What are head and neck cancers?

As the name suggests, Head and neck cancers are carcinogenic cells or masses formed in the areas surrounding the head and the neck of the human body. By extension, it also includes cancers around the mouth, sinuses, nose and throat.

The main areas under effect include:

• Oral cavity: Includes the lips, the front two-third area of the tongue, the gums, lip and cheek lining, the underside of the tongue and the hard palate.
• Salivary glands
• Paranasal sinuses and nasal cavity
• Larynx
• Throat (pharynx): It has three parts: the nasopharynx (the upper part of the pharynx, at the back/behind the nose); the oropharynx (the middle part of the pharynx, including the soft palate which we also call the back of the mouth, the base of the tongue, and the tonsils); the hypopharynx (the lower base of the pharynx).Cancerous cells of the head and neck almost always do so locally and/or to the lymph nodes present in the neck.These cancers are more than twice as common among men as they are among women. It also is seen more in the older age group (around 50) than in the younger age groups.

Types of Head and Neck Cancers:

Naso-pharyngeal Cancer

It is when the cancer starts as a growth of cells in the upper part of the throat (behind the nose) called the nasopharynx. It typically causes hearing loss or chronic ear infections. It can cause facial pain and numbness as well. Though exact causes are not known, poor lifestyle habits such as heavy smoking and tobacco use daily are seen to be contributing factors. It can be treated with chemotherapy and immunotherapy typically. A biopsy and several blood tests, and endoscopies are taken to detect and diagnose the cancer and its stage.

• The typical symptoms are bloody saliva, trouble breathing, tinnitus or a ringing in the ears, frequent migraines that feel paralysing.
• It can form tumors in the nasopharynx if not treated at the right stage and at the right time. However these cancers are typically very hard to detect.
• There are 3 types of naso-pharyngeal cancer—
  • Keratinising (type 1): It is a form of naso-pharyngeal cancer marked by wide intracellular bridges and variable keritanisation. Keratin is a protein found in the hair and nails.
  • Non keratinising (type 2): It is a differentiated form of cancer marked by arrays of well connected cells and little to no keratinisation.
  • Non keratinising (type 3): It is an undifferentiated type of cancer with no keratinisation but increased mitosis.

Oro-pharyngeal Cancer

• It affects the middle section of the mouth, also called the tonsil, which is a part of the oro-pharynx. It occurs typically in squamous cells that line your tonsil before spiralling out of your reach to form tumors. Besides, it is also seen in cells lining the soft palate, around the tongue and the walls of the pharynx.
• A typical cause of this cancer is the Human Papillomavirus (HPV).
• Alongside, smoking can also increase the risk of this cancer. Daily Tobacco use is to be strictly avoided to steer clear of this cancer.
• The symptoms typically seen are sores or blisters in the back of the mouth, difficulty with speech, swallowing or breathing, swelling in the neck, loss of appetite, loss of weight, and weakness overall.
• It can be diagnosed with an endoscopy, biopsy and CT scans.
• One can take the HPV vaccine to prevent this cancer as HPV is the leading cause of the cancer.
• Otherwise, you can refer to your specialist and go through procedures such as immunotherapy, target therapy, and chemotherapy to treat it.

Hypopharyngeal Cancer

• It is a cancer that develops in the hypopharynx, or the region where the oesophagus and larynx meet. Malignant cells form here and over time turn into tumors. It isn't very common and hence difficult to detect—which makes it quite fatal if not treated in time.
• Some signs include difficulty swallowing when you eat food and pain in the throat which extends all the way up to your ears. It can also cause hoarseness of voice.
• Steer clear of tobacco, alcohol and cigarettes to avoid this kind of cancer. People have a higher risk of it, especially in people who are passive smokers and drinkers. Additionally it can also be caused by bile reflux. So, if you have a family history of this cancer, try to eat less fatty foods to prevent bile refluxes as much as possible as they are strong acids associated with DNA damage.
• Endoscopies, biopsies and CT Scans and MRIs help to diagnose and stage these cancers.
• Surgery, chemotherapy and immunotherapy are typically effective in treating this kind of cancer.
• These were the 3 most common types of Head and neck cancers. Besides these, we also have—
  • Sarcoma of the head and neck, where cancer cells are found in the soft tissue parts of the head and neck, which include the muscles, connective tissues (tendons), vessels that carry blood or lymph, joints, and fat.
  • Cancer of the oral cavity, where cancer cells are found in the oral cavity. These areas include the lips, teeth, gums, the front two-thirds of the tongue, the inner lining of the lips and cheeks, the area underneath of the tongue, the roof of the mouth and the small area behind the wisdom teeth.
  • Cancer of the salivary glands, where cancer cells are found in the salivary glands. These glands are found just below the tongue, on the sides of the face in front of the ears, and under the jawbone.
  • Cancer of the nasal cavity, where cancer cells are found in the tissues in the small hollow spaces around the nose, known as the paranasal sinus and nasal cavity.
  • Melanoma of the head and neck, where cancer is caused by the skin pigment causer called the melanocytes.
  • Squamous cell cancer of the head and neck (SCC), a type of nonmelanoma malignancy. It is the second most common form of skin cancer.
  • Basal cell cancer (BCC), a type of nonmelanoma malignancy that arises from abnormal basal cells in the skin.

