What is Head and Neck Cancer?
Types of Oral Cancer
Head and Neck Cancer Risk Factors
Causes of Head and Neck Cancer
Symptoms of Head and Neck Cancer
Diagnosis of Head and Neck Cancer
Treatment of Head and Neck Cancer
What is Head and Neck Cancer ?
Head and neck cancer is the term given to a variety of malignant tumors that develop in the
- Oral cavity (mouth) : - 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.
- pharynx (throat) : - 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 : -
Para nasal sinuses (small hollow spaces around the nose lined with cells that secrete mucus) : - 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.
nasal cavity (airway just behind the nose)
- 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 ("Adam's apple" or voice box) : -
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.
Salivary glands (parotid, submanidular, sublingual 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, and near the jawbone.
The types of Oral Cancer are : -
- Oral Cancer.
- Salivary Gland Cancer.
- Laryngeal Cancer.
- Hypopharyngeal Tumors.
- Nasopharyngeal Cancer.
- Hypopharyngeal Tumors.
- Tumors of the Oropharynx.
- Tumors of the Nasal Cavity and Paranasal Sinuses.
Causes of cancer of the head and neck
Cancers of the head and neck are more common in men than women. In some cases (for example, salivary gland cancers, sarcomas and lymphomas) the causes are unknown.
Squamous cell carcinomas are much more common in smokers and people who drink a lot of alcohol, particularly spirits, and even more common in people who do both.
Other risk factors include the following : -
- Pipe smokers and people who hold cigarettes between their lips for long periods have a higher risk of cancers in the lip area.
- People who have long periods of sun exposure in their daily life have an increased risk of cancer of the lip and the skin of the head and neck, especially the ear.
- People who chew tobacco or betel nuts and those who use paan have a higher risk of cancers in the oral cavity.
- A diet that contains very little fresh fruit and vegetables.
- Breathing in certain chemicals and hardwood dusts (for example, in workplaces) increases the risk of cancers of the nose and sinuses.
- There are a number of precancerous conditions that can affect the head and neck, such as leukoplakia and erythroplakia, which can increase the risk of a cancer developing.
Symptoms of Head and Neck Cancer
These are common symptoms of head and neck cancer in general.
- an ulcer or sore area in the head or neck that does not heal within a few weeks
- difficulty in swallowing, or pain when chewing or swallowing
- trouble with breathing or speaking, such as persistent noisy breathing, slurred speech or a hoarse voice
- a numb feeling in the mouth or on the lips
- an unexplained loose tooth
- a persistent blocked nose, or nose bleeds
- a constant sore throat and earache affecting one side
- ringing in the ear, or difficulty in hearing
- a swelling or lump in the mouth or neck
- pain in the face or upper jaw
- in people who smoke or chew tobacco, pre-cancerous changes can occur in the lining of the mouth, or on the tongue. These can appear as persistent white patches (leukoplakia) or red patches (erythroplakia). They are usually painless but can sometimes be sore and may bleed.
How head and neck cancers are diagnosed ?
At the hospital, the specialist will ask you about your current symptoms as well as your medical history, and will want to know if you are taking any medicines. The doctor will then examine your mouth, throat and neck.
Fine needle aspiration cytology (FNAC)
Nasendoscopy for Head and Neck Cancer
In order to examine your throat and neck, the doctor may use a small mirror held at the back of your mouth. The doctor may also pass a nasendoscope (a very thin flexible tube with a light at the end) into your nose to get a better view of the back of the mouth and throat.
These tests can be uncomfortable for you, but will only last a few minutes. You may be given a local anaesthetic lozenge to suck, which numbs the mouth for a few minutes. Instead, the area may be sprayed with an anaesthetic spray, which numbs the back of your throat. If you do have a local anaesthetic in your throat, you shouldn't eat or drink anything for about an hour afterwards, until your throat has lost the numb feeling. Otherwise there is a risk of things going into your windpipe when you swallow. You could also scald your mouth or throat with hot drinks.
Biopsy for Head and Neck Cancer
The doctor can only make a definite diagnosis by taking a sample of cells from the abnormal area to examine under a microscope. This procedure is called a biopsy.
Sometimes the biopsy can be taken in the clinic. The affected area is first numbed with some local anaesthetic. A small piece of the suspected cancer is then removed using a very fine needle or a special pair of tweezers (biopsy forceps). However, it is more likely that a biopsy will be taken whilst you are asleep under a general anaesthetic. This allows the specialist to examine the mouth and throat area closely and take biopsies from any other suspicious areas..
