Head and Neck Cancer

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Overview

Head and neck cancer is a group of cancers that starts in any of the following parts of the body:

Nose and sinuses
Mouth and lips
Salivary glands
The area at the back of the nose and mouth (nasopharynx)
Voicebox (larynx)
Throat (pharynx)

Alcohol and tobacco (smoked and chewed) are the key aetiological factors, and their use increases the risk of head and neck cancers.

Symptoms

Oral Cancer

Oral cancers often arise on the tongue, lips, the floor of the mouth, minor salivary glands and on the gums.

Symptoms: Major symptoms of oral cancer are persistent mouth sores, a lump or thickening in the cheek, a white and/or red patch on the gums, tongue and cheeks, unusual or persistent bleeding, and pain or numbness in the mouth.

Throat Cancer

Throat cancer refers to the cancerous growth on the windpipe, food pipe, and tumour that arises from the glands in the neck. It also includes the cancers of different parts of the pharynx, namely nasopharynx, oropharynx, and hypopharynx along with larynx (voice box).

Symptoms: Common symptoms associated with throat cancer are a persistent lump or bump in the throat, sores that do not heal, persistent sore throat, earache and altered hearing and difficulties with breathing and talking.

Paranasal, Sinuses and Nasal Cavity Cancer

This form of cancer refers to the formation of malignant (cancer) cells in the tissues of the paranasal, sinuses and nasal cavity.

Symptoms: Major symptoms may include nasal blockage, nosebleed, swelling in the eyes and partial or complete loss of vision.

Salivary Gland Cancer

Salivary gland cancer refers to the growth of tumours in the salivary glands. It commonly occurs in the parotid gland, which is one of the salivary glands, located just in front of the ear.

Symptoms: Common symptoms of salivary gland cancer are painless lumps in the regions of the ear, cheek, jaw, lips or mouth, fluid draining from the ear, swallowing difficulties, difficulty opening the mouth, numbness or weakness in the face and facial pain.

Courses

Tobacco use is the biggest risk factor for head and neck cancer. An estimated 85 per cent of head and neck cancers are linked to tobacco use, and 75 per cent of head and neck cancers are associated with the combination of tobacco and alcohol use.

Other primary risk factors include:

Gender: Men are more likely to have head and neck cancers than women.
Age: Head and neck cancers are more commonly seen in people over the age of 50.
HPV Infection: Prolonged HPV or human papillomavirus may also lead to head and neck cancers.
Sun Exposure: Prolonged exposure to sunlight may increase the risk of lip cancer, which is a type of oral cancer.
Dental Trauma: Trauma caused due to sharp teeth is also observed to cause oral cancers.

Other risk factors include poor oral hygiene, exposure to harmful chemicals and radiation, unhealthy lifestyle habits, etc.

Diagnosis

There are various diagnostic procedures to detect and diagnose head and neck cancers:

a. Physical Examination: This is also a screening method for head and neck cancers. During the physical exam, the doctor looks for lumps on the neck, lips, gums, and cheeks. Insides of the mouth are checked for red or white patches, persistent bleeding, unhealed ulcers, etc. The nose, mouth, throat, and tongue are also inspected for abnormalities.

b. Endoscopy: This procedure uses a thin, lighted, flexible tube called an endoscope to examine the regions of the throat down to the oesophagus for the signs of head and neck cancers.

c. Biopsy: A biopsy involves the removal of a small amount of tissue from the suspected area, which is later examined under the microscope for cancer cells.

d. Molecular Testing of Tumour: Molecular tests are performed to identify specific genes, proteins, and other factors unique to the tumour. The results from these tests help specialists in planning targeted therapy.

e. Imaging: Imaging tests such as ultrasound, MRI, CT scan or PET-CT scan may be recommended to get detailed images of the region that is suspected to be affected by cancer.

Treatment

Optimal treatment for head and neck cancers depends on the location of the cancer and its stage. The treatment protocols use a multidisciplinary approach and focus on preserving the functions of nearby nerves, tissues and organs.

The main treatment options are surgery, radiation therapy, chemotherapy, targeted therapy and immunotherapy.

Early cancers (stage 1 and stage 2 cancers) are treated with a single modality treatment, either surgery or radiotherapy. Whereas, locally advanced cancers (stage 3 and stage 4 cancers) are treated with combined modality treatment, which involves either surgery and radiotherapy or chemotherapy and radiotherapy.

a. Surgery

Surgery is performed to remove the cancerous tumour and some of the healthy tissue around it called the margin of head and neck tumours. As these cancers are limited to the site of origin, surgery is the most commonly opted treatment modality.