Stages of Head and Neck Cancer (for all types):

Numeric Gradation (Stages 0-4):

| STATUS | DESCRIPTION |

| :--- | :--- |

| Stage 0 [carcinoma in situ (CIS)] | This is the first time the abnormal cells come into notice after running tests. It typically means that the cancer hasn't even developed properly yet. But the abnormal cells show signs consistent to those of cancerous cells. |

| Stage 1 | This means that the primary cell has developed but is no bigger than 1.8-2 cm in size. It has not spread to any part of the body apart from slowly infesting the lining of the affected organ. It is advisable to start treatment from this stage itself to prevent anything serious. |

| Stage 2 | The cancer hasn't spread to any organs, lymph nodes or nearby tissues yet. But the tumour is steadily getting bigger. It will typically be around 2-4cm at this point. If possible, surgery is the best choice in this stage to eliminate the cancer and its chances of spreading completely. If not possible, please at least start chemotherapy. |

| Stage 3 | This can mean either one of two things:<br>The tumour is larger than 4cm across, or<br>The cancerous cells have spread to a lymph node on the same side of the neck as the tumor and the lymph node is smaller than three centimeters. The tumour can be any size at this point. It is still not too late to revert to a healthy lifestyle and start going through treatment processes, and/or palliative care. |

| Stage 4A | This means that the cancer has either not spread to any lymph nodes but is very large in size; or has spread to a proximal lymph node; or is starting to spread to distant organs and lymph nodes. |

| Stage 4B | 4 (B)— It means that the tumor has invaded deeper areas and/or tissues. It may or may not have spread to lymph nodes and has not spread to distant sites. The tumor is of any size and may or may not have grown into other organs. It has spread to one or more lymph nodes larger than 6 cm across, or has partially metastasised. |

| Stage 4C | The cancer has definitely metastasised by this point. It has spread to distant organs such as the lungs and liver. The survival rate by this stage is very low. Palliative care is recommended. |

What causes head and neck cancers?

Though there are plenty of ways it can occur, the most common ones are:—

• Constant chewing of paan, or betel quid leaves.
• Using tobacco in the form of cigarettes, pipes, etc increases the risk for various kinds of head and neck cancers significantly.
• Alcohol abuse is another leading cause. Excessive alcohol consumption is fatal. Most head and neck cancers of the mouth and larynx are caused by tobacco and alcohol use.
• Contact with viruses: Most throat cancers are linked to have started forming since the discovery of an infection by HPV in a person. Apart from this another significant threat is the Epstein Barr virus.
• External factors: Factors like prolonged sun exposure without proper sun protection, breathing in pollutants for long periods of time, etc. can also cause head and neck cancers.
• Genetics and Ancestry: Fanconi anemia which is a genetic disorder can increase the risk of developing precancerous lesions and cancers early in life. The same goes for a lot of other genetic disorders.
• It is also noted through research that individuals with Chinese ancestry are more likely to develop naso-pharyngeal cancers.

What are the symptoms?

The symptoms include—

• Having difficulties breathing, talking or swallowing; intensive ear pain
• Swelling under the chin or on the jaw, paralysis of facial muscles.
• Sinuses that are blocked and aren't clearing; chronic sinus infections that aren't responding to antibiotics or treatment of any sorts; bleeding through the nose.
• A white or red patch on the gums, the tongue, or the lining of the mouth or the places mentioned before for head and neck cancers; a growth or swelling of the jaw that causes visible discomfort; and bleeding or pain in the mouth.
• Changes in voice
• Hoarseness in voice
• Pain in the face and temples that won't go away.

How to prevent it?

As all of us know, prevention is better than cure. Here's what can be done to prevent head and neck cancers—

• AVOID tobacco at all costs
• AVOID alcohol (except for medicinal purposes) as much as possible
• Use air filters, humidifiers at your home especially if you're in a place with a lot of congestion and pollution
• For greatly urbanised areas: try wearing a mask when going out.
• Proper sun protection: Cover your head and neck with sunscreen, especially in summer months. You can go the extra mile by using SPF based hairspray.
• Sexual Protection: Since HPV is a leading cause for head and neck cancers, make sure to use proper measures before engaging in sexual acts.
• Taking the HPV vaccine
• Regular dental examinations may identify pre-cancerous lesions in the oral cavity.
• Head and neck cancer is often curable if it is diagnosed early; however, outcomes are typically poor if it is diagnosed late. So, look for any symptoms and visit your doctor for advice.

