Treatment Plan

Best Hospitals for Head and Neck Cancer treatment in India- Throat cancer

Treatment Plan

 

Head and neck cancers is a collective term to describe cancers that usually begin in the squamous cells that line the mucosal surfaces inside the head and neck.

Head and neck cancers include cancers of the:

      ·       Oral cavity- That includes the lips, the anterior two-thirds of the tongue, the gums, the mucosal lining inside the cheeks and lips, the floor of the mouth, the hard palate, and the small area of behind the wisdom teeth called the retromolar area

      ·       Pharynx or throat-There are three parts of the pharynx namely the nasopharynx  or the upper part of the pharynx located behind the nose, the oropharynx that includes the soft palate, the base of the tongue and the tonsils), and the hypopharynx or the lower part of the pharynx.

      ·       Larynx: The larynx contains the vocal cords and the epiglottis.

      ·       Nasal and paranasal sinuses and nasal cavity- This include the maxillary, ethmoidal and sphenoidal sinuses. Nasal cavity also includes the nasal vestibule.

      ·       Salivary glands

Cancers occurring in any of these regions comes under the terminology of head and neck cancers. Almost 90% of all head and neck cancers are squamous cell carcinomas. Squamous cells are those cells that line the mucosa of the oral cavity, the pharynx, larynx etc.

Head and neck cancers account for almost 4% of all types of cancers. Men are more commonly affected than women. Head and neck cancers are very rare in those under the age of fifty. These cancers are more common in those above the age of seventy.

The exact cause of head and neck cancers are not clearly understood. Mutations to the cells lining the mucosa is thought of as a reason. But what exactly causes these mutations remain largely unknown.

 

Head and neck cancer is a collective term to denote various cancers of the head and neck region.

Head and neck cancers are curable if detected at an early stage. Early treatment through excision surgery can help in preventing the spread of the cancer to other areas. Radiation therapy may also be used in certain cases of head and neck cancers.

Oral cancers

These are cancers that occur in the oral cavity comprising of lips, anterior two-thirds of the tongue, mucosa of the cheeks and lips, the floor of the mouth, the hard palate etc

Most of the cancers of the oral cavity begin as pre-cancerous conditions like luekoplakia, erythroplakia and oral submucous fibrosis. Early identification of these conditions can help in the early initiation of treatment if necessary.

Wide excision surgery followed by reconstruction surgery is the most common form of treatment. Radiation therapy may also be used in certain situations.

Lip cancer -Wide local excision surgery followed by brachytherapy or external beam radiation therapy.

Cancers of the anterior two thirds or the front of the tongue-Wide local excision surgery followed by internal or external radiation therapy. Radiation therapy to treat the lymph nodes in the neck.

Cancers of the buccal mucosa or the lining of the cheeks- Wide local excision surgery followed by brachytherapy or external beam radiation therapy. Skin graft surgery may be needed if the cancer has spread to the deeper layers of the cheek.

 Cancers of the floor of the mouth- Wide local excision surgery followed by internal or external radiation therapy. Reconstructive surgery including skin grafting may be necessary for cancers that are large.

Cancers of the gingiva or the gums- Wide excision surgery followed by radiation therapy. Removal of the surrounding jawbone that may be affected with the cancer may also be done if necessary. Grafting may be necessary to fill in the voids left by the surgery.

Cancers of the upper gingiva and the hard palate- Wide local excision with or without radiation therapy.

The curability of oral cancers also depend, on the stage of the disease. Cancers that involve or invade the deeper structures of the head and neck are difficult to cure completely so are cancers that have metastasised to other parts of the body.


Pharyngeal cancers
  

Pharyngeal cancers include

 Nasopharyngeal cancers – Cancers that originate in the nasopharynx, the upper most part of the pharynx located behind the nose. Nasopharyngeal cancers have a better chance of cure if detected in the early stages. Radiation therapy is the primary mode of treatment for nasopharyngeal cancers. Chemotherapy may also be used in conjunction with radiation therapy. The role of surgery in nasopharyngeal cancer is limited to neck dissection surgery to remove the lymph nodes of the neck. Chemotherapy may also be used to treat advanced nasopharyngeal cancers that have spread to other parts of the body.

