Head and neck cancers generally start in the squamous cells lining the mucosal moist surfaces within the head and neck. The squamous cells are known as squamous cell carcinomas of the head and neck. These cancers may also start in the salivary glands although salivary gland cancers are not so common. There are a number of salivary gland cancers as these glands have different types of cells that may become cancerous.
Most head and neck cancers begin in the cells that line the mucosal surfaces in the head and neck area, e.g., mouth, nose, and throat. Mucosal surfaces are moist tissues lining hollow organs and cavities of the body, open to the environment. Normal mucosal cells look like scales (squamous) under the microscope, so head and neck cancers are often referred to as squamous cell carcinomas. Some head and neck cancers begin in other types of cells, e.g. cancers that begin in glandular cells are called adenocarcinomas.
Cancers of the head and neck are further identified by the area in which they begin:
Oral cavity. The oral cavity includes the lips, the front two-thirds of the tongue, the gingiva (gums), the buccal mucosa (lining inside the cheeks and lips), the floor (bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area behind the wisdom teeth.
Salivary glands. The salivary glands produce saliva, the fluid that keeps mucosal surfaces in the mouth and throat moist. There are many salivary glands; the major ones are in the floor of the mouth, near the jawbone.
Paranasal sinuses and nasal cavity. The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.
Pharynx. The pharynx is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus (the tube that goes to the stomach) and the trachea (the tube that goes to the lungs). The pharynx has three parts:
Nasopharynx. The nasopharynx, the upper part of the pharynx, is behind the nose.
Oropharynx. The oropharynx is the middle part of the pharynx. The oropharynx includes the soft palate (the back of the mouth), the base of the tongue, and the tonsils.
Hypopharynx. The hypopharynx is the lower part of the pharynx.
Larynx. The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.
Lymph nodes in the upper part of the neck. Sometimes, squamous cancer cells are found in the lymph nodes of the upper neck when there is no evidence of cancer in other parts of the head and neck. When this happens, the cancer is called metastatic squamous neck cancer with unknown (occult) primary.
Cancers of the brain, eye, and thyroid as well as those of the scalp, skin, muscles, and bones of the head and neck are not usually grouped with cancers of the head and neck.
A sore on the skin which fails to heal or is ulcerated, changes in a mole or discoloration.
A sore in the mouth that is not healing
Persistent sore throat
Dentures that are no longer fit
Numbness in other areas and in the tongue
Swelling or a lump in the neck
White or red patch in the mouth
Difficulty in swallowing, chewing and also in moving tongue and jaws
Blood in the sputum
Loosening of teeth
Persistent change or hoarseness in the voice
Frequent ongoing nasal congestion, nosebleeds or chronic sinus infections that does not respond to any treatment
Pain in ears, throat and neck
To find the cause of symptoms, a surgical oncologist evaluates a person’s medical history, performs a physical examination, and orders diagnostic tests. The exams and tests conducted may vary depending on the symptoms. Examination of a sample of tissue under the microscope is always necessary to confirm a diagnosis of cancer.
Some exams and tests that may be useful are as under:
Physical examination may include visual inspection of the oral and nasal cavities, neck, throat, and tongue using a small mirror and/or lights. The surgical oncologist may also feel for lumps in the neck, lips, gums, and cheeks.
Endoscopy is the use of a thin, lighted tube called an endoscope to examine areas inside the body. The type of endoscope the Surgical Oncologist uses depends on the area being examined. For example, a laryngoscope is inserted through the mouth to view the larynx; an esophagoscope is inserted through the mouth to examine the esophagus; and a nasopharyngoscope is inserted through the nose so that the surgical oncologist can see the nasal cavity and nasopharynx.
Laboratory tests examine samples of blood, urine, or other substances from the body.
X-rays create images of areas inside the head and neck on film.
CT scan is a series of detailed pictures of areas inside the head and neck created by a computer linked to an x-ray machine.
Magnetic resonance imaging (or MRI) uses a powerful magnet linked to a computer to create detailed pictures of areas inside the head and neck.
PET scan uses sugar that is modified in a specific way so it is absorbed by cancer calls and appears as dark areas on the scan.
Biopsy is the removal of tissue. A pathologist studies the tissue under a microscope to make a diagnosis. A biopsy is the only sure way to tell whether a person has cancer.
If the diagnosis of cancer is confirmed, the surgical oncologist will want to know the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve an examination under anesthesia (in the operating room), x-rays and other imaging procedures, and laboratory tests. Knowing the stage of the disease helps the surgical oncologist plan treatment.
Tumour Board Evaluation
Each and every Head and Neck cancer patient is evaluated by a special team of surgical oncologists (Head & Neck unit), medical oncologists, Radiation Oncologists, Onco-pathologists and Imaging Specialists. Depending on the age, general condition, type of pathology and stage of the disease, a custom made treatment plan is charted out for each and every patient.
Modalities of Treatment Available for Head and Neck Cancers
The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person’s age and general health. The patient and the surgical oncologist should consider treatment options carefully. They should discuss each type of treatment and how it might change the way the patient looks, talks, eats, or breathes.
The surgeon may remove the cancer and some of the healthy tissue around it. Lymph nodes in the neck may also be removed (lymph node dissection), if the Surgical Oncologist suspects that the cancer has spread. Surgery may be followed by radiation treatment.
Head and neck surgery often changes the patient’s ability to chew, swallow, or talk. The patient may look different after surgery, and the face and neck may be swollen. The swelling usually goes away within a few weeks. However, lymph node dissection can slow the flow of lymph, which may collect in the tissues; this swelling may last for a long time. After a laryngectomy (surgery to remove the larynx), parts of the neck and throat may feel numb because nerves have been cut. If lymph nodes in the neck were removed, the shoulder and neck may be weak and stiff. Patients should report any side effects to their Surgical Oncologist or nurse, and discuss what approach to take.
Radiation therapy is also called radiotherapy. This treatment involves the use of high-energy beams to kill cancer cells. Radiation may be given with linear accelerator (external radiation therapy). It can also be given from radioactive materials placed directly into or near the area where the cancer cells are found (internal radiation therapy or Brachytherapy).
In addition to its desired effect on cancer cells, radiation therapy often causes unwanted effects. Patients who receive radiation to the head and neck may experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Other problems that may occur during treatment are loss of taste, which may decrease appetite and affect nutrition, and earaches (caused by hardening of the ear wax). Patients may also notice some swelling or drooping of the skin under the chin and changes in the texture of the skin. The jaw may feel stiff and patients may not be able to open their mouth as wide as before treatment. Patients should report any side effects to their Oncologist or nurse and ask how to manage these effects.
Chemotherapy, also called anticancer drugs. This treatment is used to kill cancer cells throughout the body. The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect rapidly growing cells, including blood cells that fight infection, cells that line the mouth and the digestive tract, and cells in hair follicles. As a result, patients may have side effects such as lower resistance to infection, sores in the mouth and on the lips, loss of appetite, nausea, vomiting, diarrhea, and hair loss. They may also feel unusually tired and experience skin rash and itching, joint pain, loss of balance, and swelling of the feet or lower legs. Patients should talk with their medical oncologist or nurse about the side effects they are experiencing, and how to handle them.”