Head and Neck Cancer

Cancers of the head and neck mostly come from a cell type called squamous cells. These cells line the moist mucous membranes of the inner surfaces of the head and neck. Cancers of these squamous cells are referred to as squamous cell carcinomas. The salivary glands contain different cell types. This means that there are potentially many different types of cancers of the salivary glands, but cancers of the salivary glands are relatively rare.

Head and neck cancers constitute 12% of all cancers worldwide. It is the fifth most common cancer type and cause for cancer-related deaths worldwide. Nasopharyngeal cancers is one of the more common cancers in Singapore. Some head and neck cancers are:

• Mouth cancer
• Floor of the mouth cancer
• Tongue
• Soft palate cancer
• Lip cancer
• Nasal and paranasal tumours
• Nasopharyngeal (nose) carcinoma
• Salivary gland tumours
• Throat cancer
• Thyroid cancer
• Tonsil cancer

The different types of cancers of the head and neck have different prognosis as well as treatments.

Some general symptoms include:

• Lump or sores that do not heal
• Persistent sore throat
• Difficulty swallowing
• Change in the voice
• Hoarseness

The symptoms of head and neck cancers depend on the location and the organ from which the cancer develops.

Oral cavity

• White or red patch on the gums, tongue or lining of the mouth
• Swelling of the jaw
• Unusual bleeding
• Pain

Pharynx (throat)

• Difficulty breathing
• Difficulty speaking
• Pain when swallowing
• Persistent pain in the neck or throat
• Frequent headaches
• Ringing in the ears
• Trouble hearing

Larynx (voice box)

• Pain when swallowing
• Ear pain

Nasal cavity (nose) and paranasal sinuses

• Blocked sinuses that do not clear
• Chronic sinus infections that do not respond to treatment
• Nose bleeds
• Frequent headaches
• Swelling or trouble with the eyes
• Pain in the upper teeth

Salivary glands

• Swelling under the chin or around the jawbone
• Numbness of muscles in the face
• Persistent pain in the face, chin or neck

Thyroid

• Lump or swelling in the neck
• Pain in the front of the neck, sometimes goes up to the ears
• Hoarseness
• Voice changes
• Trouble swallowing
• Trouble breathing
• Constant cough that is not due to a cold

These symptoms may be caused by other less serious conditions. However, it is still important to check with your doctor should you experience any of these symptoms. Cancers with nonspecific symptoms are often missed. If they can be detected at earlier stages, which could allow for a higher chance of cure with the appropriate treatment.

• Alcohol use
• Tobacco use
• Infection with cancer-causing types of human papillomavirus (HPV)
• Infection by Epstein-Barr Virus (EBV)
• Chewing of paan (betel quid) in the mouth
• Consumption of preserved or salted foods (especially during childhood)
• Poor oral health
• Exposure to asbestos
• Occupational exposure, in construction, metal, textile, ceramic and logging industries
• Industrial exposure to wood or nickel dust, or formaldehyde
• Radiation exposure
• Asian, particularly Chinese, ancestry in the case of nasopharyngeal cancer

In the past, head and neck cancers, particularly oropharyngeal cancers, were often seen in older men who consumed alcohol and smoked tobacco. However, in the last decade, there has been a higher incidence of oropharyngeal cancer in younger, healthier and non-smoking patients. This has been associated with infection by cancer-causing human papillomaviruses (HPV).

There has been increasing evidence showing that infection by cancer-causing human papillomaviruses (HPV), such as HPV type 16, is a risk factor for head and neck cancers, particularly oropharyngeal cancers. Patients infected by the HPV viruses are prone to develop oropharyngeal cancers that involve the tonsils or the base of the tongue.

Avoiding oral HPV infection may therefore reduce the risk of HPV-associated head and neck cancers. Vaccines have been developed to counteract the HPV virus. These include Gardasil, Gardasil 9 and Cervarix. However, it is not known whether they are able to prevent HPV infection of the oral cavity.

In order to diagnose a cancer of the head and neck, your doctor may perform a physical examination. Your doctor may also conduct a biopsy. This involves collecting a sample of the abnormal tissue. The tissue will then be examined under the microscope in order to determine if it is cancerous or benign.

The use of imaging will also help your doctor to determine the diagnosis, as well as to stage the cancer. Your doctor will want to see if the cancer has spread, and if it has, to which other parts of the body. X-rays may be used, or other imaging procedures such as magnetic resonance imaging (MRI) or computerised tomography (CT). Sometimes a dye may be injected to make the detection of abnormalities easier to see.

Treatment options for head and neck cancers depends on the location of the tumour, the stage of cancer, the individual patient’s overall health and age.

Treatment is multidisciplinary and personalized. These may include the following, and possibly in combination:

• Surgery
• Radiation therapy including:
  • External Beam Radiation Therapy
  • Stereotactic Body Radiation Therapy
  • Proton Beam Therapy
• Chemotherapy
• Targeted drug therapy
• Immunotherapy

Once the diagnosis is made the consultation with an oncologist is essential in order to understand which treatment options are the most suitable.