Head and Neck Cancer
Overview
is a disorder in which the body's cells proliferate uncontrollably. Malignancies of the head and neck include cancers that begin in several locations in the head and throat, but do not include brain or eye cancers. The great majority of individuals with head and neck cancer, 85% or more, have a history of drinking, smoking, or both. The symptoms of head and neck cancer are highly dependent on the tumor's location and size. Routine physical examination (including a thorough oral examination) is the most effective technique to detect malignancies before they cause symptoms. Surgery and radiation are the primary therapies for head and neck cancer.
What are cancers of the Head and Neck?
Head and neck cancers are tumors that start in the squamous cells that line the mucosal surfaces of the head and neck (for example, those inside the mouth, throat, and voice box). Squamous cell carcinomas of the head and neck are the name given to these tumors. Head and neck cancers can also start in the salivary glands, sinuses, or muscles or nerves in the head and neck, although they are far less prevalent than squamous cell carcinomas.
What causes cancers of the head and neck?
The two most major risk factors for head and neck cancers, particularly malignancies of the oral cavity, hypopharynx, and voice box, are alcohol and tobacco use (including secondhand smoke and smokeless tobacco, sometimes known as "chewing tobacco" or "snuff"). Persons who use both cigarettes and alcohol are more likely to acquire these malignancies than people who just use nicotine or alcohol. Tobacco and alcohol use are the leading causes of head and neck squamous cell carcinomas of the mouth and voice box.
Infection with cancer-causing human papillomavirus (HPV), particularly HPV type 16, is a risk factor for oropharyngeal malignancies of the tonsils or tongue base. The incidence of oropharyngeal cancers caused by HPV infection is growing in the United States, whereas the incidence of oropharyngeal cancers caused by other causes is decreasing. Chronic HPV infection causes almost three-quarters of all oropharyngeal malignancies. Although HPV has been found in other types of head and neck cancer, it appears to be the only driver of cancer formation in the oropharynx. The causes behind this remain unknown.
Other known risk factors for specific cancers of the head and neck include the following:
- Paan (betel quid). The use of paan (betel quid) in the mouth, a common custom in Southeast Asia, is strongly associated with an increased risk of mouth cancers .
- Occupational exposure. Wood dust exposure at work is a risk factor for nasopharyngeal cancer. Certain occupational exposures, such as asbestos and synthetic fibers, have been linked to voice box cancer, although the increased risk remains debatable. Certain professions in the construction, metal, textile, ceramic, forestry, and food sectors may raise the risk of voice box cancer. Industrial exposure to wood dust, nickel dust, or formaldehyde is linked to paranasal sinus and nasal cavity malignancies.
- Exposure to radiation. Radiation to the head and neck for noncancerous or cancerous disorders is a risk factor for salivary gland cancer.
- Infection with the Epstein-Barr virus. Infection with the Epstein-Barr virus increases the risk of nasopharyngeal carcinoma and salivary gland cancer.
- Ancestry. Asian descent, particularly Chinese ancestry, is associated with an increased risk of nasopharyngeal cancer.
- Underlying genetic disorders. Certain genetic diseases, such as Fanconi anemia, might increase the chance of developing precancerous lesions and malignancies in childhood.
Types of head and neck cancer
There are 5 main types of head and neck cancer, each named according to the part of the body where they develop.
- Cancer of the larynx and hypopharynx. The larynx is also known as the voice box. This tube-shaped organ located in the neck is essential for breathing, talking, and swallowing. It is positioned at the top of the windpipe, also known as the trachea. The gullet is another name for the hypopharynx. The larynx is surrounded by the bottom section of the throat.
- Cancer of the nasal cavity and paranasal sinuses. The nasal cavity is the area right below the nose through which air flows on its journey to the throat. The air-filled spaces that surround the nasal cavity are known as the paranasal sinuses.
- Nasopharyngeal carcinoma. The nasopharynx is the air channel behind the nose in the upper region of the throat.
- Cancer of the mouth and throat. The oral cavity consists of the mouth and tongue. The oropharynx is the area of the throat between the tonsils and the tip of the voice box.
- Cancer of the salivary gland. Saliva is produced by the salivary gland. Saliva is a fluid that is secreted into the mouth to keep it moist and includes enzymes that begin the breakdown of meals.
What are head and neck cancer symptoms?
A lump in the neck or a sore in the mouth or throat that does not heal and may be uncomfortable, a sore throat that does not go away, trouble swallowing, and a change or hoarseness in the voice are all indications of head and neck cancer. Other, less severe illnesses may also cause same symptoms. Any of these symptoms should be checked out by a doctor or dentist.
