As with all cancers, in head and neck cancers also, there are 4 stages which are determined by the size and spread of the cancer. The treatment of head and neck cancers involves multidisciplinary team approach involving a team of surgeons, medical and radiation oncologists.
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Head and neck cancer is a common cancer affecting Indian men and women. It usually begins in the squamous cells present in the nasal cavity, oral cavity, tongue, larynx, and pharynx (including the nasopharynx, oropharynx, and hypopharynx), or in the cells lining salivary glands or paranasal sinuses. Beneath this lining of cells is the mucosa. If the cancer is limited only to the squamous layer of cells, it is called carcinoma in situ. Beyond that it is invasive squamous cell carcinoma. If the point of origin cannot be determined it is known as squamous cell carcinoma of unknown primary in the head and neck. If the tumor begins in the salivary glands it is known as adenocarcinoma, adenoid cystic carcinoma, or mucoepidermoid carcinoma.
Warning signs:
Patients with head and neck cancers usually present with one of the following symptoms:
o A lump in the neck
o Mouth sores
o Throat pain
o Hoarseness while speaking
o Painful swallowing
o Red or white patches on the gums and tongue
o Poorly fitting dentures (which had previously fit perfectly)
o Ear pain
o Blocked sinuses which don’t clear even after antibiotic use
o Bleeding from the nose
o Swollen eyes
o Pain in the upper teeth
o Paralysis of the face muscles and swelling under the chin and jawbone
Who are at risk?
Those who indulge in excessive smoking and smokeless tobacco products and/or alcohol are at great risk of developing head and neck cancer. Viruses such as the Epstein Barr virus (EBV) and the Human Papillomavirus (HPV) especially the HPV 16 genotype, have been known to cause cancer in the nasopharynx and tonsils and base of tongue (oropharynx) respectively. Genetics and family history also play a role in some of these cancers. Poor nutrition and poor oro-dental hygiene do play a role in its causation. Weakened immune system, radiation exposure and a history of gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD) are all associated with increased risk of head and neck cancer.
Oral cancer is often preceded by a pre-malignant lesion. Screening tests when applied to high risk individuals can help in early detection of head and neck cancers. Simple oral visual inspection could help detect many of the premalignant conditions such as leucoplakia etc. A visit to a dentist or your ENT doctor provides one with an opportunity to undergo this cancer screening test. All those individuals who are at high risk therefore must avail this opportunity.
Diagnosis
To properly identify head and neck cancers, a thorough physical examination of the mouth cavity and throat needs to be done. The lymph nodes in the neck may be enlarged. In case of any suspicious growth or lesions, a tissue biopsy is performed. Additionally, an X ray, CT scan, PET scan, MRI, biomarker testing of the tumor, panoramic radiograph, bone scan and endoscopy is done to determine the extent of spread of the cancer to the lymph nodes, its size, exact location, and injury to the bone.
Treatment
As with all cancers, in head and neck cancers also, there are 4 stages which are determined by the size and spread of the cancer. The treatment of head and neck cancers involves multidisciplinary team approach involving a team of surgeons, medical and radiation oncologists. The treatment offered depends on the location of the cancer, the stage, the patient’s age, and their overall health.
The surgery for some of the head and neck cancers can be very disfiguring. In some cases reconstructive surgery can be undertaken to help patients regain their self-confidence and enjoy better quality of life (QOL). Transoral robotic surgery (TORS) is now the preferred surgical approach for select group of oropharyngeal cancers. A structured treatment and rehabilitation plan can be mapped out before the treatment begins to improve patient outcomes. Radiation techniques have also improved over the years.
A lot of advances have happened in medical treatments of head and neck cancers. Now we have not only chemotherapy, but also targeted therapies (Cetuximab, nimotuzumab, small molecule tyrosine kinase inhibitors) and immunotherapy to treat these patients. Such advances in treatment have definitely led to improved survival and better QOL.
The author is Director, Department of Medical Oncology, Medanta the Medicity Hospital, Gurgaon. Views expressed are personal
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