Head and Neck Cancer: Symptoms, Types & Treatment

Dr.Parveen Jain, 4 mins read

Head & Neck Cancer (H & N Cancer) refers to a group of biologically similar cancers that arise in the head and neck region [comprising the lip, oral cavity (mouth), nasal cavity, sinuses, pharynx, larynx (voice box), salivary glands and thyroid]. H & N Cancer ranks sixth amongst all cancers worldwide and 3rd in India. Generally, it is an ailment of the elderly (>50yrs of age) though recently there has been a steady increase in incidence in the younger generation.
Tobacco in any form (viz. cigarettes, cigars, bidis, chewing tobacco, catechu, lime, betel nut, marijuana) contributes to over 80% of all H & N Cancers. The combination of tobacco and alcohol are direct causative factors for nearly 85% of all H & N Cancers. If tobacco is banned completely, the incidence of H & N Cancer would be reduced to 1/5th of its occurrence today. However, there are other risk factors like poor oral hygiene, sharp teeth, ill-fitting denture, Human Papilloma Virus (HPV) infection, etc.

Symptoms of Head and Neck Cancer:-

Symptoms of H & N Cancer vary according to the site of origin of the cancer. H & N Cancer very often occurs without any warning sign/symptom. Because of this characteristic, patients with H & N cancer often present with advanced disease - a fact that makes annual cancer screening important in high-risk individuals like those who are addicted to tobacco and/or alcohol. The presence of any of the following, if present for more than four weeks mandates a visit to an oncologist:

• A non-healing sore/ulcer in the mouth/tongue/lip 
• A white or red patch on the gums, tongue, or lining of the mouth 
• Swelling of the gums that prevent dentures from fitting properly
• Loose teeth 
• Inability to protrude the tongue 
• Inability to open the mouth properly
• Unusual bleeding, pain, or numbness in the mouth or the cheek 
• Thickening of the cheek 
• Earache/headache 
• Feeling of something getting stuck in the throat/ a sore throat that does not go away 
• Painful and/ or difficulty in swallowing 
• Change in voice/hoarseness 
• Difficulty in breathing 
• Swelling in the midline of the lower neck which moves with swallowing 
• Progressively enlarging lumps in the neck 
• Swelling around and/ or under the jaw may be accompanied by numbness or paralysis of one side of the face. 
• Weight loss 
• Streaking of blood in sputum 

Diagnosis Of Head and Neck Cancer:-

Endoscopy: An endoscope is a lighted tube, which may be rigid or flexible and is used to examine various internal parts of the human body. Endoscopes are named according to the site they are meant to examine, e.g. Laryngoscope for the larynx (voice box), Esophagoscope for the esophagus (food pipe), and Nasopharyngoscope for the nasal cavity and the Nasopharynx.

Imaging studies depend on the area of suspicion:

• An X-ray may be a plain film or maybe with contrast like a barium swallow (for the throat) 
• A chest X-ray is always advisable to rule out any spread to the lungs 
• Ultra-sonography of the neck to study the status of the lymph nodes in the neck and also the thyroid gland. 
• CT scan for a detailed study of the concerned site to know about the loco-regional spread of the disease. 
• MRI (Magnetic Resonance Imaging) for detailed study of the soft tissue (especially helpful in cancer of the tongue). 
• Positron Emission Tomography (PET) scan, when combined with a CT scan (PET/CT scan) is a very important tool for diagnosing distant metastases & in the post-treatment scenario ruling out recurrent disease. 
• Laboratory tests include examination of various components of the blood and urine. 

Once the diagnosis of cancer is confirmed, the patient is then staged. Staging gives information regarding the extent of cancer and helps the clinician in planning the treatment. 

Clinical examination is an important step for the staging of H & N Cancers. But, often, the doctor would need X-ray reports, CT scan, MRIs, or their combinations to assess the extent of the problem in totality. This is critical for fine-tuning the treatment for control of the disease. Generally, before starting the treatment, the Doctor will discuss the option with the patient to help one understand the disease, the process, treatment, and treatment options.

Treatment for Head and Neck Cancer:- 

• Surgery: The goal of surgery is to remove the tumor with a good margin all around and also remove the lymph nodes. Depending on the afflicted area wide excision may include a surrounding structure also. E.g., in some cases, a rim or segment of the jaw bone may be removed so that there is no compromise on getting a microscopic clean margin. While the Onco-surgeon is focused on getting the tumor out, he/ she would have a plan for reconstruction which is often discussed with an Aesthetic Surgeon and the patient, in advance. You may discuss with your surgeon the loss of tissue expected and the plan for reconstruction. He/She would use line diagrams to explain the whole process to you. 
• Radiation Therapy: Entails the use of high-energy X-rays to kill cancer cells. The source of radiation may be from a machine outside the body (external beam radiotherapy) or radioactive materials inserted into the involved organ (Brachytherapy). Many locally advanced H & N Cancers are treated with a combination of Radiation and Chemotherapy. This treatment takes advantage of both modalities of treatment for improving cure rates and conserving the organ affected by the disease.
• Chemotherapy:  Chemotherapy slows the growth of cancer cells or kills them. Chemotherapy is given in cycles spread over a few weeks or months. It is usually administered in the daycare area of the hospital. You will be required to undergo frequent physical examinations and blood tests to ensure everything is going well. 

Many patients with H & N Cancer will require chemotherapy either concurrently with radiation therapy or as a standalone modality where the disease has already spread to other organs. The Medical Oncologist will plan therapy according to your case. 

• Immunotherapy:  These are newer therapies that help your immune system fight cancer. These are used either in combination with chemotherapy or as a single agent where the disease has already spread to other organs. 
• Biological/Targeted therapy:  These are the therapies that are specifically designed to interfere with the growth of cells. These are used alone or in combination with chemotherapy. 

Also, Read: Cancer prevention 6 tips to reduce your risk