Head & Neck Cancer

Around 6.4 million head and neck cancer cases are diagnosed worldwide every year, out of which nearly 1.5 million cases are from India, which accounts for 20% of all head and neck cancers of the world

• Chewing Tobacco and Betel nut in the form of paan, gutkha, khaini, mishri, etc.
• Smoking beedi, cigarette, cigars
• Consumption of alcohol
• Poor oral hygiene
• Viral infections such as HPV (Human Papilloma Virus), EBV (Epstein – Barr Virus)

Symptoms of head and neck cancer depending on the site of involvement can include:

• Swelling or a sore that does not heal; this is the most common symptom
• Red or white patch in the mouth
• Lump, bump, or mass in the head or neck area, with or without pain
• Persistent sore throat
• Foul mouth odour not explained by hygiene
• Hoarseness or change in voice
• Nasal obstruction or persistent nasal congestion
• Frequent nose bleeds and/or unusual nasal discharge
• Difficulty breathing
• Double vision
• Numbness or weakness of a body part in the head and neck region
• Pain or difficulty chewing, swallowing, or moving the jaw or tongue
• Jaw pain
• Blood in the saliva or phlegm, which is mucus discharged into the mouth from respiratory passages
• Loosening of teeth
• Dentures that no longer fit
• Unexplained weight loss
• Fatigue
• Ear pain or infection

These cancers may not be found until they cause problems that make the person go to the doctor. Sometimes changes are seen during a routine visit to the doctor or dentist. You may be sent to see a doctor who focuses on diseases of the ear, nose, and throat (called an ENT doctor or a head and neck surgeon).

The doctor asks you questions about your health and does a physical exam. If signs are pointing to head or neck cancer, more tests will be done. Here are some of the tests you may need:

Complete head and neck exam: The doctor will check the head and neck area, looking and feeling for any abnormal areas. The lymph nodes in the neck will be felt for any signs of cancer. Because some parts of the mouth and throat are not easily seen, the doctor may use mirrors, lights, and/or special fiber-optic scopes to look at these areas.

Panendoscopy: This is a complete exam done in the operating room after you are given drugs to make you sleep. The surgeon looks inside your nose, mouth, and throat through thin tubes called scopes and may take out pieces of tissue (biopsies) to be checked under a microscope.

Biopsy: For this test, the doctor takes out a small piece of tissue where the cancer seems to be. The tissue is checked for cancer cells. This is the best way to know for sure if you have cancer.

CT scan: This is also called a “CAT scan.” It’s a special kind of x-ray that takes detailed pictures to see if the cancer has spread to the lymph nodes, lungs, or other organs.

MRI scan: MRIs use radio waves and strong magnets instead of x-rays to take detailed pictures. MRIs can be used to learn more about the size of the cancer and look for other tumors.

Barium swallow: For this test, x-rays are taken while you swallow a liquid with barium in it. Barium coats the inside surface of the throat and helps get a good picture. This test helps to see how your throat looks as you swallow.

Chest x-rays: X-rays may be done to see if the cancer has spread to the lungs.

PET scan: In this test, you are given a special type of sugar that can be seen inside your body with a special camera. If there is cancer, this sugar shows up as “hot spots” where the cancer is found. This test is useful when your doctor thinks the cancer might have spread, but doesn’t know where.

Blood tests: Certain blood tests can tell the doctor more about your overall health.

There are many ways to treat head or neck cancer, but the main types of treatment are local or systemic.

Surgery and radiation are used to treat only the cancer. They do not affect the rest of the body. This is called local treatment.

Chemo and targeted therapy drugs go through the whole body. They can reach cancer cells anywhere in the body. They are called systemic treatment. Doctors often use both local and systemic treatments for head and neck cancers. The treatment plan that’s best for you will depend on:

• Where the cancer is
• The stage of the cancer
• The chance that a type of treatment will cure the cancer or help in some way
• How treatment will affect the way you talk, breathe, and eat
• Your age
• Other health problems you have

Surgery for head or neck cancer

Some of these cancers are in places that are hard to operate on. Still, surgery may be used to take out the cancer and an edge of healthy tissue around it. In some cases, all or part of the tongue, throat, voice box, wind pipe, or jaw bone may need to be removed. Surgery may also be used to take out lymph nodes in the neck that haven’t gotten better with other treatments.

Surgery can also be used to help you do things that the cancer may have changed. For instance, if you can’t swallow because of the tumor, surgery may be done to put in a feeding tube.

Radiation treatment

Radiation uses high-energy rays (like x-rays) to kill cancer cells. Here are some ways this treatment may be used to treat head and neck cancers:

• As the main treatment to treat the tumour only with radiation therapy – Curative Radiotherapy. Sometimes concurrent chemotherapy is also given known as concurrent chemoradiation (CT-RT). This treatment usually lasts for about 6-7 weeks
• To shrink the tumor so it’s easier to take out with surgery – Preoperative Radiation therapy. This treatment usually lasts for 4-5 weeks
• To kill any cancer cells that may be left after surgery – Postoperative Radiotherapy or Adjuvant Radiation Therapy. This treatment usually lasts for around 6 weeks
• To ease problems caused by the cancer – Palliative Radiation therapy. This treatment usually lasts for about 1-2 weeks
• To treatment very low volume recurrent lesion with very advanced technology – Stereotactic Body Radiation Therapy (SBRT) is used which is usually given as 5-10 fractions and lasts for about 1-2 weeks

There are 2 main ways radiation can be given. The type most often used is aimed at the cancer from a machine outside the body. This is called external beam radiation. In today’s era of advanced technologies radiation therapy is a very safe treatment in targeting only the cancer cells and sparing normal structures present nearby like parotid glands, spinal cord, lens, ear, larynx, brainstem etc. Most commonly radiotherapy technology used in head and neck cancers is 3 Dimensional Conformal Radiation Therapy (3DCRT), Intensity Modulated Radiation Therapy (IMRT) and Stereotactic Body Radiation Therapy (SBRT)

Chemotherapy

Chemo is the short word for chemotherapy – the use of drugs to fight cancer. The drugs may be given into a vein or taken as pills. These drugs go into the blood and spread through the body. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Most of the time, 2 or more chemo drugs are also given.

Newer treatments

There are some newer drug treatments for head and neck cancers.

One is called targeted therapy. This is not the same as chemo because these drugs affect mainly cancer cells and not normal cells. They may work even if chemo doesn’t, or they may help chemo work better when give concurrent with chemotherapy. They might cause fewer side effects.

Another newer type of drug treatment is called immunotherapy. These drugs help your own immune system attack the cancer. They tend to have fewer side effects, but when they do happen they can sometimes be serious.

Here are the top ways to reduce your head and neck cancer risk:

If you smoke or use other tobacco products, reach out to a tobacco cessation centre/program to help quitting.
If you drink alcohol, do so in moderation.
Protect yourself against HPV infection by practicing safe sex
Avoid extended periods of time in the sun.
Wear a protective face mask if you are exposed to toxic fumes and dust. Companies can install air-filtration systems to minimize employees’ exposure to harmful fumes and dust.

It’s also important to schedule regular check-ups with your dentist. This is particularly important if you use tobacco or drink heavily. Many oral cancers are found during routine dental appointments.

Cancer screening refers to the exams recommended by doctors to detect cancer before symptoms develop. The purpose is to find cancer at its earliest, most treatable stages. At present, no screening method has been proven to improve survival for people with head and neck cancer. However a yearly physical exam of the head and neck by your primary care doctor is recommended especially if you consume alcohol and tobacco or have frequent dental problems or inadequate dental hygiene