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:
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:
Head and neck Cancer diagnosis can be done through cancer screening exams. Some of the commonly used diagnostic tests are:
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:
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:
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 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.
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 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, 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.