Oropharyngeal cancers- Cancers that occur in the oropharynx, the portion of the pharynx that includes the soft palate, base of the tongue and tonsils. Surgery is the most preferred mode of treatment for oropharyngeal cancers. Surgery may remove the tonsils, the base of the tongue as well as parts of the soft palate that are affected by cancer. Radiation and chemotherapy may be done after surgery to destroy any remnants of cancer cells.

Hypopharyngeal cancers – Cancers that occur in the lower most part of the pharynx. If found early, Hypopharyngeal cancers are curable. Laryngopharyngectomy, a surgery to remove the larynx and part of the pharynx or partial laryngopharyngectomy to remove part of the larynx and part of the pharynx are the common modes of treatment. A partial laryngopharyngectomy helps to prevent the loss of the voice. Neck dissection to remove lymph nodes and other cancerous tissues in the neck may also be done. Radiation therapy to remove any cancer cells may be done after surgery.

Advanced stage hypopharyngeal cancers that have metastasised respond less well to treatment.


Laryngeal cancers

Larynx contains the epiglottis and the vocal cords. The primary symptom of most laryngeal cancers is the hoarseness of voice. This makes early detection a possibility. Laryngeal cancers if detected in early stages is completely curable.

Surgery

Surgery is the first line of treatment for all stages of laryngeal cancer. The type of surgery depends on the extent of cancer and the part of larynx affected. The common surgeries include:

Cordectomy: Surgery to remove the vocal cords if only the vocal cords are cancerous.

Supraglottic laryngectomy: This surgery is done in cancers that has affected only the upper part of the epiglottis.

Hemi-laryngectomy: This surgery is done if the cancer has affected only one half of the larynx. This may help to save the voice.

Partial laryngectomy:  A surgery to remove only the part of the larynx affected by cancer. A partial laryngectomy help retain the ability to talk.

Total laryngectomy: Surgery to remove the larynx completely, in situations where the whole of the larynx is affected.

Thyroidectomy: The removal of the thyroid gland along with larynx surgery in conditions where the whole of the thyroid is affected by invasive laryngeal cancer.

All these treatments are for various stages of laryngeal cancer. The outcome and the disability associated with surgery depends on the extent of the cancer and the spread to lymph nodes and other surrounding areas.


Nasal and paranasal air sinus and nasal cavity cancers

These include the cancers of the maxillary, sphenoidal and ethmoidal air sinuses as well as the nasal cavity including the nasal vestibule.

Sinus cancers are rare, but offer a high rate of successful cure, if detected early. Spread of cancers to adjoining structures may create problems with treatment as well as affect the overall prognosis.

Surgery followed by radiation or chemotherapy is the accepted mode of treatment

Cancer of the maxillary sinus- Treatment is surgery, with or without radiation therapy.

Cancer of the ethmoid sinus- Primary treatment is usually radiation therapy. Surgery may also be done in certain situations

Cancer is in the sphenoid sinus - Radiation therapy is the first choice of treatment.  Surgery is difficult because of the anatomic location of the sinus, as it lies close to the nasopharynx.  

Cancers of the nasal cavity - Surgery is the primary treatment. Radiation therapy may also be done in certain cases.

 Cancers of the nasal vestibule- Surgery or radiation therapy may be used depending on the anatomic location of the cancer.


Salivary gland cancer

There are three pairs of salivary glands that are located on either side of the jaw. They are the parotid, sublingual and the submandibular salivary glands.

Though uncommon, cancers can affect any of these salivary glands. Early stage salivary gland cancers are curable, if treatment is started at the earliest. Advanced stage cancers are difficult to cure completely.

Surgery to remove the affected gland is the primary mode of treatment. Either a part or whole of the affected salivary gland is removed.

Radiation therapy and chemotherapy may be done in late stage salivary gland cancers.

Cancers of the mouth or oral cavity is the most common type of head and neck cancers.

The mouth or oral cavity anatomically comprises of the lips, the lining of the cheeks, the anterior two-thirds of the tongue, the floor of the mouth, the gums or gingiva and the hard palate that forms the roof of the mouth.

Of all oral cancers, cancers of the tongue ae the most common form of cancer. Cancers of the mouth account for almost 50% of all oral cancers.

Tobacco and alcohol are the primary risk factors of the cancers of the tongue. Tongue cancer is also seen in persons who do not drink or smoke. 

