Head and neck cancers are basically tumours of the Head & Neck. Head and neck cancer is a broad term referring to a range of varied cancers that initiate in the head and neck area or the upper aerodigestive tract of the body. This includes the oral cavity, the tongue, the palate, the upper & lower jaws, the salivary glands, the throat (larynx) and the nose.Head and neck cancer can be either benign or malignant.
What are the types of head & neck cancers ?
There are several types of cancer that can initiate in the Head & Neck.
- Squamous Cell Carcinomas : Most head and neck cancers initiate in the squamous cells that line the mouth, nose or throat and are called squamous cell carcinomas.
- Adenocarcinomas : The cancers that initiate in glandular cells of the lining are called adenocarcinomas.
Based on the region of the head & neck where they occur, they can be divided into :
- Mouth or Oral Cancer : Cancer that initiates in the mouth or oral cavity, counting the lips, the gums, the inside of the cheeks, the tongue, the floor of the mouth and the jaws.
- Salivary Gland Cancer : Cancer that initiates in any of the salivary glands, major or minor is counted as salivary gland cancer. This includes the major glands just ahead of the ears (the parotid glands) or just below the jaw (the submandibular glands) and tongue (sublingual glands).
- Pharyngeal Cancer : Cancer that initiates in the throat (pharynx), that is either in the nasopharynx, oropharynx or the hypopharynx are included as pharyngeal cancers.
- Laryngeal Cancer : Cancer that initiates in the larynx or the voice box.
- Nasal Cancer or Paranasal Sinus Cancer : Cancer initiating in the nose, the nasal cavity or the sinuses of the head that surround the nose.
What are the causes for head & neck cancers ?
The development of Head & Neck cancer is the consequence of both environmental factors and genetic factors acting together and is hence, multifactorial.
Smoking and chewing tobacco & alcohol abuse are key risk factors for Head & Neck cancer. It is important to know that not all smokers and alcohol users develop Head & Neck cancer, which suggests that individual variation in genetic susceptibility also plays an important role.
High risk types of Human Papillomavirus (HPV) and Epstein-Barr virus (EBV), both oncogenic viruses are also considered risk factors. HPV infection has an identified role in carcinogenesis, especially in tonsillar or pharyngeal cancer.
Breathing in asbestos and wood dust, being exposed to dry-cleaning solvents, paint or chemicals has an elevated risk of laryngeal squamous cell carcinoma.
What are the clinical features of head & neck cancers ?
The clinical features can vary from asymptomatic to painful lesions, a persistent sore or swelling that does not subside, unusual bleeding or numbness, white patches (leukoplakia) or red patches (erythroplakia), change in tone of voice, difficulty in chewing or swallowing food, loss of appetite or weight loss.
How are head & neck cancers diagnosed ?
- A complete physical examination of the body is mandatory.
- Imaging Tests: To determine what the tumour is and its exact extent, imaging tests may need to be performed so doctors can view, assess and judge the cancer and determine how far it has progressed or spread. These important diagnostic tests include the following such as X- rays, CT Scan, MRI Scan or PET Scans.
- Biopsy: Removed tissue examined under a microscope by a pathologist is the only sure-shot way to make a definitive head & neck cancer diagnosis.
How are head & neck cancers staged ?
Physical examination is most definitive if carried out when the patient is under general anaesthesia. There is a local & distant staging.
Grade and Stage describe the head and neck tumour, helping to provide guidance for the doctors in choosing the best treatment option(s). Staging is a careful attempt to find out the exact extent and spread of the cancer. The higher the stage the further the cancer has grown away from its original site in the head & neck.
Grade refers to what the cancer cells look like, and how much they resemble their cell of origin or differentiation. The higher the grade, the more aggressive the tumour is.
Staging: The TNM system
T (Tumour) 1–4: Refers to the size of the primary tumour. The higher the “T” number, the bigger the cancer is.
N (Nodes) 0–3: Shows whether the cancer has spread to the regional lymph nodes of the neck. 0 means zero nodal involvement; and 1, 2 or 3 indicates increasing or more nodal involvement.
M (Metastasis) 0–1: Cancer has spread (undergone metastasis) to other sites & organs (1) or it has not (0).
How are head & neck cancers treated ?
Treatment options for Head & Neck Cancers depend on the type of cancer, staging of the cancer, and its location. The best therapeutic approach still remains to be defined, but usually consists of combination of chemotherapy, surgery and/or radiotherapy.
In general, more patients with head and neck cancer can be cured with surgery and at times radiotherapy. Patients with the early-stage (I and II) cancer are subjected to single modality treatment (that is either surgery or radiotherapy), while patients with advanced disease (stages III and IV) are subjected to the combined approach such as radical surgery with radiotherapy or combined chemo-radiation.
The treatments for Head & Neck cancer include:
- Surgery : The aim of surgery is to remove the tumour tissue and preserve the head and neck functions, like breathing, swallowing and speech. The type of surgery depends on the part of the head and neck affected.
If tumour is small, surgery is localized. If it has spread to local lymph nodes, your surgeon has to remove the nodes, in an operation called a neck dissection or lymphadenectomy. - Radiation Therapy: A cancer treatment that utilizes high-energy x-rays or basically radiation to eradicate cancer cells. Radiation can be used on select patients that are sensitive to radiation. Radiation therapy can also be used post surgery to kill any remaining cancer cells.
- Chemotherapy : Another kind of cancer treatment that uses either drugs or chemical substances (hence the name chemotherapy) to kill cancer cells and prevent them from dividing.
What is the care to be taken after the removal of a head & neck cancer ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans because of the risk of recurrence of Head & Neck cancer.
Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely.
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