Symptoms of cancers in specific areas of the head and neck include:
- The oral cavity. A white or red patch on the gums, tongue, or mouth lining; jaw development or swelling that causes dentures to fit poorly or become unpleasant; and unusual bleeding or discomfort in the mouth.
- Throat (pharynx). Discomfort when swallowing; persistent pain in the neck or throat; ringing in the ears; or difficulty hearing
- The voice box (larynx). Breathing or speech difficulties, swallowing pain, or ear ache
- Nasal cavity and paranasal sinuses. Sinuses that are clogged and do not clear; persistent sinus infections that do not respond to antibiotic therapy; nasal bleeding; recurrent headaches, swelling, or other eye issues; discomfort in the upper teeth; or denture difficulties
- The salivary glands. Swelling beneath the chin or around the jawbone, numbness or paralysis of the muscles of the face, or persistent discomfort in the face, chin, or neck.
Diagnosis of head and neck cancers
If you have symptoms, you should normally consult your doctor or dentist first. If they suspect that your symptoms are the result of cancer or if they are unsure what the problem is, they will send you to a specialized doctor at the hospital. If your sole symptom is a lump in your neck, you may be sent to a neck lump clinic at a hospital. You will most likely be seen by an oral and maxillofacial surgeon or an ENT specialty surgeon.
At the hospital, you may have some of the following tests:
An ultrasound scan of the neck uses soundwaves to create a computer-generated image of your neck and lymph nodes.
1. Ultrasound scan of the neck
An ultrasound scan of the neck utilizes soundwaves to create an image of your neck and lymph nodes on a computer screen.
2. Nasendoscopy
A nasendoscopy examines the back of your mouth, nose, pharynx, and larynx.
3. Examination under anaesthetic (EUA)
An EUA is performed after a general anaesthesia to allow the doctor to examine the region more carefully using an endoscope. An endoscope is a thin, flexible tube that has a camera and a light at the tip.
4. Trans-nasal flexible laryngo-esophagoscopy (TNFLO)
If you are unable to tolerate a general anaesthesia, a TNFLO can be used instead of an endoscopy. It enables your doctor to examine your nose, throat, voice box, and gullet (esophagus).
5. Biopsy
The doctor takes a sample (biopsy) of cells or tissue from the abnormal location. A pathologist (a specialist who specializes in examining cells) examines the sample under a microscope for cancer cells. A biopsy of the head and neck can be obtained in a variety of methods.
Further tests for head and neck cancers
If testing reveal that you have head and neck cancer, your expert will schedule more tests. These can assist determine the size and location of the cancer, as well as if it has spread. This is known as staging. These testing might include the following:
1. X-rays
An x-ray may be taken to examine the bones in your face and neck, as well as the condition of your teeth. A chest x-ray may be performed to assess your overall health and to determine whether the cancer has progressed to your lungs (although this is rare).
2. CT scan
A CT scan uses a sequence of x-rays to create a three-dimensional image of the inside of your body.
3. MRI scan
An MRI scan utilizes magnetism to provide a detailed image of your body.
4. PET-CT scan
A PET-CT scan provides more specific information about the bodily component being examined.
How are head and neck cancers treated?
Cancers of the head and neck are uncommon. People with this form of cancer are often treated in specialized centers by a multidisciplinary team of healthcare specialists.
A group of professionals will convene to determine the best course of action for you. This is known as a multifunctional team. Your doctor, cancer expert, or nurse will go over the various therapies and their adverse effects with you. They will also discuss factors to consider while making treatment options with you.
Treatment for head and neck cancers may include:
- Surgery
Surgery is one of the most common treatments for head and neck cancer. Swelling around the throat can occur after surgery to the mouth or throat. If your operation may result in this, the surgeon will make a temporary tiny incision in your windpipe for you to breathe through. This is referred to as a tracheostomy or stoma.
High-energy rays are used in radiotherapy to eliminate cancer cells. It can be administered alone, although it is most commonly used in conjunction with chemotherapy. This is known as chemoradiation.
Chemotherapy destroys cancer cells by using anti-cancer (cytotoxic) medicines. To treat locally advanced head and neck malignancies, it is frequently administered in conjunction with radiation.
- Chemoradiation
Chemoradiation is the combination of chemotherapy and radiotherapy. Chemotherapy can make cancer cells more susceptible to radiation.
- Targeted therapies
Targeted treatment medications function by focusing on something within or near the cancer cell that aids in its growth and survival. Cetuximab (Erbitux®) is the most regularly used targeted treatment for head and neck malignancies.
- Immunotherapy
Immunotherapy medications are occasionally used to treat head and neck cancer. These medications employ the immune system to detect and destroy cancer cells.