Carcinomas of the tongue is also the most aggressive of all oral cancers and exhibit extremely high rates of lymph node metastases

Cancers of the floor of the mouth is the second most common type of oral cancers accounting for almost 15 to 20 % of all cases. Cancers of the gingiva or gums account for almost 10% of all oral cancers.

Other rare types of oral cancers include cancers of the hard palate and the buccal mucosa or the lining of the cheeks.

Cancers of buccal mucosa is more prevalent in countries where people use tobacco pouches or betel nuts. Their tendency to hold it in the buccal vestibule makes them prone to a pre-cancerous condition, called oral submucous fibrosis.

On a cellular level almost ninety percent of all head and neck cancers are squamous cell carcinomas. Squamous cells are flat cells that line the mucosa of the oral cavity larynx and pharynx. Other types of head and neck cancers are sarcomas, lymphomas, blastomas and nuero-endocrine tumours.

If the cancer is limited to the squamous cells and does not invade deeper tissue the condition is called as carcinoma in situ.

Cancers that invade the deeper structures are called as invasive squamous cell carcinomas.

Symptoms of head and neck cancer include

·       An ulcer or lesion in the mouth that does not heal within two to three weeks

·       A lump or thickening in the mucosa of the cheek.

·       An elevated white or red patch on the gums, tongue, tonsil, or lining of the mouth.

·       A persistent sore throat

·       Difficulty in chewing

·       Difficulty in swallowing.

·       Difficulty with jaw or tongue movements

·       Numbness of the tongue or other areas of the mouth.

·       Swelling in the jaws that causes dentures to fit poorly

 

Though the presence of these symptoms could be due to other less serious problems, a detailed examination is necessary to exclude the possibility of cancer.

The initial step is a complete visual examination of the oral cavity under bright light. Any suspicious finding is recorded for detailed examination. A detailed examination is done in the lymph nodes of the neck to look for any signs of lymphadenopathy.

Nasopharyngolaryngoscopy is type of endoscopy that allows the doctor to look into the pharynx and larynx. This helps to provide a detailed picture regarding the anatomy of the pharynx and larynx as well as the nasal cavity.

If there is anything suspicious of oral cancer, a biopsy is done for confirmation. There are two types of biopsies performed for oral cancers. They are excision biopsy and incision biopsy.

In excision biopsy, the growth or tumour is completely excised and sent for pathological tests. In incision biopsy only a small part of the tumour is removed for pathological tests. It is necessary to get a proper tissue sample of sufficient thickness and breadth. The samples should ideally be taken from the centre of the suspicious area.

Fine needle aspiration cytology or FNAC is a type of biopsy done for the lymph nodes, if lymph node involvement is suspected. This technique uses a fine needle and a syringe to aspirate or draw out cells from the lymph nodes. Samples are drawn from different areas to create a more representative nature to help avoid a false negative result.

Imaging techniques like x-rays, CT scans can help to determine the extent and spread of head and neck cancers.

PET scan is another important diagnostic aid that helps to determine the extent of head and neck cancers. These scans provide an accurate assessment of the extent of cancers, by tracking the metabolic processes in cancerous areas.

Radionuclide scanning is done to assess the spread of head and neck cancers to other organs in the body.

MRI or magnetic resonance imaging helps to provide a detailed picture of the anatomical structures in the head and neck.

CT scans of the Sinuses provides multiple images or pictures of a patient's paranasal sinus cavities. These scans may be performed before any surgical procedure to determine the type and extent of surgery required.

The most common site of spread of head and neck cancers is the lungs. A chest x-ray should be done mandatorily to rule out the spread of cancer to the lungs.  

 

Head and neck cancer surgery price depends on the type of surgery undertaken. Since there are many types of surgeries that come under this category, the total cost of the surgery will differ for each type of surgery.

The cost of the surgery also depends on the hospital selected, the type of room selected, the duration of stay in the hospital, and the city where the hospital is located.

Patients will also need to factor in additional costs such as travel fare, hotel stay, food and medications.

Here’s a quick breakdown of the costs based on the kind of treatment selected:

·       Cost of evaluation – Approx. 1,500 USD

·       Chemotherapy – Approx. 1,300 to 1,500 per cycle

·       Biological Therapy – Approx. 1,500 per cycle

 

Head and neck cancers is a collective term to describe cancers that usually begin in the squamous cells that line the mucosal surfaces inside the head and neck.

