Head and Neck Cancer in India and other developing countries is a common form of cancer. More than one lakh Head and Neck Cancer cases are diagnosed in India, every year. This includes Ear Cancers, Nose Cancers, Throat Cancers, Tongue Cancers and the Oral Cancers. Typically, the cells lining these organs experience a cancerous growth and affect the entire organ. Most head and neck cancers are squamous cell carcinomas, which are cancerous growths that begin in the flat squamous cells that form the inner lining of many parts of the head and neck. Invasive squamous cell carcinoma is a tumour that moves into deeper tissues and adenocarcinomas arise in the glandular cells, such as those found in the salivary glands. Alcohol and tobacco are the key etiological factors and their use increases the risk of developing Head and Neck Cancers.
The signs and symptoms vary with the location of the primary site and the stage of the cancer. The early warning signs of Head and Neck Cancer could lead to a diagnosis at an early stage and a high probability of cure in many cases. For example, hoarseness frequently occurs in the earliest stage of voice box cancers. Persistent sore throat for longer than two weeks is a possible symptom of cancer in the voice box and/or the pharynx. Other symptoms often include:
Oral cancers are most commonly seen in people who chew tobacco, but it is also seen in smokers. In addition to tobacco, today trauma due to sharp teeth and Human Papilloma Virus are emerging as cause of these cancers. They often arise on the tongue, the lip, the floor of the mouth and on minor salivary glands. Oral cancer is the uncontrolled multiplication of cancerous cells in the mouth and surrounding regions. This type of cancer may affect the tongue, lips, palate, floor of the mouth or even the pharynx and sinuses. If not treated when the disease is at an early stage, it can potentially be life threatening.
Throat cancer refers to cancerous tumours that develop in the throat. Throat cancer includes cancers of the air pipe, food pipe and those arising from the glands in the neck. Throat cancer includes cancer of the nasopharynx (the upper part of the throat behind the nose), the oropharynx (the middle part of the pharynx) and the hypopharynx (the bottom part of the pharynx). Cancer of the larynx (voice box) may also be included as a type of throat cancer.
Different cancers can develop from each kind of cell in the paranasal sinuses and nasal cavity. The nasal cavity and paranasal sinuses are lined by a layer of mucus-producing tissue with the following cell types: squamous epithelial cells, minor salivary gland cells, nerve cells, infection-fighting cells and blood vessel cells. Symptoms may include nasal blockage, nosebleed, swelling in the eyes and partial or complete loss of vision.
Cancers of the ear usually begin as skin cancers on the outer ear, ear canal or skin around the outer ear. The most common types are squamous cell carcinoma and basal cell carcinoma. If they are neglected, they may grow into the:
Head and Neck Cancers can be diagnosed with a cancer screening exam which can help detect cancer early. Early detection and screening is important because it helps save lives. Any lumps or irregular tissue changes in the initial stages require further investigation. This would be followed by biopsy and imaging studies to identify the site and the stage of cancer.
A multi-disciplinary approach is used for treatment of Head and Neck Cancers. The main treatment options are:
• Medical Oncology
• Surgical Oncology
• Radiation Oncology
Multi-disciplinary approach is known to have improved the quality of cancer care and ensure that the patient has access to the best current thinking on cancer management. This structure provides the individual practitioner and his hospital with educational tools, quality assurance and legal mechanisms to deliver state-of-the-art care. Surgery or radiation therapy by themselves or a combination of these therapies may be part of the treatment plan.
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is also given in combination with radiotherapy and before surgery to shrink the tumour and make it easier to remove, sometimes chemotherapy is given to relieve symptoms and improve quality of life.
With an increased understanding of molecular mechanisms and basic cellular pathways of cancers of the head and neck, the pathways may be modified and rational approaches in cancer therapy at the molecular level may be created. Some of the new approaches depend on tumour biology and aim specifically at inhibiting tumour growth and metastasis by targeting the tumour microenvironment or focusing on specific proteins. The goal of specific molecular targets in cancer therapy is to create a 'magic bullet' that selectively kills cancer cells. The specific components of cancer cells that are not found in normal cells can be targeted.
Surgery is performed to remove the cancerous tumour and some of the healthy tissue around it, called margin of head and neck tumours. Since these cancers are limited to site of origin, they are often treated with surgery. This procedure may be performed to obtain a diagnosis of the tumour growth or for complete removal of the tumour.
A Neck Dissection that may be performed to remove some or all of the lymph nodes in one or both sides of the neck.
Reconstructive Surgery is aimed at restoring a person’s appearance and the function of the affected area. Tissue can be taken from other parts of the body, such as the forearm, thigh or chest and used to replace tissue taken from the head and neck. If the cancer has spread to the jawbone, the affected bone will have to be removed along with the tumour. Bone taken from another part of your body (usually the lower leg) may be used to replace the missing jawbone. This is known as a free flap.
Radiation Therapy uses high-energy particles or waves (like x-rays, gamma rays, electron beams) to destroy or damage cancer cells. Radiation therapies are used along with chemotherapy and surgery, in the treatment of cancer. It is a unique blend of state-of-the-art technology and expert care by a multi-disciplinary radiation therapy team. Radiation therapies are painless and are aimed at destroying cancer cells in a specific area. It can either come from a high energy x-ray machine or from a small source of radioactive material placed close to or on the tumour.