According to Cancer.Net, head and neck cancer is the term used to describe a number of different malignant tumours that develop in or around the throat, larynx, nose, sinuses, and mouth. Most head and neck cancers are squamous cell carcinomas.
And it might cause certain obstacles in your daily life. Did you know that head and neck cancer vary in different races in Malaysia?
Sure, proper diets and a healthy lifestyle can help you avoid such cancers, though there might be other factors that can trigger it.
In conjunction with Head and Neck Cancer Awareness Month, we have Dr Ram Kumar Sharma, a Consultant Ear, Nose, Throat, Head & Neck Surgeon at Mahkota Medical Centre.
Dr Ram will share with us his knowledge and expertise relating to this type of cancer.
What are the signs that patients should look out for head and neck cancer? Will there be a visual indication of the tumour, pain in the neck or head etc.?
Greetings! Thank you, Motherhood, for providing me with this opportunity to impart my knowledge and sharing my experience.
Head and Neck (H&N) cancers are the sixth most common cancer in the world today with an incidence of 8.5 for every 100,000 population in Peninsular Malaysia.
Early diagnosis and treatment are crucial. Any delay may lead to more disease spread, poor outcomes and effectiveness of definitive treatment.
What makes it difficult is the close proximity to various important structures in the H&N region.
Clinical presentation of H&N cancers is broadly divided into patient symptoms and signs elicited during routine screening.
A. Patients may present with:
- Recurrent unprovoked spontaneous nose bleeds
- Bloodstained saliva/expectorant/secretions from the mouth
- Persistent one-sided ear blockage with or without ringing sensation
- Ulcers that do not heal in the mouth region for more than 2 weeks
- Neck swelling not responding to treatment
- Change in voice, noisy breathing
- Painful and/or difficulty in swallowing
- Headache/double vision/difficulty in opening mouth
B. Signs elicited by Specialist
- Consultation and examination specifically related to swelling in the neck regions, ulcers/mass in the mouth
- Diagnostic evaluation of the nose, mouth, throat and voice box either by direct inspection or with an endoscope-aid (camera) in the clinic setting.
What triggers head and neck cancer? And what should a person do to avoid it?
Risk factors for H&N cancer, as with any other cancer, can be classified into Non-Modifiable and Modifiable Factors.
A. Non-Modifiable
- Age – more than 50 years
- Gender – a slight male preponderance
- Family history of H&N cancers
- Race – Certain Malaysian ethnicity is prevalent; e.g. Nose cancer amongst Chinese; lymphoma amongst Malays and mouth/tongue cancers in Indians
B. Modifiable
Lifestyle
- Smoking
- Alcohol consumption
- Infection; e.g.: Epstein-Barr Virus, Human Papilloma Virus
Environmental
- Radiation exposure
- Pollution
- Sun-exposed skin
Diet
- Excessive salt/preserved food, betel nut chewing
It is almost impossible to avoid non-Modifiable factors as this makes up our profile and character. However, one can always maintain a healthy lifestyle and be cautious of the Modifiable trigger factors.
Where do the head and neck tumours locate? Is it inside the neck and head or outside growth? Or on our bones?
The common sites of H&N cancers are the nose/sinuses, mouth/throat, voice box, ears, salivary glands and thyroid gland.
These may occur with or without associated neck swellings.
If there is a delayed presentation or cancer has spread to adjacent bones, liver, brain, eyeballs or even lungs, then depending on the organ concerned, patients may present with deterioration of the concerned organ function.
For this kind of cancer, is surgery necessary? Or is chemotherapy and radiation therapy the only option?
In the event of a high index of suspicion of H&N cancer, a good and thorough history along with a complete physical examination is essential as the initial precursor to arriving at the diagnosis.
Further investigations may include a tissue biopsy to determine the type of cancer.
This may be a benign (non-dangerous type of cancer) or a malignant (dangerous type of cancer).
The biopsy will be complemented with a Computerised Tomography (CT) scan of the Head & Neck region to arrive at a definitive diagnosis.
