Head & Neck Cancers
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
- Nasopharynx
- Oral cavity: Lips, oral tongue, hard palate, buccal mucosa, gingivobuccal sulcus, floor of the mouth, alveolus
- Oropharynx: Base of the tongue, vallecula, pharyngeal wall, soft palate, uvula, tonsils
- Hypopharynx: Post-cricoid area, pyriform fossa, pharyngeal wall
- Larynx: Supraglottic, glottic, subglottic
- Maxillary sinuses
- Orbital tumours
- Thyroid malignancies
Histopathology varieties
- Squamous cell carcinoma
- Adenocarcinoma
- Others: Lymphoma, sarcoma, adamantinoma, esthesioneuroblastoma, adenoid cystic carcinoma, etc.
Clinical features
- Mass in the neck
- Neck pain
- Bleeding from the mouth
- Sinus congestion, especially with nasopharyngeal carcinoma
- Bad breath
- Sore tongue
- Non-healing painless ulcer/sores in the mouth
- White, red or dark patches in the mouth that won’t go away
- Earache
- Unusual bleeding or numbness in the mouth
- Lump in the lip, mouth or gums
- Enlarged lymph glands in the neck
- Slurring of speech (if cancer affects the tongue)
- Hoarse voice persists for more than six weeks
- Sore throat persists for more than six weeks
- Difficulty in swallowing food
- Change in diet or weight loss
Diagnosis
- History and physical examination
- Endoscopies
- Histopathology/cytology/IHC
- CECT (face and neck)
- Chest X-ray, ultrasonography (abdomen and pelvis)
- PET – CT when indicated
Treatment
- Surgery: the mainstay of treatment, necessary when indicated.
- Radiotherapy: Radical intent (organ preservation in cases of Ca-Larynx, Oropharynx.
- Adjuvant intent: after surgery, as per post-op histopathology report.
- Palliative: for symptom control such as bleeding, pain in advanced or metastatic cases.
- Chemotherapy: Neo-adjuvant: before any definitive treatment, for organ preservation plan.
- Concurrent: along with radiation for enhancing the effect of radiotherapy.
- Adjuvant: tried in the past, but no definite role.
- Palliative: in advanced/metastatic cases for symptom control.
Prognosis
- Curable if detected early. As the stage progresses, the prognosis is poorer.
Prevention
- Quit tobacco and alcohol.
- Creating public awareness.
- Regular screening programs.