Head and neck cancers

Head and neck cancers are malignant tumours arising from a variety of sites within the head and neck region, including oral cavity, pharynx (throat), larynx (voice box), paranasal sinuses, nasal cavity and salivary glands.

Important risk factors associated with head and neck cancers include smoking and alcohol consumption. Human papillomavirus (HPV) infection is also a common cause of cancer arising from base of tongue and tonsils.

If you are a smoker or drinker, the first step towards prevention is to quit smoking and to reduce alcohol consumption.
You should also seek medical advice if you have head and neck symptoms that do not resolve in two weeks.
 

Symptoms of head and neck cancers varies widely depending upon the primary site:

• Oral cavity: pain in the mouth, non-healing oral ulcers, loosening of teeth
• Throat: sore throat, difficulty in swallowing, pain in the ears, weight loss
• Voice box: hoarseness, trouble breathing
• Paranasal sinus: nose bleeding, nasal obstruction, chronic sinus infection that do not respond to treatment
• Salivary glands: swelling under the chin or in the face

If the above symptoms persist for more than two weeks, you should visit your family doctor as soon as possible. Your doctor may refer you to an oncologist (a specialist in tumors) or otolaryngologist (ear-nose-and-throat doctor) for further checkup.
 

You should seek medical advice you experience symptoms listed above. Your doctor will perform a detailed physical examination and endoscopy to look for suspicious lesion. Diagnosis of head and neck cancer has to be confirmed with biopsy.
 
Once the diagnosis of head and neck cancer is confirmed, your doctor will arrange further tests to determine the tumour extent and whether the cancer cells have spread to other organs, including:

• Magnetic resonance imaging (MRI)
• Computerized tomography (CT) scan
• Chest X-ray

Positron emission tomography (PET) scan may be required for selected patients

Management of head and neck cancers is complex. It often requires a combination of different treatment modalities including surgery, radiotherapy, chemotherapy and immunotherapy. Treatment plans can vary widely, depending on multiple factors e.g. your general health status and the disease extent.
Surgery
Surgical removal of the tumour and neck lymph nodes are potentially curative for some localized head and neck cancers. Depending on the surgical extent, reconstruction with flaps may sometimes be necessary.
 
Radiotherapy
External radiotherapy uses high-powered radiation beams to destroy cancer cells. It can potentially cure the disease, while preserving the involved organ. Treatment will be carried out on a daily basis for six to eight weeks. Radiotherapy also has a role in reducing risk of recurrence for high risk cases after surgery.  In patients who are not suitable for intensive, curative treatment, radiotherapy may also help to relieve symptoms caused by the tumour
 
Chemotherapy
Chemotherapy are chemical drugs that are delivered to your body through the blood vessels. It has the role to enhance the effectiveness of radiotherapy. If the tumor has spread to other organs, chemotherapy may also help to relieve symptoms caused by the tumor.
 
Immunotherapy
Immune-checkpoint inhibitor acts by activating your immune system to destroy cancer cells. It is given alone, or in combination with chemotherapy, to achieve disease control.

Surgery
After surgery, you may experience complications e.g. wound pain, bleeding and wound infection. Depending on the extent of resection, you may suffer from a range of long-term problems. You should consult your doctor regarding potential complications that are relevant for you.
 
Radiotherapy
During the early weeks of radiotherapy, the patient may suffer from nausea, dry mouth, taste changes, loss of appetite, etc. In the later weeks, patient may have mouth ulcers, skin darkening, throat pain and hair loss, etc. However, these will gradually subside a few weeks after the completion of the treatment. But for some patients, they may continue to suffer from dry mouth as their salivary glands will produce less saliva because of the radiotherapy. A minority of the patients may have disturbed endocrine function, or impaired nerve function.
 
Chemotherapy
Although anticancer drugs can kill cancer cells, they also affect the division of normal cells. Patients may suffer from vomiting, hair loss, diarrhea, loss of appetite, anemia (a deficiency of red blood cells), reduced white blood cells, and thus lowered immunity; so, patients may be infected more easily. In addition, the kidney function may also be affected.
 

Going through treatments for head and neck cancer can be challenging.
 
Quit smoking
If you are an active smoker, quit smoking can help to reduce treatment toxicities, and speed up recovery.
 
Nutrition
During treatment, difficulty in eating and swallowing is a common problem. You should consume a high protein and high caloric diet to help speed up recovery. Avoid foods that are deep fried, spicy, or dry and hard. Cancer treatment might weaken the immune system. Immunocompromised patient is advised to avoid to eat raw or undercooked meat, poultry, eggs, seafood, raw or unpasteurized dairy products, and ready-to-eat raw vegetables. Drink nutritious supplements to increase energy intake. Doctors may also advise temporary tube feeding to boost your nutrition status if necessary.
 
Regular follow-up
After radiotherapy, patients may have complications. Regular follow-up ensures appropriate treatment. Regular follow-up may also allow early detection and treatment of recurrence or metastasis, which allows early treatment
 
Prevention of decayed teeth and mouth infection
Radiotherapy will reduce secretion of the salivary glands, so patients may have higher chances of tooth decay. Therefore, they should:

• Consume less sweet food and drinks, brush their teeth immediately after meals, and visit dentists regularly for checkups.
• Keep mouth moist: patients may wipe mouth with clean gauze moistened with salt water before they sleep.

Stop smoking and alcohol drinking to prevent exacerbation of dry mouth.