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Head and Neck Cancer


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Published in: Health & Medicine

Head and Neck Cancer

  1. 2. Introduction <ul><li>Head and Neck Cancer is a group of cancers that includes tumors in several areas above the collar bone. </li></ul><ul><li>The way this cancer behaves depends on the site in which it. </li></ul>
  2. 3. Region affected by Cancer <ul><li>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. </li></ul><ul><li>Head and neck cancer includes cancers of the </li></ul><ul><ul><li>Mouth </li></ul></ul><ul><ul><li>Nose, </li></ul></ul><ul><ul><li>Sinuses, </li></ul></ul><ul><ul><li>Salivary glands, </li></ul></ul><ul><ul><li>Throat and </li></ul></ul><ul><ul><li>Lymph nodes in the neck. </li></ul></ul>
  3. 5. Stages of Head and Neck Cancer <ul><li>Cancers spread in three main ways. </li></ul><ul><ul><li>The first is direct extension from the primary site to adjacent areas. </li></ul></ul><ul><ul><li>The second is spread through the lymphatic channels to lymph nodes. </li></ul></ul><ul><ul><li>The third is spread through the blood vessels to distant sites in the body. </li></ul></ul><ul><ul><li>In head and neck cancer, a spread to the lymph nodes in the neck is relatively common. </li></ul></ul>
  4. 6. Subdivision of Head and Neck Cancer <ul><li>Tumors of the Nasal Cavity and Paranasal Sinuses </li></ul><ul><li>Nasopharyngeal Cancer </li></ul><ul><li>Oral Cavity Cancer </li></ul><ul><li>Tumors of the Oropharynx </li></ul><ul><li>Hypopharynx Tumors </li></ul><ul><li>Laryngeal Cancer </li></ul><ul><li>Salivary Gland Cancer </li></ul>
  5. 7. Factors Involved <ul><li>Tobacco products: </li></ul><ul><ul><li>Smoking Tobacco </li></ul></ul><ul><ul><li>Cigarettes </li></ul></ul><ul><ul><li>Cigars </li></ul></ul><ul><ul><li>Pipes </li></ul></ul><ul><ul><li>Chewing Tobacco </li></ul></ul><ul><ul><li>Snuff </li></ul></ul><ul><li>Alcohol </li></ul><ul><li>Chemicals: </li></ul><ul><li>Asbestos </li></ul><ul><li>Chromium </li></ul><ul><li>Nickel </li></ul><ul><li>Arsenic </li></ul><ul><li>Formaldehyde </li></ul><ul><li>Other Factors: </li></ul><ul><li>Ionizing Radiation </li></ul><ul><li>Plummer-Vinson Syndrome </li></ul><ul><li>Epstein-Barr Virus </li></ul><ul><li>Human Papilloma Virus </li></ul>
  6. 8. Symptoms of Head and Neck Cancer <ul><li>Oral cavity - </li></ul><ul><ul><li>A white or red patch on the gums, tongue, or lining of the mouth; </li></ul></ul><ul><ul><li>A swelling of the jaw that causes dentures to fit poorly or become uncomfortable; </li></ul></ul><ul><ul><li>Unusual bleeding or pain in the mouth. </li></ul></ul>
  7. 9. Symptoms <ul><li>Nasal cavity and sinuses </li></ul><ul><ul><li>Sinuses that are blocked and do not clear, </li></ul></ul><ul><ul><li>Chronic sinus infections that do not respond to treatment with antibiotics, </li></ul></ul><ul><ul><li>bleeding through the nose, </li></ul></ul><ul><ul><li>frequent headaches, </li></ul></ul><ul><ul><li>swelling or other trouble with the eyes, </li></ul></ul><ul><ul><li>pain in the upper teeth, </li></ul></ul><ul><ul><li>or problems with dentures. </li></ul></ul>
  8. 10. Symptoms <ul><li>Salivary glands </li></ul><ul><ul><li>Swelling under the chin or around the jawbone; </li></ul></ul><ul><ul><li>Numbness or paralysis of the muscles in the face; </li></ul></ul><ul><ul><li>Pain that does not go away in the face, chin, or neck. </li></ul></ul>
  9. 11. Symptoms <ul><li>Oropharynx and hypopharynx . </li></ul><ul><ul><li>Ear Pain </li></ul></ul>
  10. 12. Factors Delaying Head and Neck Cancer Diagnosis <ul><li>Two-thirds of oral cavity cancers and 77% of oropharyngeal cancers are not diagnosed until they are larger than four centimeters in diameter. </li></ul><ul><li>Reason can be: </li></ul><ul><ul><li>Patient procrastination in seeking medical attention, </li></ul></ul><ul><ul><li>Delayed diagnosis by physician, and </li></ul></ul><ul><ul><li>Prolonged asymptomatic period all contribute to late diagnosis. </li></ul></ul>
  11. 13. Survival Rate <ul><li>The survival rate declines dramatically from local disease to distant disease </li></ul><ul><li>In the graph, </li></ul><ul><ul><li>Localized disease is that which is confined to primary sites such as the tongue or tonsil. </li></ul></ul><ul><ul><li>Regional disease is that which has spread to the cervical lymphatics, and </li></ul></ul><ul><ul><li>Distant disease refers to distant metastases. </li></ul></ul>
