Vast cancers with rare exceptions in treatment and various diagnostic dilemmas originate in the oral cavity, nasal cavity, nasopharynx, throat (oropharynx, hypopharynx, larynx), other nearby regions are clubbed together as head and neck cancers.
Types of Head and Neck Cancers according to the primary site of origin:
- Oral Cancer
- Throat cancer
- Laryngeal cancer
- Nasopharyngeal carcinoma
Types of treatment
- Surgery
- Radiation therapy
- Chemotherapy
- Multimodal treatment
- Immunotherapy
- Targeted drug therapy
Oropharyngeal cancer: cancer/malignancy in the oropharynx, account for nearly 10% of all head and neck cancers
Oropharynx :
- part of the pharynx (throat)
- consists of the mainly soft palate, the base of tongue and tonsils
- Incidence: I increased incidence in the proportion of HPV infection prevalence
Demographic details:
- Males are affected more.
- Common in 60-70 years.
Risk factors:
- Smoking: 7 – 8 times increase risk fold
- Alcohol: increases the risk of cancer by 6-7 times
- HPV infection: 70-80% cases association is reported
Signs and symptoms :
Symptoms of oropharyngeal cancer vary by the location of the tumor.
- Difficulty or pain in swallowing
- Neck swelling
- Ear pain
- Difficulty in opening mouth
- Change in voice
- Regurgitation of food
- Loss of weight
- Loss of appetite
- Persistent sore throat
- A continuous sensation of something being stuck in the throat
Diagnostic valuation:
- Medical history
- physical examination
- Biopsy
- CT scan/MRI (local extension of the disease and lymph nodal involvement)
- Chest X-ray (rule out lung metastasis)
- CT scan thorax (observe locally advanced disease)
- PET CT (increased risk of distant metastasis-only)
Treatment regimen:
- Staging of the tumor is followed by interdisciplinary planning of treatment regimen
- Primary treatment modalities :
- Radiation, with or without surgery
- Chemotherapy
- Radiation therapy (or radiotherapy)
- Targeted drug therapy
- Immunotherapy
- Clinical trials
Laryngeal Cancer Common Signs, Symptoms, Diagnosis And Treatment
Laryngeal cancer: Cancer of voice box (larynx) in the human body 50% of all cases of laryngeal cancer are localized 15% of cases end up with distant metastasis
The larynx has three main regions:
- Supraglottic
- Glottis
- subglottic regions.
Demographic details:
- the average age at which laryngeal cancer gets diagnosed is 55-70 years
- common among females
Risk factors
- Smoking Marijuana: increases risk of fold by15 times
Signs and symptoms The specific symptoms of laryngeal cancer are dependent on the location of the primary tumor
A symptom of glottic cancer :
- a persistent change in voice (hoarseness of voice)
A symptom of supraglottic cancer:
- throat pain
- the feeling of having a lump in the throat.
Diagnostic evaluation:
- Medical history
- Physical examinations
- Direct laryngoscopy under anesthesia
- Biopsy
- Computerized tomography (CT) scan of the head and neck region (local extent of the disease and lymph node involvement)
- Chest X-ray (in order to rule out the possibility of lung metastasis).
- PET CT scan (distant metastasis)
Treatment regimen: The treatment of laryngeal cancer depends on the stage at which the patient has been diagnosed.
The treatment for metastatic or recurrent (relapsed) laryngeal cancer is usually different than the earlier stages.
Radiation therapy Surgery For patients with early-stage radiation with conservative surgery or postoperative radiation therapy with targeted drug therapy is recommended and a good prognosis is observed.
As said different approach of treatment for ‘locally advanced laryngeal cancer’ is required which includes multi-modality treatment. This treatment modality criterion is based on as age of the patient, systemic response to the drug,
medical comorbidities and presence of any DNA mutation which is predictive for its recurrence or metastasis.
Both recurrent and metastatic forms of laryngeal cancer are not considered difficult to treat any more they are just different to treat as compared to earlier stages.
Nasopharyngeal Cancer Early Signs & Symptoms, Diagnosis, And Treatment
Nasopharyngeal cancer: a rare malignant tumor that arises in the epithelium of the Nasopharynx
Nasopharynx: the upper part of the throat (behind the nose) three separate segments: the nasopharynx, the oropharynx, and the hypopharynx.
Incidence: 2-3 times higher in men, as compared to women. The average age is 50-60 years.
Distant metastasis: 5 -10% of all nasopharyngeal cancer patients with bone, lung, and liver metastases being the most common forms of cancer spread due to the affinity of these cancer cells for this site.
Risk factors:
- viral infection: Epstein Barr virus (EBV), Human papillomavirus (HPV)
- environmental factors: salted seafood with nitrosamines, fermented food consumption, Chinese medical herbs
- hereditary causes (genetic predisposition)
- Smoking
Signs and symptoms:
- Swelling in the neck
- nasal blockage
- nasal bleeding
- nasal discharge
- serous otitis media (ear infections)
- ear pain
- ear discharge
- the nasal tone of voice
- ringing sensation in the ear
- the gradual loss of hearing
- Persistent headache
- Double vision
- Facial numbness (most common cranial nerves involved in nasopharyngeal cancer are CN III, V, VI, and VII.)
Diagnosis of nasopharyngeal cancer:
- medical history\
- physical examinations (examination for cranial nerve involvement)
- Routine lab investigations: complete blood-work (CBC), liver function tests, and renal function tests
- Biopsy (Guided endoscopy)
- Computerized tomography (CT) scan
- MRI (magnetic resonance imaging) (MRI is preferred over CT scan since it better delineates the involvement of soft tissue areas and cranial nerves- for the extent of disease)
- PET CT (distant metastasis)
Treatment Regimen:
- The treatment of nasopharyngeal cancer depends on the stage at which the patient’s cancer has been diagnosed.
- Radiotherapy: nasopharyngeal carcinoma consists of radiosensitive tumors
- surgical resection extremely difficult: due to location Surgery plays a limited role
- Concurrent chemo-radiotherapy: advanced stage
- Systemic chemotherapy: metastatic nasopharyngeal cancer
- Molecular targeted therapies
- Immunotherapy treatments
- Second-line chemotherapy
Recurrence in nasopharyngeal cancer: Can be classified as either locoregional (local recurrence) or distant recurrence Locoregional recurrence: surgery and re-irradiation. Distant recurrence: systemic chemotherapy addition to molecularly targeted therapies and immunotherapy agents head and neck cancers.
By Dr. Sajjan Rajpurohit
Medical Oncologist