Head and neck cancers include cancers of the:

      ·       Oral cavity- That includes the lips, the anterior two-thirds of the tongue, the gums, the mucosal lining inside the cheeks and lips, the floor of the mouth, the hard palate, and the small area of behind the wisdom teeth called the retromolar area

      ·       Pharynx or throat-There are three parts of the pharynx namely the nasopharynx  or the upper part of the pharynx located behind the nose, the oropharynx that includes the soft palate, the base of the tongue and the tonsils), and the hypopharynx or the lower part of the pharynx.

      ·       Larynx: The larynx contains the vocal cords and the epiglottis.

      ·       Nasal and paranasal sinuses and nasal cavity- This include the maxillary, ethmoidal and sphenoidal sinuses. Nasal cavity also includes the nasal vestibule.

      ·       Salivary glands

Cancers occurring in any of these regions comes under the terminology of head and neck cancers. Almost 90% of all head and neck cancers are squamous cell carcinomas. Squamous cells are those cells that line the mucosa of the oral cavity, the pharynx, larynx etc.

Head and neck cancers account for almost 4% of all types of cancers. Men are more commonly affected than women. Head and neck cancers are very rare in those under the age of fifty. These cancers are more common in those above the age of seventy.

The exact cause of head and neck cancers are not clearly understood. Mutations to the cells lining the mucosa is thought of as a reason. But what exactly causes these mutations remain largely unknown.

 

Head and neck cancer is a collective term to denote various cancers of the head and neck region.

Head and neck cancers are curable if detected at an early stage. Early treatment through excision surgery can help in preventing the spread of the cancer to other areas. Radiation therapy may also be used in certain cases of head and neck cancers.

Oral cancers

These are cancers that occur in the oral cavity comprising of lips, anterior two-thirds of the tongue, mucosa of the cheeks and lips, the floor of the mouth, the hard palate etc

Most of the cancers of the oral cavity begin as pre-cancerous conditions like luekoplakia, erythroplakia and oral submucous fibrosis. Early identification of these conditions can help in the early initiation of treatment if necessary.

Wide excision surgery followed by reconstruction surgery is the most common form of treatment. Radiation therapy may also be used in certain situations.

Lip cancer -Wide local excision surgery followed by brachytherapy or external beam radiation therapy.

Cancers of the anterior two thirds or the front of the tongue-Wide local excision surgery followed by internal or external radiation therapy. Radiation therapy to treat the lymph nodes in the neck.

Cancers of the buccal mucosa or the lining of the cheeks- Wide local excision surgery followed by brachytherapy or external beam radiation therapy. Skin graft surgery may be needed if the cancer has spread to the deeper layers of the cheek.

 Cancers of the floor of the mouth- Wide local excision surgery followed by internal or external radiation therapy. Reconstructive surgery including skin grafting may be necessary for cancers that are large.

Cancers of the gingiva or the gums- Wide excision surgery followed by radiation therapy. Removal of the surrounding jawbone that may be affected with the cancer may also be done if necessary. Grafting may be necessary to fill in the voids left by the surgery.

Cancers of the upper gingiva and the hard palate- Wide local excision with or without radiation therapy.

The curability of oral cancers also depend, on the stage of the disease. Cancers that involve or invade the deeper structures of the head and neck are difficult to cure completely so are cancers that have metastasised to other parts of the body.


Pharyngeal cancers
  

Pharyngeal cancers include

 Nasopharyngeal cancers – Cancers that originate in the nasopharynx, the upper most part of the pharynx located behind the nose. Nasopharyngeal cancers have a better chance of cure if detected in the early stages. Radiation therapy is the primary mode of treatment for nasopharyngeal cancers. Chemotherapy may also be used in conjunction with radiation therapy. The role of surgery in nasopharyngeal cancer is limited to neck dissection surgery to remove the lymph nodes of the neck. Chemotherapy may also be used to treat advanced nasopharyngeal cancers that have spread to other parts of the body.

