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Head and neck cancer is a broad term that refers to cancerous tumours that develop in the head or neck region, which includes the oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, and salivary glands. These cancers can affect various structures in the head and neck, such as the tongue, tonsils, vocal cords, thyroid gland, and lymph nodes. It has an impact on the passageways of the body parts that are responsible for breathing, eating, and speaking.
Some of the common risk factors for head and neck cancer include consumption of tobacco and alcohol, human papillomavirus (HPV) infection, exposure to certain chemicals or substances, and family history. Symptoms of head and neck cancer can vary depending on the location of the tumor but may include persistent pain, difficulty swallowing, hoarseness (strained voice), a lump or wound that doesn’t heal, and a change in voice.
There are several types of head and neck cancer, which can be classified based on where they occur in the head and neck region as well as the type of cells involved. The most common types are:
Squamous cell carcinoma: This is the most common type of head and neck cancer, it develops in the cells that line the mucous membranes of the mouth, nose, oropharynx (posterior tongue and tonsil), larynx (voice Box) and hypopharynx (lower part of the throat which is surrounded by the larynx also known as the gullet). These cancers are usually caused by substance abuse mostly tobacco and alcohol. HPV virus is also an important causative agent of oropharangeal cancers
Salivary gland cancer: This develops in the salivary glands (glands that produce the saliva responsible for breaking down food) which are located in the mouth and neck. More than 80 % of tumors occur in parotid and sub mandibular salivary glands and most of them are benign. Only less than 20 % of salivary gland tumors occur in minor salivary glands that exist in the mouth, i.e. tongue and palate ad majority of them are malignant.
Thyroid Tumour: Thyroid Tumors also form an important part of head neck malignancies, majority of them are benign colloid goiter and adenomas. 20% of them can be malignant of which papillary variety are most common. Medullary variety can be hereditary
Lymphoma: It is a lymphatic system cancer that affects the lymph nodes, spleen, and bone marrow. A large majority of lymphomas present with multiple swellings in the neck.
Rare neck tumors: Tumors arising from nerve sheath, blood vessels like carotid body tumours
Treatment options depend on the type, location, and stage of cancer, as well as the patient’s overall health. Except for lymphomas surgery is the main stay of treatment in Head Neck cancers. In early stages it may be only surgery and in advanced stages it is surgery followed by radiation. Only in palliative settings or in situations where tumor excision can be very morbid like posterior tongue radiation or chemotherapy / radiation is used first. In addition, supportive care and rehabilitation may be necessary to help patients manage the side effects of treatment and improve their quality of life.
The main aim of surgical treatment is to remove the cancerous tumor. The tumor can be removed with the help of different surgical options like:
Laser technology– It is usually performed in the early stage of the tumor, especially when found in the larynx and oral cavity
Excision – In this, a surgery is performed to remove the cancerous tumor.
Lymph node or neck dissection – If the cancer spreads the doctor may remove lymph nodes in the neck. This may be done at the same time as an excision.
Reconstructive Surgery – When a major tissue removal is required during the cancer surgery, such as removing the jaw, skin, pharynx, or tongue, reconstructive or plastic surgery may be performed to replace the missing tissue. This procedure aids in the restoration of a person’s appearance as well as the function of the affected area.
Radiation therapy – During this therapy, high-energy x-rays or other particles destroy the cancer cells. It can be used to treat head and neck cancers and helps in curing the disease. Even with the help of chemotherapy drugs are used to destroy cancer cells and stop them from growing.
However, to ensure that the patient is fully healed, a multi-speciality approach is often required. A component of reconstructive surgery and neurosciences play a critical role in returning the patient’s life to normalcy after cancer. The treatment plan for each patient is determined by several factors like the location of the tumor, stage at which the cancer is detected, patient’s age, and overall health and well-being.
The author is associated with the Department of Oncology, CK Birla Hospital(R), Delhi. Views expressed are personal.
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