Head and neck cancers account for 3 to 5 percent of all cancers. These include cancers originating from the nasal cavity, sinuses, lips, mouth, thyroid, salivary glands, larynx (voice box) and throat. These cancers usually occur in men and are more common in patients over the age of 50.
What causes Head and Neck Cancers?
Smoking and alcohol abuse are by far the most important risk factors for head and neck cancers, and the risk is much higher for people who use both tobacco and alcohol together. People who chew tobacco have an increased risk of developing mouth cancers. In cancers of the thyroid and nasopharynx, a positive family history of cancer is an additional important risk factor. Previous exposure to radiation also increases the risk of thyroid cancer.
What are the Symptoms?
The most common symptom is the presence of a neck lump. Lumps or growths in the head and neck region are very common and there are multiple causes for the lumps, ranging from benign to malignant. Cancers in the head and neck usually spread first to the lymph nodes in the neck, causing them to be enlarged (and often painless). Therefore any lymph node which persists for more than 2 weeks needs to be assessed by a medical professional. Thyroid and salivary gland lumps also should not be ignored as there is a small but significant risk that these lumps may turn out to be cancerous.
Additional important symptoms that may suggest that cancer is present include:
Blood-stained mucus from the nose or throat (bleeding can occur from tumors in the nasal cavity or throat which are often hidden and may not be readily apparent to the patient)
Ulcers in the mouth or throat that do not heal (any ulcer or growth in the mouth persisting for more than 2 weeks will require examination and possible biopsy)
Difficulty swallowing solid food or even liquids (cancers in the throat and oesophagus usually cause problems with swallowing and endoscopy or a barium swallow x-ray may be necessary)
Hoarseness or a change in your voice (cancers in the larynx or voice box will result in voice changes and therefore the vocal cords need to be examined by an ENT specialist)
Persistent ear pain or unexplained facial pain
What diagnostic tests are available?
While the traditional practice of taking a medical history and thorough physical examination is still important, new diagnostic methods have allowed the ENT-head & neck surgeon to assess and evaluate a patient with possible head and neck cancer to provide an accurate diagnosis. Flexible fibreoptic endoscopes are routinely used to visualize areas in the head and neck which previously were hidden or poorly assessed such as the nasal cavity and larynx. Videostroboscopic examination of the larynx allows tiny lesions of the vocal cords to be picked up, and the functioning of the larynx can also examined. Fine needle aspiration biopsies to obtain tissue from the lumps for microscopic examination are now done in the clinic setting with minimal discomfort. This enables the clinician to quickly assess the histologic characteristics of the lump and determine the presence of cancer. Imaging methods to assess head and neck lumps such as ultrasound, computed tomography scans (CT) or magnetic resonance imaging (MRI) are ideally suited for the head and neck region. New imaging techniques such as PET-CT scans and 64 or 320 slice CT scanning are now routinely available and provide additional important information for the surgeon.
What are the treatments available?
Surgery for head and neck cancers has traditionally been the treatment of choice, and is still indicated for many cancerous lumps. However the use of radiotherapy and chemotherapy (often in combination) is increasingly important for the treatment of head and neck cancers. These new treatment options allow for the preservation of some of the important structures in the head and neck such as the voice box and throat, without compromising the eventual cure rate of the patient. The ENT-Head & Neck surgeon will be able to advise the patient in the optimal and ideal treatment choices. For patients undergoing surgery, new techniques of rehabilitation allow for the quality of life to be preserved. An example is the use of voice prostheses to enable patients to speak after cancer surgery of the larynx. The development of multidisciplinary teams for the treatment of head and neck cancers (inclusive of plastic surgeons, dental surgeons, speech and swallow therapists) provides new reconstructive and therapeutic methods. These techniques enable us to achieve the best possible outcome for the patient.