Head and Neck Cancer
Head and neck cancer is a group of cancers that starts in or near your throat, voice box, nose, sinuses, or mouth. Usually, it begins in the cells that line the surfaces of these body parts. Doctors call these squamous cells.
There are five main types of head and neck cancer. They are named for the specific part of your head or neck they affect. The symptoms are a little bit different for each.
Oral cavity
This type of cancer affects your lips and the inside of your mouth. This includes:
- Your gums
- The insides of your cheeks
- Under your tongue
- The top of the inside of your mouth (hard palate)
- The front two-thirds of your tongue
The symptoms of oral cancer are:
- Red or white patches in your mouth, including your gums and tongue
- Swelling in your jaw, including swelling that makes false teeth fit badly
- Bleeding or pain in your mouth
Pharynx
This is another name for your throat. It is a tube about 5 inches long, that goes from behind your nose to the top of your esophagus (which is the tube in your chest leading down to your stomach). Your pharynx includes your tonsils, the back of your tongue, and your soft palate. That is the soft part at the back of the roof of your mouth.
The symptoms of cancer of your pharynx are:
- Trouble breathing or talking
- Painful swallowing
- Neck or throat pain that does not go away
- Earaches, pain, or ringing in your ears that keeps coming back
- Trouble hearing
Larynx
This is your voice box. It holds your vocal cords and your epiglottis. That is the little piece of flesh that hangs in the back of your throat. It caps over your larynx when you eat or drink to keep food and liquid from getting in (“going down the wrong pipe”).
Symptoms of larynx cancer include:
- Painful swallowing
- Ear pain
- Changes in your voice
Nasal cavity and paranasal sinuses
Your nasal cavity is the space inside your nose. The paranasal sinuses are small spaces in the bones of your head around your nose.
See your doctor if you have symptoms of this type of cancer. Here are signs to look out for:
- Chronic sinus infections that antibiotics do not cure
- Blocked sinuses you cannot clear
- Nosebleeds
- Headaches
- Swelling around the eyes
- Pain in your upper teeth
- Problems with false teeth not fitting anymore
Salivary glands
These make saliva (spit). They are in the lower part of your mouth near your jawbone.
The following are symptoms of salivary gland cancer:
- Swelling under your chin
- Swelling around your jawbone
- Numb or paralyzed face muscles
- Pain in your face, chin, or neck that does not go away
The biggest cause of head and neck cancers is tobacco. This includes chewing tobacco and using snuff, not just smoking. Secondhand smoke(smoke from other people’s cigarettes, cigars, or pipes) can also raise your risk of getting head and neck cancer.
Drinking too much alcohol raises your risk, too. If you use tobacco and drink too much alcohol, you raise your risk even more. Other things that raise your risk are:
- Getting too much sun
- Human papilloma virus (HPV), a type of sexually transmitted disease
- Epstein-Barr virus, the virus that causes mononucleosis (mono)
- Being a man
- Being older than 40
- Being African-American
- Not taking care of your mouth and teeth
- Breathing in asbestos, wood dust, paint, or other chemical fumes
- Smoking pot
- Not getting enough vitamin A or B
- Acid reflux
- Having a weak immune system
Each kind of head and neck cancer has specific symptoms, but there are some general ones, too. They are:
- A lump in your neck
- Growths or sores in your mouth (even if they do not hurt)
- Blood in your spit or phlegm
- Changes in your skin that may signal skin cancer
During the check-up, your doctor will look inside your mouth, nose, and throat, and check for lumps in your neck. This is especially true if you use tobacco or have used it in the past, or you drink regularly.
If you have symptoms of a head or neck cancer or your doctor finds anything strange at your yearly exam, you might have to get a few tests to confirm the diagnosis, and stage of cancer. These include:
- Blood tests
- Endoscopy (a doctor looks at the inside of your head and neck with a tube that goes in through your nose and down your throat)
- Tissue sample (biopsy) and relevant tests (to determine HPV status) on the tumour
- X-rays and scans for staging
What treatment is offered?
Treatment of head and neck cancers is best guided by a multi-disciplinary approach. A few factors for consideration are:
- Location of cancer
- Stage of cancer (if lymph nodes or distant spread is present)
- Age and general health of patient
- Presence of HPV (which may affect the prognosis)
You might get just one kind of treatment, or you might get a combination of them. Options include surgery, radiation, chemotherapy, and targeted therapy.
Surgery
Resection of the tumor +/- lymph nodes is performed.
Radiation Therapy
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area.
Chemotherapy
Chemotherapy uses anticancer drugs to shrink/kill cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body.
Targeted Therapy
Targeted therapy uses drugs to block the growth and spread of cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body.
Immunotherapy
This treatment uses parts of your immune system to help fight cancer.
In early stage and localised cancer:
Surgery is usually performed. Your doctor might zap the cancer with a laser or take out the tumour and some of the healthy tissue around it. Your doctor might take out some of the lymph nodes in your neck as well.
Depending on the size and lymph node involvement, some patients may require further chemo/ radiation.
In patients who are deemed unsuitable for surgery, chemo- radiation may be performed.
In advanced, metastatic cancer:
In patients with advanced cancers not amenable to local treatment, usually a combination of chemotherapy and/ or immunotherapy/ targeted treatment (such as cetuximab) can be used for control of the cancer.
CanHOPE is a non-profit cancer counselling and support service provided by Parkway Cancer Centre, Singapore. CanHOPE consists of an experienced, knowledgeable and caring support team with access to comprehensive information on a wide range of topics in education and guidelines in cancer treatment.
CanHOPE provides:
- Up-to-date cancer information for patients including ways to prevent cancer, symptoms, risks, screening tests, diagnosis, current treatments and research available.
- Referrals to cancer-related services, such as screening and investigational facilities, treatment centres and appropriate specialist consultation.
- Cancer counselling and advice on strategies to manage side effects of treatments, coping with cancer, diet and nutrition.
- Emotional and psychosocial support to people with cancer and those who care for them.
- Support group activities, focusing on knowledge, skills and supportive activities to educate and create awareness for patients and caregivers.
- Resources for rehabilitative and supportive services.
- Palliative care services to improve quality of life of patients with advanced cancer.
The CanHOPE team will journey with patients to provide support and personalised care, as they strive to share a little hope with every person encountered.