What are the side effects of head and neck cancer treatment?
Surgery for head and neck malignancies can impair a patient's ability to chew, swallow, or speak. The patient may seem different following surgery, with swelling in the face and neck. The swelling normally goes down with time. However, removing lymph nodes may cause the flow of lymph in the area where they were removed to be slower, and lymph may gather in the tissues (a condition known as lymphedema), producing extra swelling that may persist a long time.
Lymphedema of the head and neck can be external or internal. If addressed quickly, it may usually be reversed, improved, or decreased. Patients with untreated lymphedema may be more susceptible to problems such as cellulitis, or tissue infection. If left untreated, cellulitis can be harmful, causing further swallowing or breathing issues.
Because nerves have been severed during a laryngectomy (surgical to remove the voice box) or other neck surgery, areas of the neck and throat may feel numb. The shoulder and neck may become weak and stiff if lymph nodes in the neck are removed.
Patients who get radiation to the head and neck may develop adverse effects such as redness, irritation, and ulcers in the mouth; a dry mouth or thicker saliva; trouble swallowing; changes in taste; or nausea during and after treatment. Radiation can also induce taste loss, which can reduce appetite and impact nutrition, as well as earaches (caused by the hardening of ear wax). Patients may also notice swelling or sagging of the skin beneath the chin, as well as changes in skin texture. The jaw may feel tight, and patients may find it difficult to open their mouth as wide as they could before therapy.
Although many patients' adverse symptoms resolve gradually over time, others will endure long-term side effects after surgery or radiation therapy, such as trouble swallowing, speech impairment, and skin abnormalities. Patients should notify their doctor or nurse of any adverse effects and discuss how to cope with them.
How can I reduce my risk of developing head and neck cancers?
People who are at risk of developing head and neck cancers, particularly those who use cigarettes, should consult their doctor about strategies to lower their risk.
By avoiding oral HPV infection, you can lower your risk of HPV-related head and neck cancer. The FDA granted fast clearance of the HPV vaccination Gardasil 9 in June 2020 for the prevention of oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58 in people aged 9 to 45 years. The Human Papillomavirus (HPV) Vaccines fact sheet has further information on these vaccines.
Although there is no standard or routine screening test for head and neck cancers, dentists may look for symptoms of cancer in the oral cavity during a routine checkup.
What rehabilitation is available for head and neck cancers patients?
The objective of head and neck cancer treatment is to keep the illness under control. However, doctors are also concerned with maintaining as much function of the damaged areas as feasible and assisting the patient in returning to regular activities as soon as possible following therapy. Rehabilitation is a critical component of this process. The aims of rehabilitation are determined by the severity of the condition and the therapy received by the patient.
Rehabilitation may involve physical therapy, nutritional counseling, speech therapy, and/or learning how to care for a stoma, depending on the location of the cancer and the kind of treatment. A stoma is a hole in the windpipe through which a patient breathes following a laryngectomy (voice box removal operation).
Reconstructive and plastic surgery may be required to replace bones or tissues in some cases, particularly in cases of oral cavity cancer. However, due of damage to the residual tissue from the initial operation or radiation therapy, reconstruction surgery may not always be viable. If reconstructive surgery is not an option, a prosthodontist may be able to create a prosthesis (an artificial dental and/or facial element) to improve swallowing, speech, and look. Patients will be given specialized instruction on how to utilize the gadget.
Patients who have difficulty speaking following treatment may benefit from speech therapy. A speech-language pathologist will frequently visit a hospitalized patient to schedule therapy and teach speech exercises or alternate techniques of communication. After the patient comes home, speech treatment is frequently continued.
Eating may be difficult following head and neck cancer therapy. After surgery, some patients receive nutrition straight into their veins, while others require a feeding tube until they can eat on their own. A feeding tube is a flexible plastic tube that is inserted into the stomach by the nose or an abdominal incision. After surgery, a nurse or speech-language pathologist can assist patients in relearning how to swallow.
Conclusion
Head and neck cancer is the seventh most prevalent kind of cancer in the world, and it includes a wide range of tumors that affect the upper aerodigestive tract. Although there are many distinct histologies, squamous cell carcinoma is the most prevalent. Tobacco usage, alcohol misuse, and oncogenic viruses such as human papillomavirus and Epstein-Barr virus are major risk factors.
Head and neck cancers continue to be difficult to treat, necessitating a multidisciplinary approach, with surgery, radiation, and systemic therapy all playing important roles in the treatment of locally advanced illness. Despite the fact that many therapeutic concepts overlap, therapy is often site- and histology-specific.