Oropharyngeal cancers- Cancers that occur in the oropharynx, the portion of the pharynx that includes the soft palate, base of the tongue and tonsils. Surgery is the most preferred mode of treatment for oropharyngeal cancers. Surgery may remove the tonsils, the base of the tongue as well as parts of the soft palate that are affected by cancer. Radiation and chemotherapy may be done after surgery to destroy any remnants of cancer cells.

Hypopharyngeal cancers – Cancers that occur in the lower most part of the pharynx. If found early, Hypopharyngeal cancers are curable. Laryngopharyngectomy, a surgery to remove the larynx and part of the pharynx or partial laryngopharyngectomy to remove part of the larynx and part of the pharynx are the common modes of treatment. A partial laryngopharyngectomy helps to prevent the loss of the voice. Neck dissection to remove lymph nodes and other cancerous tissues in the neck may also be done. Radiation therapy to remove any cancer cells may be done after surgery.

Advanced stage hypopharyngeal cancers that have metastasised respond less well to treatment.


Laryngeal cancers

Larynx contains the epiglottis and the vocal cords. The primary symptom of most laryngeal cancers is the hoarseness of voice. This makes early detection a possibility. Laryngeal cancers if detected in early stages is completely curable.

Surgery

Surgery is the first line of treatment for all stages of laryngeal cancer. The type of surgery depends on the extent of cancer and the part of larynx affected. The common surgeries include:

Cordectomy: Surgery to remove the vocal cords if only the vocal cords are cancerous.

Supraglottic laryngectomy: This surgery is done in cancers that has affected only the upper part of the epiglottis.

Hemi-laryngectomy: This surgery is done if the cancer has affected only one half of the larynx. This may help to save the voice.

Partial laryngectomy:  A surgery to remove only the part of the larynx affected by cancer. A partial laryngectomy help retain the ability to talk.

Total laryngectomy: Surgery to remove the larynx completely, in situations where the whole of the larynx is affected.

Thyroidectomy: The removal of the thyroid gland along with larynx surgery in conditions where the whole of the thyroid is affected by invasive laryngeal cancer.

All these treatments are for various stages of laryngeal cancer. The outcome and the disability associated with surgery depends on the extent of the cancer and the spread to lymph nodes and other surrounding areas.


Nasal and paranasal air sinus and nasal cavity cancers

These include the cancers of the maxillary, sphenoidal and ethmoidal air sinuses as well as the nasal cavity including the nasal vestibule.

Sinus cancers are rare, but offer a high rate of successful cure, if detected early. Spread of cancers to adjoining structures may create problems with treatment as well as affect the overall prognosis.

Surgery followed by radiation or chemotherapy is the accepted mode of treatment

Cancer of the maxillary sinus- Treatment is surgery, with or without radiation therapy.

Cancer of the ethmoid sinus- Primary treatment is usually radiation therapy. Surgery may also be done in certain situations

Cancer is in the sphenoid sinus - Radiation therapy is the first choice of treatment.  Surgery is difficult because of the anatomic location of the sinus, as it lies close to the nasopharynx.  

Cancers of the nasal cavity - Surgery is the primary treatment. Radiation therapy may also be done in certain cases.

 Cancers of the nasal vestibule- Surgery or radiation therapy may be used depending on the anatomic location of the cancer.


Salivary gland cancer

There are three pairs of salivary glands that are located on either side of the jaw. They are the parotid, sublingual and the submandibular salivary glands.

Though uncommon, cancers can affect any of these salivary glands. Early stage salivary gland cancers are curable, if treatment is started at the earliest. Advanced stage cancers are difficult to cure completely.

Surgery to remove the affected gland is the primary mode of treatment. Either a part or whole of the affected salivary gland is removed.

Radiation therapy and chemotherapy may be done in late stage salivary gland cancers.

Cancers of the mouth or oral cavity is the most common type of head and neck cancers.

The mouth or oral cavity anatomically comprises of the lips, the lining of the cheeks, the anterior two-thirds of the tongue, the floor of the mouth, the gums or gingiva and the hard palate that forms the roof of the mouth.

Of all oral cancers, cancers of the tongue ae the most common form of cancer. Cancers of the mouth account for almost 50% of all oral cancers.

Tobacco and alcohol are the primary risk factors of the cancers of the tongue. Tongue cancer is also seen in persons who do not drink or smoke. 

