Head and Neck Cancers

What are Cancers of the Head and Neck?

Head and neck cancers usually occur in the squamous cells lining the moist, mucosal surfaces inside the head and neck. Squamous cell carcinoma (SCC) accounts for more than 90% of all head and neck cancers. Head and neck cancers occur in the oral cavity, pharynx, and larynx. Rarer cancers include the salivary glands, nose, sinuses and middle ear.

Head and neck cancers are more common in older men who smoke and consume alcohol. The incidence is higher in South Asia and South East Asia. Risk factors include cigarette smoking, alcohol, chewing of betel nut, poor oral health, occupational risks, and radiation exposure.

Symptoms of head and neck cancers usually include a lump or a sore that does not heal, sore throat, swallowing difficulties, hoarseness or change in voice. Head and neck cancers are usually diagnosed with a biopsy, lab tests and other imaging techniques. Treatment depends on a number of factors like age, other co-morbidities, location of the cancer, stage of the cancer and general health. Treatment includes a combination of surgery, radiation and chemotherapy.

Types of Head and Neck Cancers

Oral Cancer: Cancer in the oral cavity is the most common type of head and neck cancer. Oral cancers can occur in the lips, gums, surface area behind the molars or wisdom teeth, inside the lips and cheeks, hard palate of the mouth and under the tongue.

Pharynx or Throat Cancer: The pharynx is the hollow tube inside the neck beginning behind the nose and ending at the top of the esophagus. Tumors can occur in the nasopharynx (upper part of the throat behind the nose) and the hypopharynx (the lower part of the pharynx).

Larynx or Voice Box Cancer: The larynx is the voice box located below the pharynx in the neck. The voice box is composed of cartilage tissue and contains the vocal cords. Laryngeal cancer is the second most common type of head and neck cancer.

Paranasal Sinuses and Nasal Cavity Cancer: These are much rarer cancers. Paranasal sinuses are the hollow areas in the facial bone near the nose. The nasal cavity is the hollow space inside the nose.

Salivary Gland Cancer: The salivary glands are located at the floor of the mouth near the jawbone. This type of cancer is rare.

Thyroid Cancer: This type of cancer is rare and develops as tumors in the thyroid gland. Tumors can also occur in the parathyroid gland.

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What are the Risk Factors of Head and Neck Cancers?

The incidence is higher in South Asia and South East Asia. Risk factors include:

• Cigarette smoking
• Alcohol
• Tobacco usage

• Chewing of betel nut
• Poor oral health
• Occupational risk
• Radiation exposure
• Gastro-oesophageal reflux disease (GORD): for laryngeal and pharyngeal cancer
• Human papillomavirus (HPV) 16 seropositivity presents an increased risk of oral, pharyngeal and laryngeal cancers

What are the Symptoms of Head and Neck Cancers?

Each type of head and neck cancer may be linked to a specific group of symptoms. It is important to heed warning signs and seek medical help if you have one or more of these symptoms for a long period:

• Lump or swelling anywhere in or near the neck
• Sores in the mouth that do not heal or bleed
• A red or white patch in the mouth that does not heal
• Frequent nosebleeds, nasal congestion, chronic sinus infections that do not respond to medication
• Constant sore throat

• Constant hoarseness or change in the voice
• Constant pain in the neck, throat or ears
• Trouble in chewing and swallowing
• Blood in the sputum
• Numbness anywhere in the mouth
• Loosening teeth
• Dentures that do not fit

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What is the Diagnosis of Head and Neck Cancers?

Most patients are usually referred to an ENT (“Ear, Nose and Throat”) surgeon. This specialist will usually perform a physical examination along with a combination of other tests including:

• CT scan
• Ultrasound of the neck
• Biopsy: either incision biopsy or fine needle aspiration (FNA). Both are invasive procedures using a local anesthetic
• Nasendoscopy: a thin, flexible tube with a light at the end which is used to examine the back of the mouth and throat
• Other lab tests: like complete blood count (CBC) may be recommended

What are the Treatments for Head and Neck Cancers?

Treatment includes a combination of surgery, radiation and chemotherapy. The aim of the treatment is to shrink, remover or destroy the cancer and minimize the chances of recurrence.

Small tumors which are localized can be treated with surgery and radiation therapy. Early stage cancers in the mouth can be removed with surgery. This may cause some difficulties in chewing and swallowing. However, this can be managed. Advanced cancers are usually treated with a combination of radiation and chemotherapy.

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Reconstructive surgery and dentistry services are usually required during and post-treatment. Patients may require help with adapting to chewing, swallowing and speech post-surgery.

Patients who are in advanced stages of incurable cancer are usually considered for palliative therapies and pain management.

Follow-up

Patients who have had surgery and present post-surgical difficulties in chewing, swallowing and speech will require the services of a rehabilitation specialist and speech therapist. Patients also need the services of a dietician in planning a suitable diet post-treatment.

What are the Preventive Measures for Head and Neck Cancers?

Limiting alcohol consumption, following a healthy diet with fresh fruits and vegetables, avoiding red meat and fats can be helpful in cutting back the risk of head and neck cancer.