There are instances a Magnetic Resonance Imaging (MRI) will be helpful to confirm the immediate tissue/organ involved. A whole-body CT scan will confirm the distant spread of cancer.
Once a diagnosis of H&N cancer is confirmed, the patient should be informed of the disease and available treatment options, which may be curative or palliative.
A Multi-Disciplinary Team (MDT) in a Tumour Board will be initiated comprising Ear, Nose & Throat (ENT) Surgeons, Plastic & Reconstructive Surgeons, Anaesthetists, Pathologists, Clinical and Radiation Oncologists.
Depending on the site and H&N cancer being discussed, additional doctors, such as General and Vascular Surgeon, Haematologist, Obstetrician and Gynecologists, Palliative Specialist along with Speech and Rehabilitation Therapist may be included in the discussion.
Curative treatment of H&N cancers usually comprises of Single Modality or Multi-Modality approach following discussion outcomes in the MDT.
Therefore, the patient will be kept informed of the treatment plan, aim and the step-wise treatment approach.
These may include Surgery, Chemotherapy (either before or after surgery) and Radiotherapy.
Management of H&N cancers depends on the following important factors:
- Disease/Tumour Factor – type (benign or malignant), site and location of spread with involvement of vital structures.
- Patient Factor – age, underlying medical condition or patient’s general health to sustain treatment which may include surgery, radiotherapy, chemotherapy and/or a combination of all three modalities.
- Accessibility to Clinical Oncologist and the need for Radiotherapy after the operation will be discussed accordingly.
Therefore, a comprehensive multi-disciplinary teamwork discussion of the treatment plan, once the diagnosis of H&N cancer is established, is essential and crucial for the patient.
Cancer patients fear losing their organs to cancer as it serves a purpose in your body in the first place. At what stage of cancer needs the lymph nodes to be removed?
Lymph nodes in the H&N region play an important role as a ‘guardian’ by triggering the immune system.
It is commonly enlarged in malignant cancers. The decision to remove the nodes and concomitant supporting structures will depend on the type of cancer; ie benign or malignant.
All benign cancers will not require lymph nodes to be removed.
On the other hand, malignant cancers may require selective or en-bloc removal of lymph nodes if surgery is the mainstay of treatment.
Again, this decision will be planned accordingly during the Tumour Board discussion and supported by relevant radiological and pathological findings.
If the patient opts for surgery to remove the tumour, can you describe what will it be like to recover from the surgery? And will head and neck cancer affects his/her speech or ability to chew and swallow?
The aim of any cancer treatment is ‘tumour-free.’ However, it may cause protracted outcomes depending on the tumour type and site involved.
Tumour Board discussions are essential as post-operative care and reconstructive options will be discussed and would include general and specific advice.
Can you get this cancer while being pregnant? If yes, how will it affect a woman’s pregnancy? Could the different types of treatment affect women’s ability to have children and should they talk with a fertility specialist before any of the cancer treatment begins?
Despite the occurrence of H&N cancers during pregnancy is rare, one needs to be aware of the devastating effects to the mother and pregnancy.
Again, I would like to highlight the importance of MDT discussions. It not only serves as a discussion platform but also ethical dilemmas arising in managing head and neck cancers during pregnancy can be resolved.
The timing of treatment is an important determinant of foetal wellbeing.
Diagnostic and treatment modalities may harm the foetus, while delaying or choosing suboptimal treatment in order to preserve foetal health may worsen maternal outcomes.
A multidisciplinary approach should be adopted to enable parents and clinicians to make the best available decision.
Last but not least, what are the dos and don’ts when it comes to cancer, the proper diet and physical care?
Early detection is crucial for a good outcome. However, prevention is better. Therefore, be vigilant on the trigger factors and consult your doctors if you have any symptoms.
Source: Dr Ram Kumar Sharma, a Consultant Ear, Nose, Throat, Head & Neck Surgeon at Mahkota Medical Centre
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner.
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