head and neck
cancer
what is cancer?
Cancers are cells in the body that have forgotten how to behave normally and grow out of control. This can allow them to grow into normal tissue and spread to other parts of the body and take root. All cancers are malignant, meaning they have the potential to cause serious complications and potentially lead to the end of a person's life should they be left untreated.
cancers of the head and neck
Head and neck surgeons deal with cancers in the region above the collar bone, excluding the eye and the brain. This is a very diverse area containing many different structures and types of tissue, such as the nose, mouth, throat and ears. The majority of these structures are essential to normal function, which makes treatment of head and neck cancers complex and challenging.
Based on local data (Malaysian National Cancer Registry Report 2012-2016), head and neck cancers as a whole made up the 3rd and 4th most common cancers for men and women, respectively. Given the large numbers, it is advisable to understand how to reduce your chance of getting it and also what symptoms to look for if you suspect you have head and neck cancer.
risk factors
Smoking: Smoking is a major risk factor for developing head and neck cancer. Just like with the lung, areas exposed to smoking or secondhand smoke have a much higher chance of turning cancerous. The risk from smoking can gradually decrease over years once smoking is stopped, however it can never return to normal.
Alcohol: Drinking alcohol can also increase your risk of getting cancer. Alone, the risk is slightly lower than from smoking, but if taken together, the risk from both smoking and drinking alcohol is multiplied. This is especially true for cancers of the larynx (throat).
Betel nut (sirih): Chewing betel nut is a common activity in Asian countries however it is strongly linked to mouth cancer. Just like with smoking, risk decreases after stopping but the changes to the tissue can never fully recover.
Chronic ulcers and tongue biting: Areas of repeated trauma due to cracked teeth, recurrent biting or poor fitting dentures can also turn cancerous.
Human papilloma virus (HPV): Certain strains of HPV will also increase the risk of developing cancer in the mouth and throat. This is important in sexually active individuals.
Genetics: Having a family history of head and neck cancer is important, especially in nasopharyngeal (back of the nose) cancer (NPC). Family members of NPC patients have a higher risk of developing the disease.
symptoms to look out for
A lot of head and neck cancers tend to have an occult presentation, meaning they do not give very obvious symptoms until they are very large. Symptoms can depend on the location which the cancer originates from, and to address each one is beyond the scope of this article.
Generally, as the cancers grow they lead to a dysfunction on the organs that they originate from, such as a change or loss of voice in throat cancer, or nasal obstruction and facial swelling in nose or sinus cancer. Cancers of the mouth can present as a chronic non healing ulcer.
As the cancer grows, it can spread via the lymph nodes of the neck and give rise to neck swellings. These tend to be nontender and go not go away on their own.
diagnosis
If you suspect you have cancer, you should schedule a visit to a head and neck surgeon for consultation. This will usually involve a detailed history about your symptoms followed by a physical examination that might involve a scope test in order to try to locate the source of your symptoms.
Additional scans may also be done.
If an area suspicious of cancer is found, a biopsy will be arranged to take a sample of the tissue for examination in the laboratory to identify if there are truly any cancer cells.
treatment
The treatment of head and neck cancers will depend on how advanced the cancer is and where it has spread to. If it has not grown out from the head and neck region, then typically surgery to remove the entire cancer will be performed. This involves taking out the area which the cancer grows from and also removing the lymph nodes in the neck that can be affected by it.
After surgery, chemotherapy or radiotherapy may be advised in order to fully eradicate the disease. This is a decision that will depend on the stage of the disease. The surgeon and the oncologist will decide jointly on what is needed.
conclusion
Be wary of symptoms that might point towards having head and neck cancer, such as chronic nonhealing ulcers, or persistent nontender neck swellings. If you suspect that you have cancer, please see a head and neck surgeon at the earliest possible time.
Otherwise, you can lower your risk of developing head and neck cancer by addressing any of the risk factors mentioned above.
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Stop smoking and minimise alcohol consumption.
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Avoid chewing betel nut.
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Have your dentist treat and correct any cracked teeth to prevent biting.
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Women are advised to have their HPV vaccinations, as this can protect not only against certain head and neck cancers, but cervical cancers as well.
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If you do have a family history of nasopharyngeal cancer (NPC), it is advised to go for regular screening scopes with an ENT surgeon.
