April is Head and Neck Cancer Awareness month. These are malignant tumors that form in a region at the front of the head or within the mouth and throat. This includes the sinuses, nose, mouth, throat and neck. These do NOT include tumors inside the skull or the brain proper. Those cancers are diagnosed and treated differently than these head and neck cancers.
Symptoms of Head and Neck Cancer
Because of the many different tissues and structures in this area of the body, there are wide variety of symptoms, complications and potential side effects that can occur. For instance, someone could have new problems with smelling, excessive nasal discharge or bleeding, facial pain or numbness, lumps in the mouth or on the tongue, increased difficulty or pain with swallowing, hoarseness, or even painless nodules in the neck. Of course, many of these symptoms could also be explained by other causes such as viral, bacterial or fungal infections or some benign conditions. It is very important to distinguish the cause of symptoms.
A cancer by definition is an invasive tumor that destroys surrounding tissue and must be treated or will progress and cause additional problems. If any of these symptoms last for more than several days to a couple of weeks, then it would be advisable to see your primary care provider or dentist for further evaluation.
According to the American Cancer Society, head and neck cancers account for about 4% of all diagnosed cancers in the United States affecting over 60,000 people every year.
What Causes Head and Neck Cancers?
For each individual, there is no way to identify the exact cause of the cellular mutations that cause a head and neck cancers. Nonetheless, scientists have found broad causes and risk factors that lead to these diagnoses.
For instance, the two most well-known risk factors supported by a vast amount of research includes chronic cigarette smoking and chronic alcohol usage.
Other newer research is also finding cause from other chronically exposed items like vaping products, inhaled marijuana, environmental/occupation inhalants, and oral tobacco (chew/snuff). For specific oral and throat cancers, research has implicated a direct cause with a select variant of the human papilloma virus (HPV) and the Epstein-Barr virus (EBV).
Other medical risk factors include chronic acid reflux problems and prior ionizing radiation exposure to the head and neck areas.
How are Head and Neck Cancers Diagnosed?
These cancers are diagnosed after patients are seen by a medical or dental provider. They may already have symptoms or they may not have any noticeable symptoms. Once a suspicious lesion is detected by sight, touch, or by radiographic imaging by a medical or dental provider, the patient most often will be referred to an ear nose and throat (ENT) medical provider also known as an otolaryngologist.
The next steps would include additional imaging like x-rays, CT scans, ultrasound or MRI scans. Once a suspicious lesion is detected, then a biopsy would be done using a needle or surgical excision for removal. A pathologist will review the tissue to determine if it is a cancer and if so, what type of cancer it is. The vast majority of head and neck cancers (greater than 90%) are called squamous cell carcinomas. There are many other variants.
The head and neck cancer is then subdivided to a region of origin, such as maxillary sinus, nasopharynx, palate, tonsil, oral tongue, oropharynx, base of tongue, larynx, thyroid and so forth. Each area has its own variety of treatment options and potential complications.
Often lymph nodes in the head and neck will catch the tumor and hold cancer cells in place to avoid spread to the rest of the body. These may swell up and be noticeable. Having dozens of lymph nodes throughout the head and neck, they will be evaluated to assess if the primary tumor has spread locally. This will help stage the cancer from Stage I to Stage IV.
Treatment of Head and Neck Cancer
After a diagnosis of head and neck cancer, the patient is referred to a specialized cancer provider for treatment in at least one of three types. This would include a surgeon for surgical options, medical oncologist for chemotherapy, immunotherapy or other systemic options and radiation oncologist for radiation therapy options. The treatment might need only one type of service but some may use all three.
For surgical procedures, this can vary greatly from a limited biopsy to a full resection requiring reconstruction and is based on the diagnosed area of the body and extent of tumor disease. Chemotherapy can be provided alone or in conjunction with the other treatments and include oral medications or IV infusions done on regimented cycles. Radiation therapy is targeted treatment using a radioactive source or more commonly external beam radiation therapy to a site specific area of the head and neck fields.
Because of the location of these tumors in the body, they can be very challenging for the patient to get through the treatments. Many times, symptoms with loss of smell and taste, worsening dry mouth, difficulty with swallowing, increased pain in the face and throat, loss of voice, and either swelling or tightening of throat and neck tissue make it very difficult for quality of life during and after treatments.
Therefore, these patients are often referred to a host of supporting other providers such as a speech language pathologist, physical therapist, registered dietician, social worker, specialized dentist and so forth.
As with any cancer, the sooner the diagnosis and treatment is completed, the better chance for cure and ability to limit the complications for the patient. Reach out to your primary care provider for more questions.