Head & Neck Cancers

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.
Chat Now