  12. 14. Survival Rate <ul><li>cancer) </li></ul>Patient distribution by stage of newly diagnosed disease (mainly based on oral cancer) 53% 10% 37% Distant disease/metastases Localized disease Regional disease
  13. 15. Diagnostic Test <ul><ul><li>Physical examination </li></ul></ul><ul><ul><li>Endoscopy </li></ul></ul><ul><ul><li>Laboratory tests </li></ul></ul><ul><ul><li>X-rays </li></ul></ul><ul><ul><li>CT (or CAT) scan </li></ul></ul><ul><ul><li>Magnetic resonance imaging (or MRI) </li></ul></ul><ul><ul><li>Biopsy </li></ul></ul><ul><ul><li>FNAC(Fine-needle aspiration cytology (FNAC) is used to diagnose masses presenting in the head and neck region.) </li></ul></ul>
  14. 16. Treatment <ul><li>The treatment plan for an individual patient depends on a number of factors, </li></ul><ul><ul><li>Including the exact location of the tumor, </li></ul></ul><ul><ul><li>The stage of the cancer, and </li></ul></ul><ul><ul><li>The person's age and general health </li></ul></ul>
  15. 17. Treatment Early stage Locally advanced Refractory Recurrent and/or metastatic <ul><li>Early disease is treated with surgery/radiotherapy alone </li></ul><ul><li>Locally advanced SCCHN </li></ul><ul><ul><ul><li>Chemo radiotherapy (CRT) </li></ul></ul></ul><ul><ul><ul><li>Radiotherapy </li></ul></ul></ul><ul><li>Recurrent and/or metastatic disease </li></ul><ul><ul><ul><li>Chemotherapy </li></ul></ul></ul><ul><ul><ul><li>Chemo radiotherapy </li></ul></ul></ul><ul><li>CRT is associated with significant to xicities </li></ul><ul><ul><ul><li>Eg mucositis and s wallowing dysfunction </li></ul></ul></ul>CT Surgery RT alone Palliation RT + CT
  16. 18. Surgery <ul><li>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 . </li></ul>
  17. 19. Surgery <ul><li>CO2 laser surgery is also another form of treatment. </li></ul><ul><li>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. </li></ul>
  18. 20. Radiotherapy <ul><li>Radiation therapy - This treatment involves the use of high-energy x-rays to kill cancer cells. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>
  19. 21. <ul><li>  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.  </li></ul><ul><li>With increased accuracy, often comes fewer side effects, because collateral healthy tissues are shielded in an unprecedented manner. </li></ul>
  20. 22. Chemotherapy <ul><li>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. </li></ul>
  21. 23. Photodynamic Therapy <ul><li>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. </li></ul>
  22. 24. Targeted Therapy <ul><li>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. </li></ul>
  23. 25. Residual Deficits <ul><li>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. </li></ul>
  24. 26. Rehabilitation after the Surgery <ul><li>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. </li></ul><ul><li>Rehabilitation may include : </li></ul><ul><ul><ul><li>Physical therapy, </li></ul></ul></ul><ul><ul><ul><li>Dietary counseling, </li></ul></ul></ul><ul><ul><ul><li>Speech therapy, </li></ul></ul></ul><ul><ul><ul><li>Learning how to care for a stoma after a laryngectomy. </li></ul></ul></ul><ul><ul><ul><li>Reconstructive and plastic surgery to rebuild the bones or tissues of the mouth </li></ul></ul></ul>
  25. 27. Follow Up <ul><li>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. </li></ul><ul><li>Depending on the type of cancer, medical checkups could include exams of the stoma, mouth, neck, and throat. </li></ul><ul><li>Regular dental exams may also be necessary. </li></ul>
  26. 28. What do Indian hospital have to offer? <ul><li>India has some of the world class cancer hospitals providing high quality and compassionate care. </li></ul><ul><li>We have top class doctors with vast experience of working in highly advanced cancer centers in different parts of the world. </li></ul><ul><li>These hospitals have high-end technology like Gamma Knife, IMRT, PET Scan, Novalis etc. </li></ul>
  27. 29. Contact <ul><li>To contact any of these hospitals and seek a no obligation opinion, feel free to contact: </li></ul><ul><ul><li>[email_address] </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul>
  28. 30. Thank You High Beam Global 209, Udyog Vihar, Phase – 1, Gurgaon. Phone: +91-124-4824560, Mobile : +91 - 9268278340 Fax: +91-124-4824550 E-mail: Web address: