Head & Neck Cancer
Cancers of the head and neck usually arise from the inner lining of several structures and this type of tumor is call squamous cell carcinoma, the following sites are most commonly affected:
- Oral cavity
- Pharynx (throat)
- Larynx (vocal cords)
- Nasal cavity
- Salivary glands
Signs and symptoms are often lacking in early stage disease and vague and are nonspecific in later stages. Each site may have a different presentation. Oral cavity cancers usually present with a mass or ulcer that does not heal. Pain may be noted, especially when exposed to certain foods. Dentists or oral hygienists often discover these tumors. Cancers of the vocal cords often present with hoarseness. This group of cancers often spread via lymph vessels into the lymph nodes throughout the neck. The first sign of head and neck cancer can be an enlarged lymph node in the neck. This is frequently not painful or tender to palpation. Most enlarged lymph nodes due to benign conditions, including infections.
Squamous cell cancer of the head and neck is a common disease, with approximately 47,000 cases each year in the United States. The incidence is higher in men. The combined use of tobacco and alcohol is the most common etiological factor, approximately 200 times more common than in people who neither smoke nor drink alcohol. Viral infections, such as certain subtypes of the Human papilloma virus (HPV), account for cancers at some sites. Nasopharynx cancer is endemic in some areas of Southeast Asia and other areas outside the United States and is associated with infection with the Epstein-Barr virus. Lastly, sun exposure places patients at risk for cancers of the lower lip.
Summary of treatment/management strategies
Treatment of head and neck cancer is driven by the desire to cure the disease, while at the same time preserving function, such as swallowing and voice. Early stage, small tumors are generally treated with either surgery or radiation therapy. The decision to use one or the other is predicated by site of disease and local expertise of treating physicians. For example, small oral cavity tumors can be surgically removed to eliminate the need for radiation. Conversely, early vocal cord tumors are frequently treated by radiotherapy to preserve voice function.
For large tumors or when there is spread to the lymph nodes a combination of radiation therapy, chemotherapy, and surgery is often used. Chemotherapy is often given with radiation therapy, termed chemoradiotherapy. If the airway is compromised, then a temporary or permanent tracheotomy may be necessary. For patients who do recur, salvage surgery or, in selected cases, a second course of radiation therapy can be employed with long-term survival in 10-30 percent.
The expertise of plastic surgeons, speech therapist, dieticians, and nurses greatly improves the overall care and outcome of patients who are afflicted with these cancers. Head and neck cancers require an experienced oncology team to provide the very best multidisciplinary care.