• Oral (Mouth) Cancer
• Laryngeal Cancer
• Pharyngeal (Throat) Cancer
• Thyroid Cancer
• Nasal Cavity & Paranasal Sinus Cancers
• Parathyroid Tumors
• Salivary Gland Tumours
• Skin cancers

• swelling in the neck
• a non-healing ulcer in the mouth
• a red or white patch in the mouth that doesn't go away
• persistent hoarseness or a change in the voice
• 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
• frequent nosebleeds, ongoing nasal congestion, or chronic sinus infections that do not respond to treatment

Risk involved

• Tobacco and Alcohol Use
• HPV infection
• may be genetic

Prevention

• Lifestyle changes- e.g. Cessation of smoking and tobacco chewing
• Periodic check up in case of symptoms

Doctors may ask the patient for many tests to find or diagnose cancer. They also do tests to see if cancer has spread to another body parts from where it started.

For almost all types of cancer, a biopsy is one of the only sure ways for the doctor to learn if an area of the body has cancer. In a biopsy, the doctor takes a tiny sample of tissue for testing in a laboratory; if in case a biopsy is not possible, then the doctor may suggest other tests so that diagnosis can be made.

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 During a physical examination, if the doctor feels for any lumps on the neck, lips, gums, and cheeks, then the doctor will also examine the nose, mouth, throat, and tongue for abnormalities, by generally using a light and a mirror for a clearer view.
• Endoscopy: An endoscopy allows the doctor to look the inner body with a thin, lighted, flexible tube known an endoscope. The examination has various names depending on the part of the body which is examined, such as laryngoscopy to see the larynx, pharyngoscopy to see the pharynx, or nasopharyngoscopy to see the nasopharynx. When these procedures are mixed, they are sometimes attributed to a panendoscopy.
• Biopsy : A biopsy is a procedure in which the small amount of tissue is removed for the examination under a microscope, post that analysis of tissues is done by a pathologist..
• Molecular testing of the tumor. The doctor may ask for running laboratory tests on a tumor sample to analyze specific genes, proteins, and various factors that are unique to the tumor. The basis on the results of these tests, it will help the doctor to decide whether your treatment options include a sort of treatment known as targeted therapy.
• X-ray/barium swallows: An x-ray is an approach to build a picture of the structures that are inside the body, by using a tiny amount of radiation. A barium swallow may be needed to describe abnormalities along with the swallowing passage.
• Panoramic radiograph : This test is done to detect cancer or evaluate the teeth before radiation therapy or chemotherapy. This is often called a Panorex. It is a rotating, panoramic, x-ray of the upper and lower jawbones.
• Ultrasound: An ultrasound uses the sound waves to generate a picture of internal organs. It is an important test in evaluation of thyroid carcinoma.
• Computed tomography (CT or CAT) scan : A CT scan constructs a 3-dimensional image of the inner body using x-rays that are taken from various angles; a computer combines these images into an intricate, cross-sectional view that shows any abnormalities or tumors.
• Magnetic resonance imaging (MRI): An MRI uses magnetic fields, not x-rays, to produce specific images of the body, mainly the images of soft tissue, like the tonsils and tongue. MRI may also be used to measure the size of a tumor and neck node status.
• Positron emission tomography (PET) or PET-CT scan A PET scan is usually combined with a CT scan which is known as a PET-CT scan. A PET scan is a way to produce pictures of organs and tissues that are inside the body. A little amount of radioactive sugar stuff is injected into the patient’s body. This sugar substance is taken up by a cell that uses most of the energy. As cancer tends to use the energy very actively, it soaks up more of the radioactive substance. Post that scanner detects this substance to produced images of the inner body.
  PET CT scan can detect if cancer spreads to other organs in the body.

Once the diagnostic tests are done, the doctor will evaluate all of the results with the patient. If the patient is suspected of cancer, all these reports help the doctor describe the type of cancer. All the process of diagnosis is known as staging.

Numerous cancers of the head and neck can be cured, mostly if they are found at an early stage. While removing cancer is the principal goal of the treatment, conserving the function of the adjacent nerves, organs, and tissues are also very important. When planning treatment, doctors contemplate how treatment might affect a patient’s standard of living, for instance how a patient feels, looks, talks, eats, and breathes.

Generally, the major treatment options are surgery, radiation therapy, chemotherapy, and targeted therapy. Surgery or radiation therapy by themselves or a mix of these treatments can be part of a patient’s treatment plan. Treatment alternatives and guidance depends on several factors, which include:

• The category and stage of head and neck cancer
• Viable side effects
• Preference of patient and overall health

Patients care plan may also involve treatment for symptoms and side effects, which is a key part of cancer care. One can take time to learn about all of the treatment options and be sure to ask questions about things that are not clear. In addition to this feel free to talk to the doctor about the goals of every treatment and what all can be expected while getting treatment.

