Understanding Head & Neck Cancers

  • Apr 20, 2019
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  • More than one million cases annually in India.
  • Commonly affects adults of all age groups.
  • About 75% of head and neck cancers due to alcohol and tobacco abuse.

Causative agents and risk factors

  •  Alcohol or tobacco abuse
  • Human papillomavirus
  • Radiation exposure
  • Certain workplace exposures
  • Epstein-Barr virus
  • Gastro-oesophageal reflux disease

Sites affected

  1. Nasopharynx
  2. Oral cavity: Lips, oral tongue, hard palate, buccal mucosa, gingivobuccal sulcus, floor of the mouth, alveolus
  3. Oropharynx: Base of the tongue, vallecula, pharyngeal wall, soft palate, uvula, tonsils
  4. Hypopharynx: Post-cricoid area, pyriform fossa, pharyngeal wall
  5. Larynx: Supraglottic, glottic, subglottic
  6. Maxillary sinuses
  7. Orbital tumours
  8. Thyroid malignancies

 

Histopathology varieties

  1. Squamous cell carcinoma
  2. Adenocarcinoma
  3. Others: Lymphoma, sarcoma, adamantinoma, esthesioneuroblastoma, adenoid cystic carcinoma, etc.

 

Clinical features

  1. Mass in the neck
  2. Neck pain
  3. Bleeding from the mouth
  4. Sinus congestion, especially with nasopharyngeal carcinoma
  5. Bad breath
  6. Sore tongue
  7. Non-healing painless ulcer/sores in the mouth
  8. White, red or dark patches in the mouth that won’t go away
  9. Earache
  10. Unusual bleeding or numbness in the mouth
  11. Lump in the lip, mouth or gums
  12. Enlarged lymph glands in the neck
  13. Slurring of speech (if cancer affects the tongue)
  14. Hoarse voice persists for more than six weeks
  15. Sore throat persists for more than six weeks
  16. Difficulty in swallowing food
  17. Change in diet or weight loss

 

Diagnosis

  1. History and physical examination
  2. Endoscopies
  3. Histopathology/cytology/IHC
  4. CECT (face and neck)
  5. Chest X-ray, ultrasonography (abdomen and pelvis)
  6. PET – CT when indicated

 

Treatment

  1. Surgery: the mainstay of treatment, necessary when indicated.
  2. Radiotherapy:
    1. Radical intent (organ preservation in cases of Ca-Larynx, Oropharynx.
    2. Adjuvant intent: after surgery, as per post-op histopathology report.
    3. Palliative: for symptom control such as bleeding, pain in advanced or metastatic cases.
  3.  

  4. Chemotherapy:
    1. Neo-adjuvant: before any definitive treatment, for organ preservation plan.
    2. Concurrent: along with radiation for enhancing the effect of radiotherapy.
    3. Adjuvant: tried in the past, but no definite role.
    4. Palliative: in advanced/metastatic cases for symptom control.

 
Prognosis
Curable if detected early. As the stage progresses, the prognosis is poorer.

Prevention

  1. Quit tobacco and alcohol.
  2. Creating public awareness.
  3. Regular screening programs.
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