Head And Neck Cancer

Overview of Head And Neck Cancer in India

Cancers that start in the mouth, throat, larynx (voice box), nasal cavity, sinus cavity, or salivary glands are categorised as head and neck cancers. The majority of these cancers start in thin, flat cells located on the moist surfaces of these areas; therefore, they are commonly referred to as head & neck squamous cell carcinoma (HNSCC).

HNC is the 6th most frequently occurring type of cancer worldwide, making up approximately 6% of all cancer cases globally. Tobacco use (smoking or chewing), excessive alcohol use, HPV infection, poor dental hygiene, and prolonged sun exposure (for lip cancer) are common risk factors for developing these cancers.

Common signs & symptoms of HNC include a persistent sore throat, difficulty swallowing, hoarseness, mouth sores that do not heal, swelling of the neck, unexplained bleeding, and earache.

Depending on the location & stage of each individual cancer, treatment may include surgery, radiation therapy, chemotherapy, targeted therapies, and immunotherapy. Early detection of HNC significantly improves treatment outcomes, making awareness of risk factors as well as signs & symptoms important for timely diagnosis and treatment.

What Is Head And Neck Cancer?

The majority of head & neck cancers develop from squamous cells, which make up the moist and mucosal surfaces in this area of the body. Squamous cell carcinoma (SCC) represents over 90% of total head & neck cancers. These cancers occur in the mouth, throat/pharynx and larynx. There are some other less common cancers that affect salivary glands, the nose/sinuses and the middle ear as well.

Most people with head & neck cancers are older males who smoke and drink to excess, although there is a higher incidence of these cancers in Southeast Asia/South Asia. Common risk factors for developing head and neck cancer include cigarette smoking/alcohol consumption, chewing bhanga/betel nuts, poor oral hygiene, occupational hazards and exposure to radiation.

Common symptoms that may indicate the presence of a head & neck cancer include: a non-healing sore/lump; persistent sore throat; difficulty swallowing; hoarseness/change in voice. A diagnosis of head & neck cancer is established through biopsy, laboratory testing and imaging studies. The specific treatment plan will be determined by taking several factors into account, including patient age, other co-morbidities, location/type/stage of cancer, and overall patient health. A combination of surgical intervention, radiation treatment, and chemotherapy will typically be required to treat head & neck cancers.

Types of Head And Neck Cancer:

Oral​‍​‌‍​‍‌​‍​‌‍​‍‌ Cancer

Cancer that happens in the mouth is actually the biggest group of head and neck cancers. You can get oral cancer in your lips, gums, the area behind your molars or wisdom teeth, inside of your lips and cheeks, the hard palate, and the underside of your tongue.

Pharynx or Throat Cancer

Pharynx or throat is a tube in our neck. It starts right behind the nose, and its end is at the entrance of the swallowing tube. Cancers can appear in the nasopharynx (the top part of the throat behind the nose) and the hypopharynx (the lower part of the pharynx).

Larynx or Voice Box Cancer

The larynx or voice box is a structure located in the neck below the pharynx. It is made up of cartilage and contains the vocal cords. Laryngeal cancer ranks as the second most frequent head and neck cancer after oral cancer.

Cancer of Paranasal Sinuses and Nasal Cavity

They are quite a rare type of cancer. Paranasal sinuses are the hollow parts of the bones of the face around the nose. The nasal cavity is the hollow space inside the nose.

Salivary Gland Cancer

Salivary glands are situated at the floor of the mouth next to the jawbone. This kind of cancer doesn’t occur very often.

Thyroid Cancer

Almost no cases of this type of cancer are found in the thyroid gland, while tumours also may develop in the parathyroid ​‍​‌‍​‍‌​‍​‌‍​‍‌gland.

Procedure:

Surgery

Surgeons (if possible) take out both the tumor and a margin of normal tissue around it. For example, your surgeon may want to take out some of your lymph nodes (often in your neck) if he or she believes cancer is there and/or if there is a reasonably large chance that it will spread.

Surgeons may use one of the following types of surgery:

• Tumor resection – Removal of a cancerous tumor and some surrounding normal tissue.
• Neck dissection – Removal of lymph nodes from the neck area that have cancer in them.
• Laryngectomy – Removal of part (or all) of the voice box to treat laryngeal cancer.
• Glossectomy – Removal of part or all of the tongue when cancer begins there.
• Maxillectomy – Removal of part or all of the upper jawbone when cancer is found there.

Radiotherapy

External beam radiotherapy (EBRT) is one of the most common forms of radiation treatment for head and neck malignancies. This form of treatment employs high-energy X-rays directed toward tumour cells. Radiotherapy can be used alone or combined with other modalities (i.e. surgery or chemotherapy).

Chemotherapy

Chemotherapeutic agents are also used in treating head and neck malignancies, primarily for patients with advanced disease. Chemotherapy may be given concurrently with radiotherapy.

Targeted Therapy

Targeted therapies are typically used for adenocarcinomas of the head and neck and are commonly administered in conjunction with other treatments. The FDA has approved several targeted therapies for treating head and neck cancer, including Cetuximab (Erbitux®) and Larotrectinib (Vitrakvi®).

Immunotherapy

Immunotherapies employ various mechanisms to help your body’s immune system recognise and attack your tumour cells. Pembrolizumab (Keytruda®) and nivolumab (Opdivo®) are two examples of immunotherapies used to treat advanced, recurrent, or metastatic head and neck cancers.

Clinical Trials

Clinical trials are research studies that evaluate the safety and efficacy of experimental or new treatment methods. Talk to your doctor to see if participating in a clinical trial would be appropriate for you.

Radionucleotide Therapy

Thyroid malignancies and uncommon neuroendocrine tumours are evaluated and treated with this highly specific radioactive chemical therapy.

Reconstructive Surgeries For Head And Neck Cancer

Reconstructive surgeries help to improve one’s appearance and the ability to speak, swallow, and breathe after tumor removal. The reconstruction option that is chosen depends on how large and where the defect is located.

Free Flap Reconstruction is used for major resections to reconstruct very complex structures to allow for restoration of function using tissue taken from a different area of the body to the head/neck.

Local/Regional Flaps: local and regional flaps are frequently used for smaller and medium-sized defects and are reconstructed using tissue that is rotated or moved from the area of the surgical site.

Bone Reconstruction: When bone has been removed (from the jaws or facial bones) bone can be reconstructed using bone grafts or using vascularized bone flaps to restore the ability to chew and to restore facial contour.

Dental/Oral Prosthetics: Custom prostheses; for example, obturators are prosthetic devices that have been made specifically to replace missing oral/dental structures; they improve one's ability to speak, chew, and swallow when surgery cannot completely recreate the oral/dental structures.

Tracheoesophageal Prosthesis (TEP): People who have had their larynx removed (laryngectomy) will have a TEP placed that will be used to help provide communication.