Head and Neck Cancer

Cancers occurring in the head and neck region are usually categorised together. They form a diverse group and include cancers of the skin over this region, cancers in the sinuses, nose, mouth, throat, thyroid and salivary glands. Cancers of the brain and eye are usually not classified within the same group.

This depends on the location of the cancer.

Common to all locations

• Neck lump – may be the tumour itself or a lymph node enlarged by tumour cells
• Significant loss of appetite and loss of weight

Mouth

• Non-healing ulcer
• Tumour or growth

Throat (larynx, oropharynx & hypopharynx)

• Hoarseness
• Persistent sore throat
• Difficulty or pain on swallowing

Nose (nasal cavity, sinuses & nasopharynx)

• Blood-stained mucus or nose bleed
• Nasal blockage
• Nasal blockage

Skin

• New skin nodule especially if growing
• New mole especially if growing or irregular pigmentation
• Non-healing ulcer

Head and neck cancer and its treatment can lead to significant problems functionally and cosmetically even if cured. Prevention is certainly better than cure in this situation and the greatest risk reduction can be achieved by not smoking and not consuming alcohol.

Risk factors for head and neck cancer include:

• Smoking
• Drinking alcohol
• Tobacco or betel nut chewing
• Excessive sun exposure for skin cancer
• Family history of nasopharyngeal cancer (NPC)

The total increase in risk with smoking and alcohol together is higher than the sum of their individual risks.

When you have any of the above symptoms, your primary care doctor will refer you to an Otolaryngologist or Head & Neck Surgeon. Your surgeon will first perform a complete head and neck examination, which will usually include examination of the mouth, flexible fibreoptic endoscopy of the nose, pharynx and larynx and examination of the neck.

Depending on the suspected location and type of tumour, the following investigations may be ordered.

To determine the type of cancer

• Biopsy – removing a small piece of tumour for testing if it can be easily reached
• Fine needle aspiration cytology (FNAC) – using a needle to extract cells for testing, from lymph node or if tumour is deep

To evaluate extent or stage of cancer

• CT or MRI scan of the head and neck region
• CT of lungs and liver
• Bone scan

Miscellaneous tests

• EBV serology – blood test for risk of nasopharyngeal cancer

A diagnostic operation, panendoscopy, may be necessary on top of the above investigations, to accurately determine the extent of the tumour and examine the rest of the areas at risk for a second cancer, which may exist in up to 10% of patients.

This operation involves examining the entire pharynx and larynx (throat), trachea (windpipe) and oesophagus (food passage) with the aid of rigid scopes under general anaesthesia.

After completion of staging, in some hospitals, patients may be discussed in a multidisciplinary tumour board, comprising surgeons, medical oncologists, radiation oncologists, pathologists, radiologists and nuclear medicine physicians. All treatment options will be presented to patients, together with recommendations.

Stage 1 and 2 cancers are considered early-stage disease and a single modality of treatment is usually sufficient. This may be surgery or radiotherapy. Chemotherapy alone is not the treatment of choice for head and neck cancers.

Stage 3 and 4 cancers are considered advanced-stage disease and require multiple modality treatment.

This involves various combinations of surgery, radiation and chemotherapy:

• Surgery followed by radiation
• Surgery followed by chemotherapy and radiation
• Chemotherapy and radiation alone