Carcinomas of the tongue is also the most aggressive of all oral cancers and exhibit extremely high rates of lymph node metastases

Cancers of the floor of the mouth is the second most common type of oral cancers accounting for almost 15 to 20 % of all cases. Cancers of the gingiva or gums account for almost 10% of all oral cancers.

Other rare types of oral cancers include cancers of the hard palate and the buccal mucosa or the lining of the cheeks.

Cancers of buccal mucosa is more prevalent in countries where people use tobacco pouches or betel nuts. Their tendency to hold it in the buccal vestibule makes them prone to a pre-cancerous condition, called oral submucous fibrosis.

On a cellular level almost ninety percent of all head and neck cancers are squamous cell carcinomas. Squamous cells are flat cells that line the mucosa of the oral cavity larynx and pharynx. Other types of head and neck cancers are sarcomas, lymphomas, blastomas and nuero-endocrine tumours.

If the cancer is limited to the squamous cells and does not invade deeper tissue the condition is called as carcinoma in situ.

Cancers that invade the deeper structures are called as invasive squamous cell carcinomas.

Symptoms of head and neck cancer include

·       An ulcer or lesion in the mouth that does not heal within two to three weeks

·       A lump or thickening in the mucosa of the cheek.

·       An elevated white or red patch on the gums, tongue, tonsil, or lining of the mouth.

·       A persistent sore throat

·       Difficulty in chewing

·       Difficulty in swallowing.

·       Difficulty with jaw or tongue movements

·       Numbness of the tongue or other areas of the mouth.

·       Swelling in the jaws that causes dentures to fit poorly

 

Though the presence of these symptoms could be due to other less serious problems, a detailed examination is necessary to exclude the possibility of cancer.

The initial step is a complete visual examination of the oral cavity under bright light. Any suspicious finding is recorded for detailed examination. A detailed examination is done in the lymph nodes of the neck to look for any signs of lymphadenopathy.

Nasopharyngolaryngoscopy is type of endoscopy that allows the doctor to look into the pharynx and larynx. This helps to provide a detailed picture regarding the anatomy of the pharynx and larynx as well as the nasal cavity.

If there is anything suspicious of oral cancer, a biopsy is done for confirmation. There are two types of biopsies performed for oral cancers. They are excision biopsy and incision biopsy.

In excision biopsy, the growth or tumour is completely excised and sent for pathological tests. In incision biopsy only a small part of the tumour is removed for pathological tests. It is necessary to get a proper tissue sample of sufficient thickness and breadth. The samples should ideally be taken from the centre of the suspicious area.

Fine needle aspiration cytology or FNAC is a type of biopsy done for the lymph nodes, if lymph node involvement is suspected. This technique uses a fine needle and a syringe to aspirate or draw out cells from the lymph nodes. Samples are drawn from different areas to create a more representative nature to help avoid a false negative result.

Imaging techniques like x-rays, CT scans can help to determine the extent and spread of head and neck cancers.

PET scan is another important diagnostic aid that helps to determine the extent of head and neck cancers. These scans provide an accurate assessment of the extent of cancers, by tracking the metabolic processes in cancerous areas.

Radionuclide scanning is done to assess the spread of head and neck cancers to other organs in the body.

MRI or magnetic resonance imaging helps to provide a detailed picture of the anatomical structures in the head and neck.

CT scans of the Sinuses provides multiple images or pictures of a patient's paranasal sinus cavities. These scans may be performed before any surgical procedure to determine the type and extent of surgery required.

The most common site of spread of head and neck cancers is the lungs. A chest x-ray should be done mandatorily to rule out the spread of cancer to the lungs.  

 

Head and neck cancer surgery price depends on the type of surgery undertaken. Since there are many types of surgeries that come under this category, the total cost of the surgery will differ for each type of surgery.

The cost of the surgery also depends on the hospital selected, the type of room selected, the duration of stay in the hospital, and the city where the hospital is located.

Patients will also need to factor in additional costs such as travel fare, hotel stay, food and medications.

Here’s a quick breakdown of the costs based on the kind of treatment selected:

·       Cost of evaluation – Approx. 1,500 USD

·       Chemotherapy – Approx. 1,300 to 1,500 per cycle

·       Biological Therapy – Approx. 1,500 per cycle