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

Risk Factors

• constant irritation of the gums or cheek by sharp teeth or dentures
• poor nutrition,
• infections due to the human papilloma virus (HPV)

Treatment

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. 

The Esophagus is a hollow muscular tube that connects the mouth to the stomach. Each time you swallow food or liquid, the esophagus transports it to the digestive system.

What is Esophageal Cancer?

Esophageal cancer can develop when cells in the soft tissues lining this tube begin to grow and divide abnormally, forming a tumor. Tumors typically start in the innermost layer of the esophagus and then spread outward. The spread of cancer from the esophagus to the lymph nodes and other organs is called metastasis.

What are the types of Esophageal Cancer?

Most esophageal tumors can be classified as one of two types — adenocarcinoma or squamous cell carcinoma.

Adenocarcinoma is the most common form of esophageal cancer in the United States, accounting for more than 50 percent of all new cases. It starts out in glandular cells, which are not normally present in the lining of the esophagus. These cells can grow there due to a condition called Barrett’s esophagus, which increases a person’s chance of developing esophageal cancer. Adenocarcinoma occurs mainly at the lower end of the esophagus and the upper part of the stomach, known as the gastroesophageal junction or the GE junction.

Adenocarcinoma of the esophagus occurs most often in middle-aged white men. Since the 1970s, the disease has become more common more rapidly than any other cancer in the United States. Doctors say the rise may be due to an increase in the number of people who develop gastroesophageal reflux disease (GERD), a condition in which contents from the stomach, such as acid, move up into the esophagus repeatedly, causing chronic inflammation

Squamous Cell Carcinoma

The second most common form of esophageal cancer is squamous cell carcinoma. This type of cancer begins when squamous cells, thin flat cells that line the inside of the esophagus, mutate and begin to grow uncontrollably. Squamous cell carcinoma of the esophagus is strongly linked with smoking and the consumption of excessive amounts of alcohol.

Gastroesophageal Reflux Disease and Esophageal Cancer

Normally, a sphincter muscle at the end of the esophagus opens to allow food to enter the stomach and closes to prevent harmful digestive acids from bubbling back up into the esophagus. When this sphincter muscle does not function normally, however, it can lead to a condition known as GERD. Studies have shown that having severe GERD over the course of many years increases the chance of developing gastroesophageal adenocarcinoma.

The following are the most common risk factors for esophageal cancer.

• Age : Esophageal cancer is most often diagnosed in people over age 50.
• Tobacco and Use of Alcohol : Use of tobacco in any form can increase your risk of developing esophageal cancer — particularly squamous cell carcinoma. The more you smoke and the longer you smoke, the greater your risk of esophageal cancer.
• Barrett’s Esophagus: Caused by long-term reflux of acid from the stomach into the esophagus, Barrett’s esophagus increases the risk of esophageal adenocarcinoma.
• Race: Squamous cell cancer of the esophagus is more common among blacks than whites. Adenocarcinoma is more common in white men than men of other race
• Obesity: Being overweight is a risk factor for esophageal adenocarcinoma.
• Vitamin Deficiencies: Some studies have linked esophageal cancer with deficiencies in beta carotene, vitamin E, selenium, or iron.
• Gender: Esophageal cancer is more common in men than in women, but the gender gap is narrowing.

Screening

Screening refers to any test that is given to detect disease before it begins to cause symptoms.Screening for esophageal cancer is not recommended for most people. However, your doctor may recommend regular endoscopic screening for adenocarcinoma if you have been diagnosed with Barrett’s esophagus or are at high risk of esophageal cancer for other reasons.

Diagnosis and Treatment at Max Cancer Centre Shalimar Bagh

Dedicated surgical oncologists, medical oncologists, radiation oncologists, gastroenterologists, radiologists, and pathologists work together closely to develop every patient’s treatment plan. We meet regularly to discuss individual patients and the latest advances in treatment.This team approach is particularly important in the treatment of esophageal cancer, because it is often best managed using a multidisciplinary approach. Having representatives of many different disciplines involved in your care ensures that all possible approaches to your treatment will be considered, and that your care will be well coordinated and personalized to your specific needs.

Diagnosis and Staging

Getting an accurate diagnosis is the first step toward getting the best cancer care.

