Head and neck cancerHead and neck cancer actually includes many different malignancies. The way a particular head and neck cancer behaves depends on the site in which it arises (the primary site). For example, cancers that begin on the vocal cords behave very differently than do those that arise in the back of tongue, just an inch or less from the vocal cords.
The most common type of cancer in the head and neck is squamous cell carcinoma, which arises in the cells that line the inside of the nose, mouth and throat. Other less common types of head and neck cancers include salivary gland tumors, lymphomas and sarcomas.
Cancers spread in three main ways. The first is direct extension from the primary site to adjacent areas. The second is spread through the lymphatic channels to lymph nodes. The third is spread through the blood vessels to distant sites in the body. In head and neck cancer, a spread to the lymph nodes in the neck is relatively common.
The lymph nodes most commonly involved are located along major blood vessels underneath the sternocleidomastoid muscle on each side of the neck, particularly the internal jugular vein node at the angle of the jaw. The risk of spread to other parts of the body through the bloodstream is closely related to whether the cancer has spread to the lymph nodes in the neck, how many nodes are involved, and their location in the neck. The risk is higher if cancer is in lymph nodes in the lower part of the neck rather than only in those located in the upper neck.
Types of Head and Neck CancerThere are several different types of head and neck cancer, categorized according to the specific tissue or organ where the cancer originates—from cancerous lesions on the lower lip to paranasal sinus tumors deep within the skull. Click on one of the links below for detailed information on each type of cancer, including staging and treatment guidelines.
Tumors of the Nasal Cavity and Paranasal Sinuses : - The nasal cavity is the passageway just behind the nose. When we breathe through our nose, air passes through the nasal cavity en route to the pharynx and tracheobronchial tree, which leads into the lungs. The paranasal sinuses are air-filled cavities around the nose.
Nasopharyngeal Cancer : - The nasopharynx is the upper part of the throat behind the nose - the nostrils lead into it, and openings on the sides of the nasopharynx connect to the ears.
Cancers of the Oral Cavity : - The oral cavity includes all the various parts of the mouth: the lips; the lining inside the lips and cheeks (the buccal mucosa); the bottom of the mouth; the front of the tongue; the front part of the top of the mouth (the hard palate); the gums; and the area behind the wisdom teeth (the retromolar trigone).
Tumors of the Oropharynx : - The oropharnyx is the part of the throat at the back of the mouth (the throat is technically known as the pharynx). It's a 5 inch, hollow tube that extends all the way from the nose down to the top of the trachea (the windpipe that leads to the lungs). Parts of the oropharnyx include the back of the tongue, the soft palate (the back part of the roof of the mouth), the tonsils and the part of the throat behind the mouth.
Hypopharyngeal Tumors : - The hypopharynx is the bottom part of the pharynx, or throat. The pharynx is a 5-inch hollow tube that extends from the nose, down the neck to the esophagus. Both air and food pass through the pharynx. The air continues on through the trachea to the bronchi and lungs. Food continues on to the esophagus and digestive system.
Laryngeal Cancer : - The larynx is more commonly known as the "voicebox." It's a 2 inch, tube-shaped organ in the neck. Air passes through the larynx on its way into or out of the lungs, and when we talk the vocal cords inside of the larynx tighten up and vibrate, producing sound.
Salivary Gland Cancer : - Salivary glands are located throughout the oral cavity. They are responsible for making saliva, a substance that keeps the mouth moist and aids in digestion.
Risk FactorsHead and neck risk factors depend on location.
- Oral Cavity (Mouth): -Risk factors include tobacco use, alcohol use, sun exposure, and possibly human papillomavirus (HPV) infection.
- Salivary Glands: - Risk factors include radiation therapy or diagnostic X-rays.
- Paranasal Sinuses and Nasal Cavity: - Risk factors include inhalation of certain industrial elements (like wood or nickel dust) and possibly tobacco or alcohol use.
- Nasopharynx: - Risk factors include work-related exposure to wood dust, consuming certain salted foods or preservatives, and the Epstein-Barr virus. It is also worth noting that those of Asian ancestry (part Chinese) appear to develop Nasopharynx cancer more easily than the general population.
- Oropharynx: - Risk factors include tobacco use, alcohol use, poor oral hygiene, and possibly HPV.
- Larynx: -(Voicebox) Risk factors include tobacco use, alcohol use, and exposure to airborne asbestos (especially in the work environment).
