Head and Neck Cancer

About Head and Neck Cancer

Cancers of the head and neck region are fairly uncommon and pose a difficult treatment challenge. Cancers of the head and neck are classified by the area where they originate:

Oral cavity: The oral cavity includes the lips, the front of the tongue, the gums (gingiva), the inside lining of the cheeks and lips (buccal mucosa), the floor of the mouth under the tongue, the bony top of the mouth (hard palate), and the small area behind the wisdom teeth.

Salivary Glands: The salivary glands produce saliva; the fluid that keeps mucosal surfaces in the mouth and throat moist. There are many salivary glands; the major ones are in the floor of the mouth, and near the jawbone.

Para Nasal Sinuses and Nasal Cavity: The Para nasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.

Pharynx: The pharynx is a hollow tube that begins behind the nose and leads to the esophagus (the food pipe that leads to the stomach) and the trachea (the tube bringing air to the lungs).

The pharynx has three parts:

• Nasopharynx: The upper part of the pharynx is behind the nose.
• Oropharynx: The middle part of the pharynx, which includes the soft palate (the back of the mouth), the base of the tongue, and the tonsils.
• Hypopharynx: The lower part of the pharynx.

Larynx: also known as the voice box, contains the vocal cords and the epiglottis, which moves to cover the larynx when one eats to prevent food from entering the airway.

Lymph nodes: in the upper part of the neck. Sometimes, squamous cancer cells involve the lymph nodes of the neck with no evidence of cancer anywhere else. This would be classified as metastatic squamous neck cancer with unknown (occult) primary.

Cancers of the brain, eye, and thyroid, as well as those of the scalp, skin, muscles, and bones of the head and neck are not usually grouped with head and neck cancer.

Signs & Symptoms

There are varying types of symptoms that can present from cancers of the head and neck region – most of which depend on the area where the cancer has originated. For example, the following is a list of the different regions of the head and neck areas where cancers can come from, and symptoms associated with those areas.

Oral Cavity: A white or red patch on the gums, tongue, or lining of the mouth, a swelling of the jaw that causes dentures to fit poorly or become uncomfortable, any unusual bleeding or pain in the mouth.

Nasal Cavity and Sinuses: Sinuses that are blocked and do not clear, chronic sinus infections that do not respond to treatment with antibiotics, bleeding through the nose, frequent headaches, swelling or other trouble with the eyes, pain in the upper teeth, or problems with dentures.

Salivary Glands: Swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain that does not go away in the face, chin, or neck.

Oropharynx and Hypopharynx: Ear pain, hoarseness, difficulty swallowing, change in voice quality. Nasopharynx: Trouble breathing or speaking, frequent headaches, pain or ringing in the ears, or trouble hearing or nosebleeds.

Larynx: Pain when swallowing, ear pain, hoarseness or raspy voice. In addition to some of the local symptoms, cancers of the head and neck can spread to the lymph nodes in the neck, and patients can present with swelling or a lump in the neck.

It is important to realize that many of the symptoms listed above can occur due to many other problems that are not related to cancer. Therefore, it is important to check with your doctor or dentist about any of these symptoms.

Diagnosing Head & Neck Cancer

A doctor will evaluate a patient’s medical history, perform a physical examination, and order diagnostic tests. These exams and tests are tailored to the patient’s symptoms. Typically, one of the most important tests is a biopsy, in which a sample of the abnormal tissue is taken to confirm a diagnosis of cancer.

Some useful exams and tests include:
Physical examination: Visual inspection of the oral and nasal cavities, neck, throat, and tongue as well as feeling for lumps on the neck, lips, gums, and cheeks.

Endoscopy: Inserting a thin, lighted tube, called an endoscope, through the nose to examine the larynx, hypopharynx, oropharynx, and nasopharynx.

Laboratory tests: Examine samples of blood, urine, or other substances from the body.

Radiology studies: These are used to look into the body and see if there are any anatomic abnormalities. X-rays are used to view areas inside the head and neck on film. CT (or CAT) scan is a series of detailed x-rays created by a computer link of areas inside the head and neck. Magnetic resonance imaging, or MRI scans use a powerful magnet linked to a computer to create detailed pictures of areas inside the head and neck. A PET scan uses a type of glucose (sugar molecule) that is modified in a specific way so it is absorbed by cancer cells and appears as dark areas on the scan.

Biopsy: is the removal of tissue. A Pathologist studies the tissue under a microscope to make a diagnosis. A biopsy is the only sure way to tell whether a person has cancer. If the diagnosis is cancer, then the staging will depend on the extent of disease and whether the cancer has spread either to lymph nodes or to distant sites or whether the cancer has been contained in one location. The stage is critical in deciding on the proper treatment plan.

Who Treats Head and Neck Cancer?

Patients with head and neck cancers are best treated by a team of specialists including some or all of the following:
Otolaryngologist: This is an ear, nose, and throat specialist. Sometimes an even more specialized Head and Neck Surgeon performs very difficult surgical removal of head and neck cancers.

Pathologists: This specialist reviews the cells and tissue taken from the biopsy, determines the type of cancer, reviews the specimen to determine the extent of the cancer, and provides very important information to help tailor further treatments.

Radiation Oncologist: A physician who uses highly conformal and sophisticated radiation to treat tumors of the head and neck region.

Medical Oncologist: Provides chemotherapies that can benefit patients with these types of cancers.

Plastic Surgeons: Certain surgeries to remove cancers in this area require closure with the aid of a plastic surgeon, including skin grafting or muscle flaps for optimal cosmetic outcomes.

Oral Surgeons, Dentists & Prosthodontists: These specialists play many roles in the diagnosis, treatment and support of patients with head and neck cancers.

How is Head and Neck Cancer treated?

Many factors are important when selecting the best treatment plan for an individual patient. Those factors include the location of the tumor, the stage of the cancer, the person’s age and general medical condition. There are three main types of treatments that are used in head and neck cancer treatment: surgery, radiation therapy and chemotherapy. Typically, one, two or all three of these treatment modalities are used.
Surgery: The surgeon may remove the cancer and/or the lymph nodes in the neck. Side effects of surgery may include problems with chewing, swallowing, or talking and sometimes surgery can alter the way a patient looks.

Chemotherapy: Chemical agents or drugs that are typically given intravenously or by mouth are used to kill cancer cells, as well as to sensitize cells for radiation therapy.

Radiation therapy: is also referred to as radiotherapy. This treatment utilizes high-energy x-rays to kill cancer cells. Radiation therapy is most commonly delivered using a machine coming from outside thebody (external radiation therapy). However, radioactive materials can also be placed directly into or near the cancer (internal radiation therapy or radiation implant also known as brachytherapy). Although the goal of radiotherapy is to eradicate cancer cells, side effects may include: skin irritation and possible skin breakdown, mouth and throat sores, dry mouth or thickened saliva, difficulty in swallowing and loss of taste.

Radiation Therapy for Head and Neck Cancer at ARC - IGRT & RapidArc

The physicians at ARC were among the first in the country to use RapidArc Rotational Radiation therapy in the treatment of head and neck cancers. RapidArc provides the highest sophistication of radiation delivery and accuracy that is available anywhere in the world. At ARC, RapidArc is combined with Image Guided Radiation Therapy, or IGRT, as a highly precise targeting technology that allows day-to-day visualization of all tissues and organs in the head and neck area. As tumors begin to shrink during the treatment course, minor changes or shifts in the radiation beam can be made to ensure a more precise treatment. With increased accuracy, often comes fewer side effects, because collateral healthy tissues are shielded in an unprecedented manner.