What are Head and Neck Cancers ?

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.

Types of Head and Neck Cancer

Head and neck cancer can be categorized into 5 main types that are named after the body part from where they start. Five main types include -

Nasaopharyngeal Cancer: The nasopharynx is the airway passageway at the upper part of the nose at the back of the nose.

Salivary Gland Cancer: Saliva produced by the salivary gland is the fluid that is released within the mouth in order to keep the mouth moist. Mouth helps in breaking down the food as it contains certain enzymes.

Hypopharyngeal and Laryngeal Cancer: A tube shaped organ located in the neck used for swallowing, breathing and talking is the larynx. The hypopharnx, also referred to as gullet, is the lower part of the throat surrounding the larynx.

Oropharyngeal and Oral Cancer: Both tongue and the mouth is included in the oral cavity. The middle part of the throat is included in oropharynx.

Paranasal Sinus and Nasal Cavity Cancer: The air-filled areas surrounding the nasal cavity is known as the paranasal sinuses. The space at the back of the nose from where air passes on the way to the throat is known as the nasal cavity.

Symptoms of Head and neck Cancer

• 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

Staging of Head and Neck Cancer

TNM staging is considered as the most common staging for head and neck.

• The size of the tumor is described by T
• The spread of the cancer to the lymph node and also the involvement of nodes is described by N
• The spread of the cancer to another part of the body is described by M

Diagnosis of Head and Neck Cancer

Urine and blood test /Physical examination: Lumps in the cheeks, lips, neck and gums are examined by performing a physical examination of a patient. Abnormalities are also noticed by inspecting throat, nose, tongue and mouth. Cancer can be diagnosed by performing urine and blood tests.

Biopsy: A small amount of tissue is removed for examining under a microscope for diagnosing head and neck cancer.

X-ray: This helps in creating pictures of the structures within the body by using little radiation. The abnormalities of the swallowing passage can be identified by a barium swallow.

Endoscopy: The inside of the body can be viewed by using flexible and light tube known as an endoscope. The head and neck areas are examined by inserting this tube through the nose into the throat.

Ultrasound: The picture of the internal organs is created by performing an ultrasound that uses sound waves.

Bone Scan: Radioactive tracer is used for looking inside the bones. This tracer is injected into the vein of a patient. This is detected by a special camera as it gets collected in the bone areas. Gray color appears representing a healthy bone and dark color represents the injured areas due to cancer.

Computed Tomography Scan: A tumor or abnormalities of the head and neck are viewed by performing computed tomography (CAT or CT) scan.

Positron Emission Tomography (PET) Scan: By the means of this scan, the pictures of tissues and organs within the body are created. The injection of a radioactive substance is done into the body of a patient. The tissues and organs that use most of the energy absorb this radioactive substance. It is the tendency of the cancer to use energy actively thereby absorbing more radioactive substance.

Magnetic Resonance Imaging (MRI): The detailed images of the body that include base of the tongue and the tonsils are produced by performing an MRI that makes use of magnetic fields.

Panorex: The x-ray of lower and upper jawbones is performed for detecting cancer or for evaluating teeth before chemotherapy or radiation therapy.

Head and Neck Cancer Treatment

Chemotherapy, surgery and radiation therapy are the three main types of treatment for administering head and neck cancer. Surgery or radiation therapy is considered as the primary treatments while chemotherapy is usually used as an adjuvant or additional treatment. Primary cancer can be easily treated with the help of radiation therapy. Radiation therapy can also effectively treat the neck. A neck dissection is also sometimes necessary for removing involved lymph nodes in the neck when the amount of disease in the neck nodes is very wide.

Surgery is considered as a very important treatment that can be done either before or after the radiation therapy. Radiation therapy is given afterward when it is necessary to remove the primary tumor surgically. The tumor is first tried to shrink by using radiotherapy and surgery is followed by radiotherapy. Following radiation therapy procedures are used for treating head and neck cancer -

• Intensity-Modulated Radiation Therapy (IMRT): The specific areas inside the tumor or malignant tumors are targeted by this high-precision radiotherapy that makes use of computer-controlled x-ray accelerators that delivers precise radiation doses. The high intensity radiation beam is focused on the tumor so as to damage it without disturbing any surrounding healthy cells.
• External Beam Therapy (EBT) : Through this therapy, a high-energy beam x-rays are delivered at the location of the tumor. The tumor site is the target of this beam and it can destroy cancer cells while sparing nearby healthy tissues. There is no placement of radioactive sources in the body of a patient.