Head and neck cancer (HNC) are one of the most common cancers in developing countries, especially in Southeast Asia[1]. According to a 2017 study in Cancer Management and Research[2], it represents the sixth most common cancer and accounts for 6% of all cases of cancer in the world. It is more common in men as compared to women. It is clinically known as head and neck squamous cell carcinoma (HNSCC) as the squamous cells, which are the cells that line the surfaces of the various parts of the body, turn cancerous. Oral cancers are the predominant forms of head and neck squamous cell cancer (HNSCC) in India which is mainly attributed to the use of tobacco, areca nut (supari), and alcohol.
Dr. Ramandeep Kaur Consultant, Patel Hospital, Punjab shares in detail about the common types of head and neck cancer, symptoms, diagnosis, and treatment of cancer.
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What Are The Symptoms of Head and Neck Cancer?
Head and neck cancer encompasses a variety of tumors that originate in the hypopharynx, oropharynx, lip, oral cavity, nasopharynx, or larynx. There are few main types of head and neck cancer which are named based on the part of the head and neck they affect. This is the reason why the symptoms of head and neck cancer vary from each other.
Oral cancer: It is the type of cancer which affects the lips, tongue, gums, inside of the cheeks and mouth. The common symptoms of oral cancer include red/white patches inside the mouth, swelling in the jaw, bleeding, and pain in the mouth.
Throat cancer: Also known as the cancer of the pharynx, this type of cancer affects the pharynx, a tube that originates from the nose and connects to the esophagus (food pipe). It includes the tonsils, back of the tongue and soft palate in the mouth. Throat cancer may show symptoms such as pain during swallowing, neck or throat pain, earache, difficulty in hearing and troubled breathing.
Larynx cancer: As the name suggests, it is the cancer of the larynx, also known as the voice box. It is the structure that holds the vocal cords and epiglottis (a structure that hangs at the back of the throat). Some of the common signs and symptoms of larynx cancer are ear pain, voice changes, and pain when swallowing.
Nasal cavity cancer: It is the type of head and neck cancer in which the nasal cavity, space inside the nose, is affected. It also affects the paranasal sinuses, which are the spaces present inside the bones around the nose. The symptoms to watch out for include headaches, nosebleeds, toothache, blocked sinuses, chronic sinus infections, and swelling around the eyes.
Salivary gland cancer: Salivary glands, glands which produce saliva, are present in the floor of the mouth and near the jawbone. The symptoms that indicate cancer of the salivary glands include swelling under the chin or jawline, pain in the face and chin that fails to subside and numbness of the facial muscles.
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Although each type of cancer has some specific symptoms, there are few general symptoms as well. Some of the common symptoms of head and neck cancer include:
-Oral pain
-Ulcer in the oral cavity
–Blood in your spit/phlegm
-Difficulty in opening the mouth
-Enlargement of the nodes in the neck
-Dysphagia (difficulty in swallowing)
-Odynophagia (painful swallowing)
-Dyspnoea (difficulty in breathing)
-Hoarseness of the voice
-Significant weight loss
How Is Head And Neck Cancer Diagnosed?
In most cases, your doctor might conduct a detailed physical examination with emphasis on the head and neck region. He might even ask you for your clinical history and family history to look for risk factors of head and neck cancer. If he suspects anything wrong in the examination, he might also you to get a few tests done. These include:
-Fine-needle aspiration biopsy, which involves sampling of the cells of an enlarged lump in the neck, thyroid or salivary glands by using a needle.
-Biopsy (taking a small piece of tissue) of an ulcer or growth in the mouth, throat, nasal cavity, or a skin lesion.
-Radiology, including an ultrasound of the neck, CT and MRI scanning of the head and neck.
-Nuclear medicine scanning which includes the use of various isotope scans and PET scan.
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At present, there are no reliable blood tests or markers, unlike other cancers, that help us diagnose head and neck squamous cell carcinomas. Blood tests for thyroglobulin and calcitonin may be advised, which are the markers for different variants of thyroid cancers.
How Is Head And Neck Cancer Treated?
After obtaining a diagnosis, doctors assign a disease stage (cancers are staged I to IV) to cancer basis outcome of investigations. The treatment options are discussed among the surgical, radiation and medical oncologists, pathologists and radiologists. Usually, head and neck cancer treatments are classified as early-stage cancer and advanced stage cancer treatment.
Early stage cancer (I and II) is generally treated with single modality treatment which is surgery or radiation therapy. However, this depends upon the clinical presentation and your doctor makes an informed decision based on various parameters. The choice of treatment is dictated by the site and type of cancer, and also the number of risk factors a patient has.
Advanced stage cancer (III and IV) is usually treated with multimodality treatment which involves two or sometimes all three treatment modalities such as surgery, radiation therapy, and chemotherapy depending upon clinical judgement.
A multidisciplinary approach to treatment is to be followed in association with speech and swallowing therapists, psychological counselors and social and rehabilitation workers for better patient care and treatment outcome.
(The article is reviewed by Dr. Lalit Kanodia, General Physician)
References:
1. Joshi P, Dutta S, Chaturvedi P, Nair S. Head and neck cancers in developing countries. Rambam Maimonides Med J. 2014 Apr 28;5(2):e0009.
2. Lo Nigro C, Denaro N, Merlotti A, Merlano M. Head and neck cancer: improving outcomes with a multidisciplinary approach. Cancer Manag Res. 2017 Aug 18;9:363-371.