Surgery may also be performed to obtain a diagnosis of the tumour. Apart from this, surgery may be opted for:

1. Neck Dissection: It is performed to remove cancer that has spread to the lymph nodes in the neck.
2. Reconstructive Surgery: When cancer surgery requires major tissue removal, such as tissues in the jaw, skin, tongue or pharynx, reconstructive surgery is performed, which is aimed towards restoring the patient’s appearance and functions of the affected area. Tissues taken from various body parts such as the forearm, thigh or chest, replace the tissues excised from the head and neck region.
3. Minimally Invasive Surgery: Through minimally invasive surgery, doctors operate tumours in the head and neck region using specialised instruments like an endoscope, lasers, and energy devices that are coupled with a surgical microscope and a robot. The primary goal of minimally invasive surgery is to, minimise tissue disruption and pain, while still performing safe and effective cancer surgery. The biggest advantage of this approach is that there is little or no change in speech, swallowing or appearance after cancer surgery; this translates to early recovery after the treatment.

b. Radiation Therapy

Radiation therapy is a treatment modality wherein high-energy radiation is delivered to the target area to kill the cancer cells and shrink the tumour growth. The key advantage of radiation therapy is the precision in its action, through which it reduces the damage caused to the surrounding tissues. There are two ways by which the radiation is delivered to the target area:

1. External Beam Radiation Therapy (EBRT): EBRT involves the delivery of high-energy X-rays or proton beams from outside the body to the location of the tumour, where it destroys the cancer cells.
2. Brachytherapy: In this type of radiation therapy, the source of radiation, known as an implant or seed, is placed inside or next to the cancerous mass. It allows the delivery of high radiation doses specifically to the cancer tissue without affecting the adjacent healthy tissues.

c. Systemic Therapy

Systemic therapies act on the entire body and help in treating the cancerous growths wherever they are located, including the ones that are too small to detect.

1. Chemotherapy is the third major treatment modality, wherein potent drugs are used to destroy the cancer cells, by affecting their ability to grow and reproduce. Chemotherapy is generally used in combination with radiation therapy or surgery. It is sometimes used to alleviate the symptoms too.
2. Targeted therapy is a unique form of cancer treatment that depends on tumour biology. It specifically aims at inhibiting tumour growth and metastasis by targeting the tumour microenvironment or focusing on specific proteins. The goal of specific molecular targeting in cancer treatment is to create a “magic bullet” that selectively kills the cancer cells while sparing normal or healthy cells.
3. Immunotherapy or biological therapy is another form of systemic therapy that stimulates the body’s natural defences to fight cancer. It uses materials synthesised either by the body or in a laboratory to improve, target, or restore immune system function. The only form of immunotherapy approved by the FDA for head and neck cancers is the ‘Immune Checkpoint Inhibitors’. Through a complex set of mechanisms, these checkpoint inhibitors signal the immune system to recognise the cancer cells and attack them.

Complementary therapies are the therapies used along with the conventional treatment modalities. These therapies promote overall wellbeing in patients by alleviating the temporary after-effects of the treatment given, reducing emotional stress, and naturally boosting the immune system in patients.

Frequently Asked Questions

1. What should I do if I feel a lump on my neck?

Not all lumps in the neck point towards head and neck cancers. In most cases, these lumps could be swollen lymph nodes, which are caused due to infection or inflammation. However, if these lumps are persistent and do not go away after the inflammation is cured, you must immediately see your doctor who will be thoroughly examining these lumps before arriving at a conclusive diagnosis.

2. Can HPV cause head and neck cancer?

Yes, studies show that a chronic HPV infection can cause head and neck cancers. Oral HPV infections are caused due to unhealthy sexual habits.

Oral HPV infections gradually form tumours in the head and neck region if your immune system fails to recognise and fight these abnormal cells. HPV-induced head and neck cancers are more common among men than women.

3. Are head and neck cancers treatable?

Yes, head and neck cancers are treatable. However, for positive clinical outcomes and better survival rates, they have to be detected in their early stages. That said, even advanced-stage head and neck cancers can be treated with a better prognosis if diagnosed accurately and treated appropriately. The treatment plans could be unimodal or multimodal.

4. Does head neck cancer cause weight loss?

Yes, head and neck cancers cause weight loss before, during and after the cancer treatment. Weight loss starts with appetite loss in most cases. Other factors that lead to weight loss among head and neck cancer patients include increased metabolism, loss of skeletal muscle, extreme fatigue, and decreased quality of life.

5. What are the potential side effects of head and neck cancer treatment?

Different head and neck cancer treatments are associated with different side effects. Radiation therapy may lead to fatigue, weight loss, and pain with swallowing. Chemotherapy, on the other hand, may cause nausea, low blood counts, and changes in taste. A few side effects, like nausea, wear off as soon as the treatment ends. However, other side effects, like fatigue and discomfort with swallowing, take some time to improve.