Head and Neck Cancer

Head and Neck Cancer

Overview

Head and neck cancers in our country constitute approximately 35% all cancer cases in and more than 60 to 80% of patients present with advanced disease.

Being aggressive tumours, a comprehensive cancer care is needed for treatment of head and neck cancers

Head and Neck Oncology provides comprehensive treatment and rehabilitation for patients afflicted with cancers arising in the head and neck, such as:

  • Oral cancer (including gums and tongue)
  • Throat cancer, also known as cancer of the pharynx or pharyngeal cancer
  • Voice box cancer, also known as cancer of the larynx or laryngeal cancer
  • Sinus cancer
  • Salivary gland cancer

Risk Factors

Smoking:

  • Smoking is a risk factor for all tumour sites.
  • Leaving a cigarette on the lip is predictive of lip cancer risk irrespective of cumulative tobacco consumption.
  • Chewing tobacco and similar substances eg. betel quid, which is common in India is a risk factor for cancer of the oral cavity.
  • A long duration of passive smoking is also a risk factor

Alcohol:

  • Alcohol consumption strongly increases the risk of developing cancers of the oral cavity, pharynx and larynx.
  • There is a strong relationship between the quantity of alcohol consumption and the level of risk.

Diet:

  • Poor diet is a risk factor for head and neck cancer.
  • Frequent consumption of fruit and vegetables is associated with a reduced risk.
  • Several specific nutritional deficiencies (eg. zinc and vitamin A) may predispose individuals.
  • Eating Cantonese-style salted fish increases the risk.
  • There is evidence to suggest that the presence of gastro-oesophageal reflux disease (GORD) is a risk factor for laryngeal and pharyngeal cancer.

Infectious agents:

  • Human papillomavirus type 16 (HPV16) seropositivity is associated with an increased risk of oral, pharyngeal and laryngeal cancer.
  • The incidence of HPV-related oropharyngeal carcinoma is rising rapidly in developed countries and is easily missed.
  • It has a different presentation and better prognosis than other head and neck cancers

Signs and symptoms

Symptoms of H&N cancer vary according to the site of origin of cancer.

The presence of any of the following, if present for more than four weeks mandates a visit to the Head & Neck surgeon:

  • A non-healing sore/ulcer in the mouth/tongue or lip
  • A white or red patch on the gums, tongue or lining of the mouth
  • Inability to protrude the tongue
  • Inability to open the mouth properly
  • Swelling of the gums that prevents dentures from fitting properly
  • Unusual bleeding, pain or numbness in the mouth or cheek
  • Thickening of the cheek
  • Loose teeth
  • Earache/headache
  • Feeling of something getting stuck in the throat/ a sore throat that does not go away
  • Slurred speech
  • Change in voice/ hoarseness
  • Painful and/or difficulty in swallowing
  • Difficulty in breathing
  • Swelling around and/or under the jaw which may be accompanied by numbness or paralysis of one side of the face
  • Weight loss
  • Swelling in the midline of the lower neck which moves with swallowing
  • Progressively enlarging lumps in the neck
  • Streaking of blood in sputum

Evaluation

  • Clinical examination and biopsy from suspicious lesion helps in diagnosing oral and other head and neck cancers.
  • Upper GI endoscopy/ Direct pharyngo laryngoscopy is necessary to look for extent and other synchronous cancers
  • Sometimes when neck lymph node enlargement is initial presentation, neck node biopsy helps in arriving at a diagnosis
  • CECT neck helps in staging of diseases.
  • CT chest/ PET CT helps in metastatic work up

What are the treatment options?

Different types of treatment options are available for patients with cancers of the head and neck.

  1. Surgery
    • Complex head and neck cancer resection surgeries
    • Endoscopic surgery
    • Reconstructive head and neck surgery
    • Plastic surgery for cosmetic and functional reconstruction
    • Advanced skull base tumour resections
    • Orbital and maxillary tumours resection and reconstruction
    • Laryngeal tumours resection with reconstruction and voice rehabilitation
  2. Chemotherapy
    • Oral chemotherapy drugs
    • Systemic chemotherapy
    • Targeted drug therapy
    • Immunotherapy
  3. Radiation Therapy
    • Intensity-modulated radiation therapy
    • Stereotactic radiation therapy
    • Image-guided radiation therapy
    • Motion management with CT & PET scan and CT, along with respiratory gating
  4. Diagnostic Services
    • Sentinel lymph node biopsy
    • Ultrasound-guided biopsies
  5. Radiology
    • PET (positron emission tomography) scans
    • High-resolution CT (computed tomography) scans
    • Magnetic Resonance Imaging (MRI)
  6. Speech & Swallowing Rehabilitation post-surgery

What we offer in our centre?

Complex head & neck cancer surgeries being done in our hospital, according to sub-sites include

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A consultation with our panel of doctors, specialists and surgeons will help you determine what kind of services you may need to help diagnose and treat your condition. If you or someone in your family or friend’s circle are facing any health issues, please get in touch with us, we are here for you.