Head and Neck Cancer

What are head and neck cancers?

Head and neck cancers account for more than 5.5 lakh of the total cancer cases reported in India every year, putting India in the sixth place worldwide. 80 per cent of the cancer is attributed to tobacco consumption, while 75 per cent is due to alcohol.Cancers in the mouth, throat, salivary glands, nose and sinuses are collectively termed head and neck cancers.

Types of head and neck cancers

Mouth (oral) cancer

Cancer occurring in the tissues of oral cavity is termed as oral cancer. It accounts for around 30% of all cancers in India. More men suffer and die from oral cancer than women.

  • A persistent sore in the mouth or  face which does not heal
  • Difficulty or decrease in opening the mouth
  • Development of white, red or mixed patches on tongue, gums or inner linings of mouth
  • A lump or hard mass in the neck
  • Chronic pain in mouth, tongue/jaw pain
  • Difficulty in chewing or swallowing
  • Swelling, thickening, lumps or bumps on lips, gums or inner cavity of mouth
  • Hoarseness or change in voice
  • Loose teeth and ill-fitting dentures
  • Unexplained weight loss

Throat cancer

Cancerous tumors that develop in the organs that help you swallow and speak are termed as throat cancers. It most often begins in the flat cells lining the inside of the throat and can also affect  the piece of cartilage (epiglottis) that acts as your windpipe.

Nose cancer

Nasal cavity and paranasal  cancers affects the sinuses, or spaces in the bones of the face near the nose are termed as nose cancers.  They are usually found because of signs or symptoms a person is having. Many of the symptoms of these cancers can also be caused by infections ,because of which these cancers aren't found until they have grown large enough to block the nasal airway or sinuses, or until they've spread to nearby tissues or even to distant parts of the body.

  • Nasal cavity
  • Paranasal sinuses
  • Nasal congestion and stuffiness that doesn’t get better or even worsens
  • Pain above or below the eyes
  • Blockage of one side of the nose
  • Nasal drainage in the back of the nose and throat
  • Nosebleeds
  • Pus draining from the nose
  • Decreased or loss of sense of smell
  • Numbness or pain in parts of the face
  • Constant watery eyes
  • Headache
  • Enlarging lymph nodes in the neck (seen or felt as lumps under the skin)

Diagnosis of head and neck cancers

Medical history, General physical examination and Oral examination

Lifestyle history: A complete history is taken before the examination regarding duration and frequency of tobacco use in any form like cigarette, beedi, chewing pan, gutka, khaini etc and of alcohol consumption.

General physical & oral examination: A careful examination of entire inner cavity of the mouth which includes the roof of mouth, back of the throat, and inside of cheeks and lips is then carried out. Your doctor looks for red or white patches or any other abnormal areas over head, neck or face ,for example lumps, swelling or any other problem with the nerves of mouth or face. If any abnormal area is found during examination, it is confirmed by further tests which are detailed below.

Invasive tests

Brush cytology: In this test, the suspected area/lesion is  brushed  and the cells  are looked at under microscope for abnormal cells by a pathologist.

Fine Needle Aspiration Cytology (FNAC): FNAC is generally used to diagnose metastatic carcinoma of head and neck, in the cervical region. In this test, a thin needle which is attached to a syringe is used to draw few cells from the suspected lump or swelling. These cells are smeared onto a glass slide, then stained and examined under microscope by a pathologist to examine for abnormal cells.

Biopsy: A small piece of tissue is taken from suspicious area using a punch biopsy instrument. Sometimes it may be done under the guidance of endoscopy, if the lesion is not easily accessible. This tissue is processed in the laboratory and examined for presence or absence of cancer.

Imaging tests

Imaging tests are done to confirm the diagnosis and document the extent of spread of disease, staging etc. The most common diagnostic imaging tests are X-rays, CT scan, MRI and PET scan and reported by the radiologist.

HPV tests

Human Papillomavirus (HPV) Testing: Oral cancers with HPV infection are on the rise. It is a screening test that identifies the type(s) of oral Human papillomavirus (HPV), a viral infection that could potentially lead to oral cancer. Your doctor will recommend to test the biopsy to rule out HPV infection as the possible cause.

IHC tests

Immunohistochemistry (IHC) Testing: Tissue sample is taken from the cancer site and sent to pathology lab to see if the programmed cell death ligand (PD-L1) is expressed in their cancer. Your doctor will recommend to test the biopsy sample to know if your cancer will respond to Immunotherapy.

Omics diagnostic tests

Genomics & Transcriptomics: Tests that can identify DNA-& RNA based changes (point mutations, gene amplification, fusion, deletion, insertion, or nucleotide polymorphisms) leading to abnormality at the gene level and requires personalised medicine approach.

Tissue sample is taken from the cancer site and sent to a Genomics lab to see if there any genomic abnormalities or mutations in your cancer. For example If your cancer has genomic abnormalites /mutations in the epidermal growth factor receptor ( EGFR) gene, Your doctor will recommend treatments that target the EGFR protein as researchers have found that drugs that block EGFR help stop or slow the growth of certain types of head and neck cancer.

Cancer care team for head and neck cancers

  • Medical oncologist
  • Radiation oncologist
  • Surgical oncologist
  • Reconstructive/plastic
  • surgeon
  • Maxillofacial prosthodontist
  • Otolaryngologist
  • Oncology nurse
  • Physical therapist

Treatment of head and neck cancer

Targeted therapy

Radiation therapy

Immunotherapy

Chemotherapy

Onco surgery

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