northern India to acquire Novalis Tx for Intensity Modulated Radiotherapy (IMRT), Image-Guided Radiation Therapy (IGRT), Radiosurgery, Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Stereotactic Radiosurgery/Radiation Therapy (SRS/SRT). Additionally, it is equipped with an advanced Da Vinci XI Robotic System for treating complex conditions like cancer and heart tumour. This is next-frontier technology for minimally invasive surgery. The instrument is equipped with a 3D vision system that bends and rotates faster than the human wrist.
If a patient has symptoms of head and neck cancer, the doctor will take a complete medical history, including signs and symptoms, in addition to this the following tests may be required to diagnose head and neck cancer:
- Physical examination
- 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)
Treatments offered at Max Institute of Cancer Care:
A) Surgery
The goal of treatment when surgery is the main option is cure, which is possible when we can remove the tumour with good margin all around and also remove the lymph nodes.
Wide Excision: Depending on the afflicted area Wide Excision may include a surrounding structure also. For example, in some cases, a rim or segment of the jaw bone may be removed so that there is no compromise on getting a microscopic clean margin.
Partial Laryngectomy: When Surgery Is Inevitable, Partial Laryngectomy is performed in suitable cases. This helps preserve the voice to a great extent.
Neck Dissection: Neck dissection is done so that the appearance and shoulder function is well-preserved.
B) 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 (Brachytherapy).
Chemo-radiation
Many locally advanced H&N cancers are treated with a combination of Radiation and Chemotherapy. This treatment takes advantage of both the modalities of treatment for improving cure rates and conserving the organ affected by the disease. It gives hope of conserving the larynx to allow patients 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. Chemotherapy may be administered as:
- Neoadjuvant chemotherapy – before definitive treatment (surgery)
- Adjuvant chemotherapy – following surgery
- Chemo-radiotherapy – with radiotherapy
- Palliative chemotherapy – in an advanced setting
Head & Neck Oncology explained
Head & Neck Oncology explained
Dr. Manisha Arora
Senior Consultant - Department of Obstetrics & Gynaecology Obstetrics And Gynaecology
Tumor Board Timings
Head and Neck Oncology - Tuesday 12:00 pm - 1:00 pm
Central Tumour Board - Monday 8:30 - 9:30 AM
Central Tumour Board - Friday 8:30 - 9:30 AM
Head and Neck Oncology - Tuesday 12:00 pm - 1:00 pm
Central Tumour Board - Monday 8:30 - 9:30 AM
Central Tumour Board - Friday 8:30 - 9:30 AM
Gastrointestinal & HPB Oncology & Head &Neck - Friday 4:00 pm - 5:00 pm
Gastrointestinal & HPB Oncology & Head &Neck - Friday 4:00 pm - 5:00 pm
Head and Neck Oncology - Friday 4:00pm – 4:30pm
Central Tumor Board - Monday & Thursday 8:30am-9:30am
Virtual Tumour Board PAN INDIA - Wednesday 3:00 PM - 4:00 pm
Virtual Tumour Board PAN INDIA - Saturday 9:00 AM - 12:00 AM
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Our Medical Experts
Max Healthcare is home to 2500+ eminent doctors in the world, most of whom are pioneers in their respective fields. Additionally, they are renowned for developing innovative and revolutionary clinical procedures.