Diagnosis of head and neck cancer, maintenance of the body:

• Biopsy: A piece of tissue is collected from the areas which are consistent with the symptoms given. It can be collected depending on how easily the cancer can be accessed.
  • If the cancer is easy to access, a healthcare professional might cut out some of the tissue with a cutting tool. Sometimes a needle can go through the skin and into the cancer to draw out some cells. Special tools can collect cells from inside the throat or inside the nose.
  • These samples are then tested in the lab. As aforementioned, HPV virus is a leading cause of head and neck cancers. So the cells are typically tested to that standard first.
• Endoscopies: To physically see the extent of the cancer, a tiny camera will be shoved down your throat to see how far the cancer has spread.
  • To look inside the nose a similar test is performed where the camera is inserted through the nostrils. However for the buccal cavity it is advisable to use just a light and a mirror.
• Imaging tests and blood tests: MRIs, CT scans, and PET scans are standard tests used to diagnose any type of cancer at any stage. Your doctor will most likely recommend these tests first along with some blood tests.

How is it treated?

Head and neck cancer, if detected in the first two stages, is quite treatable. It is treated in a number of ways—

• Surgery: It is most commonly used for most head and neck cancers. However, if the cluster is concentrated on the larynx (or too close to it), alternatives may be looked for as the person may lose the ability to speak.
• Transoral robotic surgery (TORS) is seen to be quite safe for people with oro-pharyngeal cancer.
• Targeted therapy: Type of treatment where more extensive primary tumors or those with stage III or IV cancer, planned combinations of pre- or postoperative radiation and complete surgical excision are generally used.
• Chemotherapy
• Radiotherapy
• Immunotherapy: Familiarises the immune system to fight cancer cells. It uses drugs or other substances to identify and attack specific cancer cells or those that are at a risk of turning cancerous without harming normal cells.
• Photodynamic therapy may help with mucosal dysplasia and smaller, more manageable head and neck tumors.
• Palliative care: This is also used when the cancer is well developed, but can be preferably used through any stage of the cancer development. It is aimed at making you feel better rather than intensively curing cancer.

Side effects of treatment

People cured of head and neck cancer are still at risk of a number of things, which may be a consequence or side effect treatment.

• Formation of second primary tumors: which ranges from 9% to 23% at 20 years. So essentially you might have a chance of it relapsing OR another uncancerous tumor.
• Physical appearance is of course affected, either by treatment or the cancer itself.
• Difficulties in swallowing or breathing, and residual pain to manage.
• The treatments for throat cancer can also be harmful to the digestive system as well as other body systems. Radiation therapy can lead to nausea and vomiting, which can deprive the body of vital fluids and electrolytes.
• Frequent vomiting can also upset the balance of stomach acids.

FAQs:

• Q) How does one reduce risk of second primaries?
  • The chance of a second primary (new) cancer varies depending on the site of the original cancer, but it is higher for people who use tobacco and drink alcohol. So, if you're drinking or smoking tobacco or anything related to it, please don't.
• Q) What scans should I get?
  • Doctors will typically advise for an MRI, CT, PET scan, alongside x-rays, physical exams, and blood tests. The doctor may monitor thyroid and pituitary gland function, especially if the head or neck was treated with radiation as these are essential glands that cannot be harmed in any way shape or form.
• Q) How likely is it to occur?
  • Globally, head and neck cancer accounts for 650,000 new cases of cancer and 330,000 deaths annually on average. Around 70-71% of throat cancers are at an advanced stage when discovered.
  • That being said, men are 89% more likely than women to be diagnosed with these cancers and are almost twice as likely to die of them. This is due to evidence suggesting that transmission rates of HPV from women to men are higher than from men to women, as women often have a higher immune response to infection.
• Q) Which type of head and neck cancers have the highest recovery rate?
  • Papillary and follicular thyroid cancers have the best prognosis of all head and neck cancers.
  • Besides, it is also observed that HPV-related oropharyngeal cancers have a very good prognosis.
  • Early stage tumors have the best prognosis.
• Q) Can cancers in the region affect my speech?
  • Yes, it definitely can.
  • Even before you start going through treatment procedures or anything of the sort, the blob of cancer cells (especially if you have any type of pharyngeal cancer), can affect your ability to speak.
  • There is no definite way to prevent this. You can go for jaw exercises and try to move your lower jaw as much as you can to improve the ability to speak.
• Q) Will the treatment affect my daily life?
  • It can and it might affect your daily life. You might experience symptoms such as—
    • Dry mouth
    • Loss of taste or teeth—feeling too drained to eat
    • Speech difficulties
    • Swallowing issue
    • Weakness and nausea
    • Feeling 'icky' towards food
    • Weight loss.
  • These are just a few of the side effects of the treatment you might experience.
• Q) How, then, do I manage my quality of life after the cancer?
  • You can ask for—
    • Your family and friends, or social workers for emotional support.
    • Speech-language pathologists help manage speech and swallowing problems.
    • Nutritionists provide dietary counseling.
    • Dentists will help recover your teeth if you lose any and make artificial dental or facial parts if necessary.
    • Cancer support specialists, emotional therapists encourage healthy lifestyle choices. Talk to someone you trust if you feel overwhelmed.
    • Social workers provide emotional support.
    • Seek palliative care.