What are they?
Usually cancers of the head and neck are carcinomas which start in the cells that form the lining of the mouth, nose, throat or ear, or on the surface layer of the tongue. Other cancers of the head and neck include:
- lymphomas from the cells of the lymphatic system
- sarcomas from the cells of the muscles, cartilage or blood vessels
- melanomas from cells that give pigment (colour) to the eyes and skin
- cancers of the thyroid gland, larynx (voice box) and ocular melanoma
Causes of head and neck cancer are mostly unknown. But there are a number of risk factors that can increase your chance of developing this type of cancer.
- Age and sex: most common in people over 50, and more common in men
- Smoking: squamous cells carcinomas are more common in smokers
- Drinking Alcohol: more common in people who drink spirits especially
- Chewing tobacco or betel nuts
- Exposure to Sunlight: increased risk of cancer of the lip and the ear
- Poor diet
- Exposure to chemicals
- Human Papilloma Virus or HPV
- Inherited faulty genes
Depending on what type of head and neck cancer that presents, there will be specific sets of symptoms. Most common symptoms are:
- Ulcer or sore area that does not heal within a few weeks
- Difficulty in swallowing or chewing
- Trouble with breathing or speaking
- Numbness in the mouth or lips
- Unexplained loose tooth
- Persistent nose bleeds
- Constant sore throat and earache on one side
- Difficulty in hearing
- Lump in the mouth or neck
- Unexplained pain in the facial area
If you have any of these symptoms you should have them checked by your doctor, but remember, they are common to many illnesses other than Head and Neck Cancer.
After visiting your GP you will probably be referred to a hospital for some tests. These may include:
- MRI Scan
- CT Scan
- PET Scan
- Bone Scan
- Fine needle aspiration. A biopsy where a small needle is passed gently into the affected area
- Blood test
- Nasendoscopy. Using a small mirror held at the back of your mouth a nasendoscope (a very thin flexible tube with a light at the end) is passed into your nose checking the back of the mouth and throat. The patient may be given a lozenge to suck on, containing a local anesthetic, thus making it less uncomfortable. It is a very quick test
- Microcytoscopy. A small amount of blue dye is painted onto the abnormal area, which is then looked at very closely using a microscope
The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site.
Head and neck cancers are generally divided into four stages:
- Stage1: small and localised
- Stage 2: Spread to surrounding structures
- Stage 3: Spread to surrounding structures
- Stage 4: Spread to other parts of the body
A common way of staging head and neck cancers is the TNM staging system.
- T relating the size of the Tumour
- N relating whether the cancer has spread to the lymph Nodes
- M relating to the spread of cancer to another part of the body (secondary or Metastatic cancer)
A team of doctors and other staff at the hospital will plan the treatment. It will depend on the size and position of the tumour. You may be treated by an oncologist (a doctor who specialises in treating cancer with chemotherapy) and a radiologist (a doctor who specialises in treating cancer with radiation). Together they and the other staff make up an MDT (Multi Disciplinary Team) that attends to the treatment of patients.
Treatment may involve:
Most people have chemotherapy to shrink the size of the tumour and to get rid of any cancer cells around the body. This is usually followed with surgery to remove the tumour. More chemotherapy and radiotherapy usually follows.
Sometimes, treatment for head and neck cancer has associated side effects.
Chemotherapy and Radiotherapy:
Chemotherapy and radiotherapy can be used alone or together (this is called chemo-radiotherapy). Often chemo or radiotherapy starts again after surgery to kill any small cancerous areas not removed in surgery. This is called adjunct chemotherapy.
The aim of surgery is to remove the tumour completely. The surgery may cause scarring on the face or neck. Some people may also need to have reconstructive surgery to the face.
Other surgeries used include:
- Photodynamic therapy: Light energy or laser is used to remove small tumours in the mouth and the pharynx. This may be combined with a light-sensitive drug (Photosensitising agent).
- Micrographic surgery: Usually for cancers of the lip. The surgeon removes the cancer in thin layers, and will continue to remove more layers until no cancer cells are seen in the tissue. This technique makes sure only the minimum of healthy tissue is removed.
- Skin Flaps: After a part of the mouth, throat or facial skin has been removed there may be a need to replace a piece of skin taken from another part of the body.
- Bone graft: Affected bone in the face (eg. jaw bone) may be removed and replaced with part of a bone taken from elsewhere in the body. Usually taken from the leg.
- Prosthesis: This is a specially-designed soft plastic replacement for the part of the face that has been removed.