Head and Neck Cancers

Head and Neck cancers refer to a diverse group of cancers that involve this region of the body with exclusion of cancers of  thyroid gland, skin, lymph glands and brain. Roughly 13,000 Americans develop these cancers every year. They are more common in men than in women. Smoking and Tobacco use, along with alcohol, impose a great risk on individuals to develop these cancers. Most of these cancers origin from the tissues that line the airways in nostrils, salivary glands and throat, as well as inside the mouth, gums, tongue and upper part of esophagus.

Causes:

Following is a list of factors that increase the risk of these cancer

• Tobacco

• Alcohol

• Viruses

• Industrial exposure to metals, wood dust, textiles, etc.

• Prior Radiation therapy to head and neck area.

• Vitamin A deficiency,

• Iron deficiency

Signs and Symptoms:

Patient do not have any signs at very early stages. Sinusitis, obstruction of one nostril, nose bleed, hoarseness, repeated or chronic ear infection, difficulty swallowing and eventually feeling a lump in the neck are among the common manifestation of these cancers.

Diagnosis:

When there is a suspicion for this condition, patients should be seen by an ENT (Ear, Nose and Throat) specialist. He will perform a physical examination followed by endoscopy to visualize the upper airways and esophagus. CT scan or MRI are part of work up of any patient with these cancers. If an abnormal area is seen in the ENT endoscopy or physical examination, then a biopsy is performed and the tissue sample is sent to the pathologist. If patients present with a lump in their neck, or an enlarged lymph gland, a fine needle aspiration or a surgical biopsy may be indicated.

Treatment

Most patients are treated with a combination of Surgery, Chemotherapy and Radiation therapy. Surgery is most appropriate for patients with very early stages of a disease, specially when the location of cancer makes it easy to operate. Aggressive surgery could lead into loss of voice as well as severe disfigurement of the patients. Preservation of voice has to be kept in mind at all times. Even for patients with more advanced disease, combination of chemotherapy and radiation therapy could still cure a good percentage of patients. Certain cancers, i.e. Nasopharyngeal tumors ( located deep and high in the back of airways) are almost never treated with surgery.

Most patients with head and neck cancers are treated with a combination radiation therapy and chemotherapy, which may include  5-FU , Cisplatinum  and Cetuximab. 5-FU is given as a continuous infusion over 4-5 days.  Cisplatinum and Cetuximab are given in one dose on day one of a 21 to 28 days cycle. The same regimen is repeated every 3-4 weeks. Patients benefit from having a Port-A-Cath for administration of chemotherapy. Most important Side effects of this regimen are:

• Hair loss

• Nausea, Vomiting

• Low white blood counts

• Anemia

• Soreness of the mouth

• Skin rash due to cetuximab

Other drugs may also be used in some sort of combination; Leucovorin, Methotrexate, Bleomycin, Carboplatin, Cytoxan.

Radiation therapy:

Radiation to the neck is a treatment that is offered over 6-8 weeks. patients may notice some side effects such as:

• Soreness and dryness in the mouth

• Skin irritation,

• Difficulty swallowing

Most of these side effects will subside after completion of treatment, however some may persist for a very long period of time (Dry mouth.)

Prognosis:

Depends on the extent of the disease at diagnosis as well as the response to treatment, Most patients with early stage cancers can be cured. In others, the disease can be controlled very well with treatment for a period of time that may vary from months to years. If the disease reoccurs, the treatment will most likely be either chemotherapy or possibly surgery.