Head and neck cancer treatment in India

Cost and time for this procedure varies greatly based on the clinical condition of the person.
Cost and time for this procedure varies greatly based on the clinical condition of the person.
  • About 2000 head and neck cancer cases are detected every day
  • About 1000 people die to head and neck cancer every day
  • Men are almost 3 times more at risk of head and neck cancer than women
  • Oral cavity is the most common site for the head and neck cancers
  • About 90% of the head and neck cancers start in the squamous cells lining the mouth, nose and throat

All about Head and Neck Cancer

This article has been reviewed and approved by Dr Niti Raizada for authenticity and medical correctness on 31 May 2020

Head and neck cancers are a group of cancers that occur in various parts of the head and neck region. It includes cancers of the mouth, nose, throat, voice box, salivary glands, air sinuses, etc. These cancers usually originate from the mucosal linings of these parts.

Head and neck cancers are the seventh most common type of cancers in the world. It accounts for almost four percent of all cancers. 

Mouth cancers, including those of the lips, are the most common head and neck cancers.Cancers of the thyroid, jawbones, nerves, or blood vessels, as well as the skin in the head and neck areas, also come under head and neck cancers. However, these cancers are relatively uncommon.

Men are twice more likely to have head and neck cancers than women. These cancers are not common in those below the age of forty. Most of those who have it are above the age of fifty. 

These cancers occur due to changes in the way the cells divide and survive.The symptoms of head and neck cancers will depend on the site of cancer. Difficulty or pain while swallowing food is one of the most common early signs. Other common ones include swellings in the neck, throat pain, hoarseness, etc.

The most common treatments for head and neck cancers are surgery, radiation therapy, and chemotherapy. The success of the treatment will depend on the stage of the disease.

What causes head and neck cancer?

Cancers occur when some cells in an area or organ start to divide without control. Also, these cells tend to live longer than normal cells.

All cells have a central nucleus with chromosomes inside it. Inside the chromosomes are the genes that contain chemicals called DNA. Changes or damages to the DNA strands that make up the genes that control cell division causes cancers. But it is still not clear as to what causes these changes. Anyway, Head and neck cancers also occur due to these changes.

But there are a few things or risk factors that increase your risk of head cancers.

Risk factors of head and neck cancer

A risk factor is anything that increases your chance of getting a type of cancer, or any disease for that matter. Some of these factors are under your control, so you can avoid it if you want. Some other factors, like advancing age, are not under your control.

Some of the most critical risk factors for head and neck cancer include

  • Tobacco use- Smoking is the most critical risk factor for head and neck cancers. More than eighty-five percent of those who have these cancers are smokers. 
  • Chewing betel nuts or gutka, which contains tobacco and snuffing, also increases the risk considerably.
  • Excessive alcohol consumption- Heavy drinking increases your risk to a great extent. Those who smoke as well as drink heavily are at a much higher risk than others who have only one habit. 
  • Your age- Most of those who have these cancers are above fifty. So your risk increases as you age. It is mainly because these cancers grow very slowly and show symptoms only after a long time. 

 

Some other common risk factors include

  • History of Human papillomavirus infections
  • Exposure to the sun for longer periods
  • A weak immune system
  • Exposure to chemicals that cause cancer such as asbestos, wood, silica, and nickel dust.
  • A diet that contains very few nutrients. Your risk will be more if the diet includes more of salty, processed, and other junk foods.
  • Diseases like Plummer-Vinson syndrome
  • Poor oral hygiene

 

You can reduce your chances of getting head and neck cancers by avoiding those risk factors under your control. If you have HPV infections, you should undergo regular screening to detect cancer at its very early stages.

You may have head and neck cancers even without these risk factors. Also, those having any or all of these risk factors need not get these cancers.

Symptoms of head and neck cancer

Your symptoms will depend on the area of cancer.

Mouth cancers.  They usually start as small ulcers, growths, elevated patches, or thickening of some areas of the mouth. The ulcers typically grow with time and will not heal by itself or respond to any medicines. The growths, patches, and thickened areas will slowly start increasing in size. You will also begin having pain that will radiate to other parts of the face. Teeth in the area of cancer will slowly get loose.

Throat cancers -  It includes cancers of the pharynx, larynx, tonsils, etc. The pharynx is the standard passage for air and food, which divides into the larynx or windpipe and esophagus or food pipe.

A cough that does not go away, persistent sore throat, and difficulty and pain while swallowing food are the common symptoms of throat cancers. 

Others include hoarseness of voice, a lump or swelling in the neck, and at times difficulty in breathing.

Salivary gland tumors- The symptoms include pain and swelling in the area of the gland. Numbness of one side of the face will occur if the tumor is large. 

Sinus cancers- Symptoms include pain below the eyes, severe nasal congestion, loss of smell, nose bleeds, pus draining from the nose, etc. 

Head and neck skin cancers- They usually begin as ulcers, warts, crusts, moles, or sores that appear all of a sudden. These will then slowly start burrowing deep. After some time, there will be a pain, bleeding, etc. from the sites. 

Thyroid cancers- You will have a lump, swelling, pain, etc. in front of the neck, Changes in voice may occur in later stages.

