Head and Neck Cancers
Introduction
Cancer of the head and neck is common. Oncologists divide patients by the subsite of the head and neck that has the primary cancer. The common subsites are: nasal cavity and sinuses, nasopharynx, oropharynx (tonsil and base of tongue), hypopharynx, laryngeal (or glottis), lip and oral cavity, and salivary glands. The location of the primary tumor often determines which types of treatment you may need to help control your cancer.
Causes
Historically, the most common cause of cancers of the head and neck was tobacco usage (cigarette smoking and chewing tobacco). While tobacco usage continues to account for a number of cases of cancer of the head and neck, other causes are also emerging. More recently in the United States, virally driven tumors like HPV-driven tonsil cancers and EBV-driven nasopharyngeal cancers are becoming much more common. There can be a synergistic effect between smoking and these viruses in the predisposition for cancer.
Clinical Manifestations and Diagnosis
Cancers of the head and neck can sometimes present as a swelling or mass in the neck, which may represent cancer that has spread to a lymph node. Other patients will notice a mass sensation in their throat or associated difficulty swallowing. Still others may be diagnosed by their dentist if they have a spot in their cheek or on their tongue.
There are no widely utilized screening tests for cancers of the head and neck in the United States. However, if you are experiencing difficulty swallowing or feeling swelling in your neck, consult your primary care provider. You may also be referred to an ear nose and throat (ENT) physician for a biopsy.
If a mass is felt in your neck or a concerning area is observed by a physician, you may have a CT scan of the neck. If a biopsy of the concerning site reveals cancer (oftentimes a squamous cell carcinoma), you may have additional imaging studies like an MRI or a PET/CT scan.
Treatment Strategies
Treatment strategies for cancers of the head and neck are guided by the location of the primary tumor site. If the primary tumor is in the oral cavity or the oral tongue, patient's will usually undergo surgery. They may need additional treatment with either radiation therapy or chemotherapy or both depending on the results of the surgery.
For patients with nasopharyngeal carcinoma, or oropharyngeal cancers (e.g. tonsil cancer or base of tongue cancer), radiation or radiation plus chemotherapy together are often recommended.
For cancers of the larynx (voicebox), patients may have a choice between surgery or radiation therapy.
Radiation treatments typically last 7 weeks to achieve a total of 35 daily radiation treatments. If you need radiation treatments after his surgical resection, sometimes treatment courses may be shorter, 6 to 6-1/2 weeks.
Speak to your oncologist for more details concerning your specific case.
Prognosis and prognostic factors
Each patient has a unique cancer type and stage with different underlying risk factors. During a oncology consultation visit, your oncologist will discuss what to expect from treatment. Ask your doctor about the expected outcomes.
Virally mediated cancers of the head and neck, like some HPV-driven tonsil cancers and base of tongue cancers, will often respond well to chemotherapy and radiation together. Cancers that are driven by smoking typically recur more frequently, however there may still be a good chance of cure depending on the stage of the tumor.
Treatment Side Effects
Radiation treatment side effects tend to affect the tissues that are close to the tumor where the radiation is directed. Some side effects can be more pronounced during and shortly after radiation treatment (acute side effects). While other side effects may occur many months or years after treatment (chronic or late side effects).
With radiation to the head and neck area, there are a number of side effects that will occur. Patients may get skin irritation called radiation dermatitis and desquamation. The skin area treated we will often turn red like a sunburn over the course of the radiation treatments.
Just like the sunburn on the outside of the skin, patient also experience a "sunburn" on the inside of their throat. This irritation of the throat can cause pain and difficulty swallowing.
There may also be a loss of sense of taste or foods may taste bad. This often begins a few weeks into treatment and may persist for many months afterwards.
If the salivary glands received radiation, patient's often will have dry mouth that may be long-term or permanent.
A stiffening of the muscles of the neck with decreased range of motion may also be a permanent challenge for patients.
Fatigue is also a commonly reported side effect.