Other risk factors for head and neck cancer may include the following: -
- Use of paan (betel quid) in the mouth - typically used by Southeast Asian immigrants
- Consuming Yerba mate - a beverage similar to tea typically consumed by South Americans
Causes of pain include: -
- Pain caused by cancer(compression or infiltration of pain sensitive structures).
- Pain caused by treatment (consequence of radiotherapy, surgery or chemotherapy).
- Pain associated with debilitating disease (postherpetic neuralgia or bedsores).
- Pain unrelated to cancer or treatment (arthritis ,migraine or neuropathy).
The majority of pain is caused by cancer (83%) and /or secondary effects of oncological therapy (28%).
The assessment of the type and the cause of pain is important because the first indicates the appropriate symptomatic therapy and the latter the appropriate treatment of the underlying disease.
Diagnosis and TreatmentA weekly head and neck cancer tumor board where patients and/or physicians can meet with a multidisciplinary team of experts who provide second opinions and care planning.
Advanced surgical approaches aimed at maximum organ conservation.
The cranial base surgery center, offering innovative surgery that spares healthy nerves and facilitates brain surgery in deep regions where it was previously not possible.
Intensity modulated radiation therapy (IMRT) that reduces the dose of radiation received by healthy tissue, and can allow doctors to deliver radiation to difficult-to-reach areas.
Stereotactic radiation, another method for delivering precise doses of radiation down to millimeter accuracy.
Proactive management of treatment side effects such as mucositis (inflammation of the mucous membranes) and dry mouth (xerostomia).
A multidisciplinary approach, combining surgery, radiation and chemotherapy for maximum effectiveness.
Chemotherapy prevention approaches aimed at minimizing cancer recurrence.
Surgery is an important part of the treatment of head and neck cancers and aims to remove them completely. The part of your mouth or throat that the doctor may remove depends on where the tumour is. Very small cancers can often be treated with a simple surgical operation under local or general anaesthetic, or with laser surgery, with no need to stay in hospital overnight.
Surgery for Head and Neck Cancer
If the cancer is larger, surgery will often involve a hospital stay and an operation under general anaesthetic. Sometimes the amount of surgery may involve more than one part of your head and neck, and may cause scarring on your face or neck. Some people may also need to have reconstructive surgery to the face.
Specialist types of surgeryLaser surgery may sometimes be used to remove small tumours in the mouth and the pharynx. This may be combined with a light-sensitive drug (sometimes called a photosensitising agent) in treatment known as photodynamic therapy (PDT).
A type of surgery called micrographic surgery or Mohs’ surgery is sometimes used for cancers of the lip. The surgeon removes the cancer in thin layers, and the tissue that has been removed is examined under a microscope during the surgery. The surgeon will continue to remove more layers until no cancer cells are seen in the tissue. This technique makes sure that all the cancer cells are removed, but that only the minimum of healthy tissue is removed.
What to expect from the operation ?
If you need to have surgery, your doctor will discuss the best type of operation for you, depending on the size and position of your cancer, and whether it has spread. It is important to make sure that you have discussed your operation fully with your surgical team. This will help you to understand exactly what is going to be removed and how this will affect you after the operation – in both the short and the long term.
It is likely that during the operation the surgeon will also remove some of the lymph glands on one or both sides of the neck, even if they are not swollen. This is called a neck dissection. Sometimes this is done because the glands may contain a small number of cancer cells that did not show up in the earlier scans.
Photodynamic therapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor that stays longer in cancer cells than in normal cells. A laser is directed at the tumor, which destroys the cancer cells. Photodynamic therapy is currently used to relieve swallowing problems for a brief period; it is not a curative therapy.
Proton therapy. Proton radiation therapy can be used as a boost (part of treatment) to reduce normal tissue toxicity. It can be used as part of the treatment for some skull-base tumors (for example, nasopharynx, chordoma [a rare tumor that usually occurs in the spine and base of the skull], chondrosarcoma [a cartilage-based tumor]) to further limit the radiation dose to normal structures, such as the optic nerves and brainstem.
HPV. Research continues regarding the link between HPV and head and neck cancers, both in terms of why this virus raises the risk for the disease and why it may affect treatment results in some cases. Investigation is also underway about whether the HPV vaccine, currently used to prevent cervical cancer, is effective in preventing head and neck cancers as well.
In addition, there are many valuable, ongoing investigations of new types of chemotherapy and multi-modality studies (where more than one treatment approach is used).
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