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.
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 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.
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 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.