Head and Neck Cancer is a group of cancers that includes tumors in several areas above the collar bone.
The way this cancer behaves depends on the site in which it.
Region affected by Cancer
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.
Head and neck cancer includes cancers of the
Lymph nodes in the neck.
Stages of Head and Neck Cancer
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.
Subdivision of Head and Neck Cancer
Tumors of the Nasal Cavity and Paranasal Sinuses
Oral Cavity Cancer
Tumors of the Oropharynx
Salivary Gland Cancer
Human Papilloma Virus
Symptoms of Head and Neck Cancer
Oral cavity -
A white or red patch on the gums, tongue, or lining of the mouth;
A swelling of the jaw that causes dentures to fit poorly or become uncomfortable;
Unusual bleeding or pain in the mouth.
Nasal cavity and sinuses
Sinuses that are blocked and do not clear,
Chronic sinus infections that do not respond to treatment with antibiotics,
bleeding through the nose,
swelling or other trouble with the eyes,
pain in the upper teeth,
or problems with dentures.
Swelling under the chin or around the jawbone;
Numbness or paralysis of the muscles in the face;
Pain that does not go away in the face, chin, or neck.
Oropharynx and hypopharynx .
Factors Delaying Head and Neck Cancer Diagnosis
Two-thirds of oral cavity cancers and 77% of oropharyngeal cancers are not diagnosed until they are larger than four centimeters in diameter.
Reason can be:
Patient procrastination in seeking medical attention,
Delayed diagnosis by physician, and
Prolonged asymptomatic period all contribute to late diagnosis.
The survival rate declines dramatically from local disease to distant disease
In the graph,
Localized disease is that which is confined to primary sites such as the tongue or tonsil.
Regional disease is that which has spread to the cervical lymphatics, and
Distant disease refers to distant metastases.
Patient distribution by stage of newly diagnosed disease (mainly based on oral cancer) 53% 10% 37% Distant disease/metastases Localized disease Regional disease
CT (or CAT) scan
Magnetic resonance imaging (or MRI)
FNAC(Fine-needle aspiration cytology (FNAC) is used to diagnose masses presenting in the head and neck region.)
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
Treatment Early stage Locally advanced Refractory Recurrent and/or metastatic
Early disease is treated with surgery/radiotherapy alone
Locally advanced SCCHN
Chemo radiotherapy (CRT)
Recurrent and/or metastatic disease
CRT is associated with significant to xicities
Eg mucositis and s wallowing dysfunction
CT Surgery RT alone Palliation RT + CT
Surgery . The surgeon may remove the cancer and some of the healthy tissue around it. Lymph nodes in the neck may also be removed , if the doctor suspects that the cancer has spread .
CO2 laser surgery is also another form of treatment.
Transoral laser microsurgery allows surgeons to remove tumors from the voice box with no external incisions. It also allows access to tumors that are not reachable with robotic surgery.
Radiation therapy - This treatment involves the use of high-energy x-rays to kill cancer cells.
Radiation may come from a machine outside the body. It can also come from radioactive materials placed directly into or near the area where the cancer cells are found.
One of newer treatments Image Guided Radiation Therapy, or IGRT , is a highly precise targeting technology that allows day-to-day visualization of all tissues and organs in the head and neck area.
In IGRT, as tumors begin to shrink during the treatment course, minor changes or shifts in the radiation beam can be made to ensure a more precise treatment.
With increased accuracy, often comes fewer side effects, because collateral healthy tissues are shielded in an unprecedented manner.
Chemotherapy -This treatment is used to kill cancer cells throughout the body. 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.
Photodynamic therapy - Photodynamic therapy may have promise in treating mucosal dysplasia and small head and neck tumors. Amphinex is giving good results in early clinical trials for treatment of advanced head and neck cancer.
Targeted therapy - Targeted therapy, according to the National Cancer Institute, is “a type of treatment that uses drugs or other substances, such as monoclonal antibodies, to identify and attack specific cancer cells without harming normal cells.” Some targeted therapy used in squamous cell cancers of the head and neck include cetuximab, bevacizumab, erlotinib, and reovirus.
Even after successful definitive therapy, head and neck cancer patients face tremendous impacts on quality of life. Despite marked advances in reconstructive surgery and rehabilitation, intensity-modulated radiotherapy (IMRT) and conservation approaches to certain malignancies, some patients continue to have significant functional deficits.
Rehabilitation after the Surgery
Rehabilitation is a very important part of treatment for patients with head and neck cancer. The goals of rehabilitation depend on the extent of the disease and the treatment a patient has received.
Rehabilitation may include :
Learning how to care for a stoma after a laryngectomy.
Reconstructive and plastic surgery to rebuild the bones or tissues of the mouth
Regular follow-up care is very important after treatment for head and neck cancer to make sure the cancer has not returned, or that a second primary (new) cancer has not developed.
Depending on the type of cancer, medical checkups could include exams of the stoma, mouth, neck, and throat.
Regular dental exams may also be necessary.
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These hospitals have high-end technology like Gamma Knife, IMRT, PET Scan, Novalis etc.
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