• Endoscopy
• Biopsy

Staging the tumor requires performing one or more possible studies, including:

• CT scans of the chest and upper gastrointestinal tract
• A combined PET/CT scan, which allows doctors to measure and analyze the location of tumors more accurately. This technology can also help track how the tumor responds to treatment as your care progresses.
• Endoscopic ultrasound, a procedure that uses an endoscope with a small ultrasound probe at its tip. The device can measure how thick the tumor is and see whether it has invaded the wall of the esophagus. The test can also help your doctors to determine whether cancer cells are in the lymph nodes.
• Bronchoscopy, an endoscopy procedure, to evaluate cancer involvement of the trachea (windpipe) or main bronchi (airways)
• Interventional radiology or surgical biopsies if suspicious areas are identified outside the esophagus Using results from your staging studies, your doctors will classify the cancer into one of four stages. The stage indicates how large the tumor has grown and how widely it has spread in the body.

Treatment

Surgery: Surgery is an important part of treatment for many people with esophageal cancer. In the procedure called an esophagectomy, the goal is to remove all of the tumor in order to prevent its regrowth and spread. It is the primary modality of treatment in most cases of esophageal cancer.Surgery is an important part of treatment for many people with esophageal cancer. In the procedure called an esophagectomy, the goal is to remove all of the tumor in order to prevent its regrowth and spread.Studies have shown that cancer centers that perform more surgeries deliver better results for patients, including better survival rates, than those with less experience.We have among the lowest rates of complications following esophageal surgery in the country.Our thoracic surgeons are experts in performing complex esophageal surgery, including advanced minimally invasive techniques and robotic surgery. These approaches have been shown to lead to faster recovery after surgery than traditional open surgical approaches. Because surgical oncologists at Max Cancer Centre, Shalimar Bagh work as part of a multidisciplinary team, we are also very careful to recommend surgery only as part of a comprehensive treatment plan that will offer you the best results.

When Surgery Is Performed

Whether your doctors recommend surgery as the initial treatment for your esophageal cancer depends on several important factors, including:

• Whether the cancer is adenocarcinoma or squamous cell carcinoma. Squamous cell carcinoma does not always require surgery. It can sometimes be managed with chemotherapy and radiation therapy alone.
• The size of the tumor
• How deeply the cancer has invaded the layers of tissue in the wall of the esophagus
• Whether the cancer has spread to the lymph nodes
• Your overall health

In some cases, limited precancerous changes or very early stage tumors may be treated with a simple endoscopy and removal of the diseased inner lining of the esophagus — a technique called endoscopic mucosal resection (EMR). Radiofrequency ablation (RFA), an endoscopic procedure used to treat remaining areas of disease including Barrett’s esophagus, may also be used. If successful, surgery may be avoided in these cases.

Surgery is the best treatment option for more-advanced tumors, or early tumors and precancerous changes in the lining of the esophagus that cannot be treated with endoscopic techniques.

For most patients — because diagnosis of esophageal cancer usually happens only once it has reached an advanced stage — surgery is not the first treatment given. In many cases, patients first receive a combination of chemotherapy and radiation therapy to shrink the tumor and to increase the likelihood that any remaining cancerous tissue will be completely removed during a later surgery.

Esophagectomy

During surgery for esophageal cancer, the thoracic surgeon removes the tumor along with part of the normal esophagus, as well as a margin of tissue around the cancer and nearby lymph nodes to which cancer cells may have spread. This procedure is called an esophagectomy. Once these tissues are removed, the stomach is reattached to the remaining part of normal esophagus. In some cases, the colon or small intestine is used instead of the stomach to complete the connection.

Esophagectomy can be performed using open surgical methods or minimally invasive techniques. Your surgeon will carefully consider the appropriate approach for you.

Minimally Invasive Robotic Surgery

Many operations for esophageal cancer at Max Cancer Centre can now be performed using minimally invasive approaches, including robotic-assisted approaches. Minimally invasive surgery is a set of techniques that use small incisions to enter the body, limiting the amount of healthy tissue that is affected during an operation. Minimally invasive approaches are not effective for all patients with esophageal cancer, but when appropriate these techniques may offer a variety of benefits, including:

1. Shorter hospitalization
2. Less pain
3. Decreased complications, particularly in older patients

Our surgeons are leaders in performing robotic-assisted surgery. Our team of thoracic surgeons is increasingly integrating robotic assistance into esophageal surgery, including complex esophageal cancer operations. This sophisticated surgical tool offers finer precision than is possible with other minimally invasive techniques.

Chemotherapy

Please read the detailed information available.

Radiation Therapy

Radiation therapy for esophageal cancer is the use of high-energy beams to shrink or eliminate tumors