Complications of head and neck cancer

Head and neck cancers can spread to other areas of the body. It is because of the presence of a large number of lymph nodes in this area. Mouth cancers will spread locally and affect the jawbones.

Diagnosis of head and neck cancer

If you have any symptoms and your doctor suspects any head and neck cancer, you will have a few tests.

Internal examination- Your doctor will examine the mouth and throat thoroughly to look for any signs of cancer. He or she will also look for any abnormal swellings and lymph node enlargement in the head and neck region.

Endoscopy- An endoscope is a flexible tube with a camera at the end, which transmits images to a monitor. Your doctor will insert the endoscope into your throat or nasal cavity to look for any signs of cancer.

Barium swallow x-ray- It is a special type of x-ray before which you will drink a liquid containing barium. Barium will coat the throat and highlight the areas with problems

MRI, CT scans- These give an exact idea about the location and extent of cancers.

PET scans- You will have this if your doctor suspects that cancer may have spread to other areas of the body. The radiologist will inject a dye into your veins before the scan. As cancer cells absorb more color than healthy cells, those areas will be visible in the scan as bright areas.

Biopsy for head and neck cancers- During a biopsy, the pathologist will take a small tissue sample from an area of suspected cancer. He or she will then observe this under a microscope for cancer cells. It gives an idea about the type and stage of cancer, which helps to plan the treatment.

Treatment for head and neck cancers

Treatments for head and neck cancers will depend on the location, type, and stage of cancer. Surgery is the most common treatment option if the cancer is in the early stages. You will have radiation therapy, chemotherapy, etc. if you have advanced-stage cancers.

Surgery for head and neck cancers

During surgery, the surgeon will remove the whole of the area with cancer. He or she will also remove a small area of healthy tissue along the margins of cancer.

Surgery is ideal for treating cancers of the mouth, lower parts of the pharynx, larynx, tonsils, salivary glands, etc. The surgeon will also remove the lymph nodes around the area. It helps to prevent the spread of cancer to other areas after surgery. 

In mouth cancers that involve a large area, the surgeon will also remove parts or full of the jawbones and other adjoining bones. Similarly, throat cancers will need the removal of a major part of the pharynx, and a part or whole of the larynx. Removal of the affected tonsils will also be necessary.

You will have open, endoscopic, or robotic surgery for treating head and neck cancers. Endoscopic and robotic surgeries are minimally invasive as the surgeon inserts the surgical instruments through the mouth and throat.

Reconstructive surgery 

Removal of tumors in and around the mouth will create gaps in the face. Surgery to remove the pharynx and larynx will remove the connections between the mouth, nose, etc. to the windpipe and food pipe. It will cause problems with eating and breathing.

To correct these problems, you will need reconstructive surgeries. It helps to recreate the areas lost due to surgery by using tissues from neighboring areas or other parts of your body. You will also have prostheses to replace the missing portions to improve your looks. Similarly, reconstructing the pharynx and larynx will improve your ability to eat and breathe.  

Radiation for head and neck cancers

You will have radiation therapy to destroy any cancer cells that remain after surgery. Radiation therapy is the best treatment option if the location of the cancer is in an inoperable area. You will also have the treatment before surgery to shrink the tumor. There are many side effects of radiation therapy. Painful sores in the mouth and throat, dry mouth, taste changes, etc. are among the common ones. 

Chemotherapy for head and neck cancers

You will have chemotherapy if the cancers are in an advanced stage and have spread to other areas. It also helps to treat cancers that have come back after surgery or radiation. In those who have advanced-stage cancers, chemotherapy provides relief from symptoms.

Latest treatments for head and neck cancers

Immunotherapy- This treatment aims to improve your immunity with the help of biologic agents to destroy cancers.

Targeted therapy- It uses medicines to destroy cancer cells. An advantage is that it does not harm normal cells and target only the cancer cells. So there are fewer side effects. This treatment is suitable only for some types of cancers.  

Prognosis of head and neck cancer

Treating head and neck cancers in the early stages increases the success of treatment. As the cancer advances in stage, treatments become less effective

This article has been reviewed and approved by Dr Niti Raizada for authenticity and medical correctness on 31 May 2020

Dr Niti Raizada
Dr Niti Raizada
MBBS, MD, DM-Medical Oncology, MRCP
Dr. Niti Raizada is a senior Medical Oncologist with over fifteen years of experience in the field. Dr Niti has special interests in the areas of Thoracic, Gastrointestinal, Breast, Gynaecological Oncology, and Bone Marrow Transplants. She did her MBBS at Gandhi Medical College, Bhopal; MD-General Medicine at G R Medical College, Gwalior, DNB-General Medicine from National Board Of Examination,DM from Adyar Cancer Institute Chennai and Fellowship in Hematology from Hammersmith Hospital and Imperial College,London. She is a member of American Society of Clinical Oncology,USA; Royal College of Physicians,Edinburgh,UK; Member of Pharmacy Committee,Member of DNB teaching program in Medical Oncology and European Society of Medical Oncology (ESMO).
Head and neck cancer treatment in India
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