By looking at the sample of cells under the microscope, the doctors will be able to tell if cancer cells are present. They will also be able to find out the type of cancer; for example, whether it has begun in the cells lining the mouth and throat (squamous cells).
Fine needle aspiration cytology (FNAC) for Head and Neck Cancer
This is a quick, simple procedure that is done in the outpatient clinic. Using a fine needle and syringe, the doctor takes a sample of cells from a lump and sends it to the laboratory to see if any cancer cells are present. An FNAC may be quite uncomfortable and the area may be bruised for a week or so afterwards.
Microcytoscopy for Head and Neck Cancer
This is a new test that is still being evaluated in research. It is sometimes used for people with pre-cancerous conditions who need to have regular biopsies. Instead of having biopsies a small amount of blue dye is painted onto the abnormal area, which is then very closely looked at using a microscope. Microcytoscopy should not be painful although it may be a little uncomfortable.
Treatment used for head and neck cancer in India
There are three main types of treatment for head and neck cancer : -
Two other treatments may sometimes be used : -
Sometimes the treatment of head and neck cancers will involve two or more treatments combined together.
- Photodynamic therapy (PDT)
- Biological therapies
Treating head and neck cancer with surgery in India
Surgery is an important part of the treatment of head and neck cancers and aims to remove the cancer 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.
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 mean that you will have scars on your face or neck. Some people may also need to have reconstructive surgery to the face
Sometimes laser surgery may 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 is being tested in research trials for cancers of the lip and oral cavity. The surgeon removes the cancer, and during the surgery the tissue that has been removed is examined under a microscope. This is to make sure that all the cancer cells are removed.
The surgeon may need to remove part of the mouth or throat lining and occasionally some facial skin. This can be replaced using a thick piece of skin taken from another part of the body - usually the forearm or chest. This is known as a skin flap.
If the cancer is affecting part of your jawbone, the affected bone may be removed with the tumour. In this case, you may need to have part of a bone taken from elsewhere in your body to replace the missing jawbone. This is known as a bone graft. Modern techniques enable you to move your jaw again straight after the operation.
Treating head and neck cancer with radiotherapy in India
Radiotherapy may be used alone, instead of surgery. It can also be used after an operation, to destroy small areas of cancer that could not be removed by the surgery. It may also be given in combination with chemotherapy, which is known as chemo-radiotherapy.
Radiotherapy can be given in one of two ways:
from outside the body as external beam radiotherapy (a beam of x-rays or electrons from a large machine called a linear accelerator)
by implanting radioactive material into the tumour and leaving it there for a few days. This is known as internal radiotherapy, interstitial radiotherapy or brachytherapy.
Treating head and neck cancer with chemotherapy in India
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. As the drugs circulate in the bloodstream, they can reach the cancer cells all over the body.
Chemotherapy may be used before or after surgery or radiotherapy to try to increase their effectiveness. Sometimes chemotherapy may be given at the same time as radiotherapy (a treatment known as chemo-radiotherapy), as they can be more effective if they are given together.
Chemotherapy may also be given to people whose cancer has spread to other parts of the body or whose cancer has come back after radiotherapy. It is used in this situation to try to shrink and control the cancer and relieve symptoms, to try to prolong a good quality of life.
Treating head and neck cancer with photodynamic therapy in India
PDT uses a combination of laser light of a specific wavelength and a light-sensitive drug to destroy cancer cells.
The light-sensitive drug (the photosensitising agent) is injected into a vein. It circulates in the bloodstream and is taken up by cells throughout the body. The drug is taken up more by cancer cells than healthy cells. It is not activated until it is exposed to laser light of a particular wavelength. When a laser is shone on to the cancer, the drug is triggered to interact with oxygen, which then destroys the cancer cells.
There is a delay of four days between injection and the activation of the drug using the laser light. The laser light used in PDT is focused through a fibre-optic tube, and is shone for only a few minutes. The doctor holds the fibre-optic tube very close to the cancer so that the correct amount of light is delivered and the PDT causes the minimum amount of damage to normal, healthy cells.
In early-stage cancer of the head and neck PDT may be used to try to cure the cancer and is usually given as part of research trials.
PDT can sometimes be used to shrink an advanced cancer to reduce symptoms, but it cannot cure an advanced cancer.
The list of of world class Cancer hospitals in India is as follows : -
||Apollo Hospital, Chennai, India
||Apollo Specialty Hospital, Chennai, India
||Apollo Hospitals, Bangalore, India
||Indraprastha Apollo Hospital, Delhi, India
||Fortis Hospital, Noida, India
||Narayana Cancer Hospital, Bangalore, India
||Artemis Hospital, Gurgaon ( Delhi ) , India
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