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Head and Neck Cancer Treatment in India

Head and Neck Cancers

Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat). These squamous cell cancers are often referred to as squamous cell carcinomas of the head and neck. Head and neck cancers can also begin in the salivary glands, but salivary gland cancers are relatively uncommon. Salivary glands contain many different types of cells that can become cancerous, so there are many different types of salivary gland cancer.

Types of Head and Neck Cancer

Cancers of the head and neck are further categorized by the area of the head or neck in which they begin. These areas are described below and labeled in the image of head and neck cancer regions.

Oral cavity: Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor (bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area of the gum behind the wisdom teeth.

Pharynx: The pharynx (throat) is a hollow tube about 5 inches long that starts behind the nose and leads to theesophagus. It has three parts: the nasopharynx (the upper part of the pharynx, behind the nose); the oropharynx(the middle part of the pharynx, including the soft palate [the back of the mouth], the base of the tongue, and thetonsils); the hypopharynx (the lower part of the pharynx).

Larynx: The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.

Paranasal sinuses and nasal cavity: The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.

Salivary glands: The major salivary glands are in the floor of the mouth and near the jawbone. The salivary glands produce saliva.

Symptoms of Head and neck Cancer

The symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing, and a change or hoarseness in the voice.

Oral cavity. A white or red patch on the gums, the tongue, or the lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.

Pharynx. Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing.

Larynx. Pain when swallowing or ear pain.

Paranasal sinuses and nasal cavity. Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.

Salivary glands. Swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away

causes of head and neck cancer

  • Smoking cigarettes, cigars or pipes.
  • Chewing tobacco or betel quid (paan)
  • Alcohol.
  • Human papilloma virus (HPV) infection.
  • Diet.
  • Sunlight.
  • Exposure to chemicals.
  • Pre-cancerous conditions

Staging of Head and Neck Cancer

Staging involves using the letters T, N and M to assess tumors by:

  • the size of the primary tumor (T);
  • the degree to which regional lymph nodes (N) are involved. Lymph nodes are small organs located along the channels of the body’s lymphatic system which store special cells that fight infection and other diseases); and
  • the absence or presence of distant metastases (M) – cancer that has spread from the original (primary) tumor to distant organs or distant lymph nodes.

Each of these is categories is further classified with a number 1 through 4 to give the total stage. Thus a T1-N1-M0 cancer would describe a T1 tumor, N1 lymph node involvement, and no metastases.

Once the T, N and M are determined, a “stage” of I, II, III or IV is assigned:

  • Stage I cancers are small, localized and usually curable.
  • Stage II and III cancers typically are locally advanced and/or have spread to local lymph nodes.
  • Stage IV cancers usually are metastatic (have spread to distant parts of the body) and generally are considered inoperable.

Diagnosis of Head and Neck Cancer

Diagnosing a head and neck cancer includes one or more of the following tests

Medical History & Physical Examination: the doctor or nurse will take a complete medical history, noting all symptoms and risk factors. The doctor will thoroughly examine the head and neck area, feeling for abnormalities, looking at the inside of the mouth and throat, and using mirrors and lights to examine hard-to-see areas.

Endoscopy
In some cases, the doctor may use a flexible, lighted tube called an endoscope to examine areas of the head and neck that are less accessible. This tube may be inserted through the nose or mouth, using a topical anesthetic (a medication applied directly to the nose and throat) to make the examination more comfortable.

Urine and blood test /Physical examination: Lumps in the cheeks, lips, neck and gums are examined by performing a physical examination of a patient. Abnormalities are also noticed by inspecting throat, nose, tongue and mouth. Cancer can be diagnosed by performing urine and blood tests.

Imaging Tests
Imaging tests such as CT, MRI, or ultrasound may be required to gain more information about the location and extent of the tumor. Doctors also use PET scans to help diagnose head and neck cancers. PET scans are often combined with CT to determine whether the cancer has spread to lymph nodes in the neck or other areas of the body. Additional imaging tests may include panorex (a special x-ray of the jaws), barium swallow (which helps to image abnormalities in the esophagus), dental x-rays, chest x-rays, and radionuclide bone scanning (a sensitive method of measuring bone activity).

Biopsy
A biopsy involves removing a small amount of tissue or fluid for examination under a microscope. Depending on the size and location of the nodule or lesion, a biopsy can be performed with either a small scalpel or needle in an outpatient setting, or in the hospital while the patient is under general anesthesia.

Head and Neck Cancer Treatment

Many cancers of the head and neck can be cured, especially if they are found early. Treatment varies according to the type, location, and extent of the cancer, and often includes a combination of surgery, radiation therapy, and chemotherapy.

Surgery

Surgery is the primary (first) treatment for most cancers of the head and neck. Improvements in surgical techniques allow surgeons to remove many more tumors while preserving nearby structures involved in sensory and physical functioning. New techniques allow surgeons to remove these lymph nodes while sparing nerves that are important for shoulder function. Complex surgery to remove tumors at the base of the skull once considered nearly impossible can now be safely performed.

Minimally Invasive Surgery

Minimally invasive surgical techniques are used when possible to remove tumors that are located near structures involved in sensory and physical functioning. In many cases, patients can recover more quickly when treated with minimally invasive surgery compared with traditional, open surgery.This surgery includes

Endoscopic Laser Surgery

This technique may be used to remove tumors in the larynx (voice box) or pharynx (throat) while preserving the structures involved in speech and swallowing. The surgeon inserts a thin, lighted tube called an endoscope through the patient’s mouth and into the throat. Surgeons remove the tumor using a special laser that is attached to the endoscope.

Minimally Invasive Video-Assisted Thyroidectomy (MIVAT)

A tiny video camera that is attached to an endoscope is used to remove thyroid tumors through a small incision.

Robotic Surgery

Tumors of the tongue and tonsils can be removed with the aid of small robotic arms that are placed in the mouth, avoiding the need to make a large incision or to split the jawbone

Radiation Therapy

Radiation therapy alone or in combination with chemotherapy is standard curative treatment for many patients with head and neck cancers. Which approach is used depends on the extent of the tumor; radiation and chemotherapy are used in combination when treating more advanced disease. In select situations, such as oral cavity tumors, the patient undergoes surgery followed by radiation therapy and/or chemotherapy. .

Patients may be treated with one or both of the following types of radiation therapy:

External-beam radiation therapy

a type of external-beam radiation therapy called intensity-modulated radiation therapy (IMRT), which uses highly sophisticated computer software and three-dimensional images from CT scans to deliver radiation to tumors with greater precision than conventional radiation therapy

Brachytherapy

Tiny, radioactive seeds are implanted into the tumor site, where they deliver the highest dose of radiation possible with minimal effect on nearby healthy tissue.

Proton Therapy

Proton therapy,is  an advanced form of radiation therapy, to deliver high doses of radiation to tumors that may be resistant to conventional forms while minimizing exposure to the surrounding healthy tissues. Proton therapy directs its cancer-fighting energy to precise locations within the body

Chemotherapy

Increasingly, chemotherapy — in combination with radiation therapy — is used to treat head and neck cancers that are difficult to reach surgically or that cannot be cured by surgery alone. This approach is also used to treat patients for whom surgery would cause significant functional or cosmetic disability, such as loss of the larynx (voice box), with its associated loss of natural voice and the need for a permanent stoma (hole) in the front of the neck.