Head And Neck Cancer
Head and neck cancer encompasses a range of cancers that develop in the mouth, throat, larynx (voice box), nasal cavity, or sinuses, thyroid, parathyroid and submandibular glands.
Types of Head and Neck Cancer:
1.Oral Cavity Cancer:
Affects the lips, the front two-thirds of the tongue, the gums, the lining of the cheeks and lips, the floor of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area of the gum behind the wisdom teeth.
2. Pharyngeal Cancer:
- Includes cancers in the nasopharynx (upper part of the throat behind the nose), oropharynx (middle part of the throat), and hypopharynx (bottom part of the throat)
3. Laryngeal Cancer:
- Affects the larynx or voice box.
4. Nasal Cavity and Paranasal Sinus Cancer:
- Develops in the space just behind the nose or in the sinuses around the nose.
5. Salivary Gland Cancer:
- Starts in the salivary glands, which produce saliva.
6. Thyroid & Parathyroid Gland Cancer
Risk Factors
- Age: Most gastrointestinal cancers are more common in older adults.
- Diet: Heavy alcohol use increases the risk. High-fat diets, red meat, and processed meats have been linked to some GI cancers.
- Genetics: Family history and genetic predispositions (e.g., Lynch syndrome, familial adenomatous polyposis) can increase risk.
- Chronic Inflammation: Conditions like Crohn’s disease or ulcerative colitis may increase the risk of colorectal cancer.
- Infections: Infections such as Helicobacter pylori (H. pylori) are linked to stomach cancer, while hepatitis B and C are associated with liver cancer.
- Lifestyle: Smoking, excessive alcohol consumption, obesity, and lack of physical activity can also contribute to the risk.
Symptoms
It varies depending on the type and stage of the cancer but may include:
- Difficulty swallowing
- Persistent sore throat
- Changes in voice or hoarseness
- Unexplained weight loss
- Ear pain
- Persistent nasal congestion or sinus infections that do not respond to treatment
- Bleeding or pain in the mouth
Diagnosis
- Laser technology: This may be used to treat an early-stage tumor, especially if it was found in the larynx.
- Excision: This is an operation to remove the cancerous tumor and some surrounding healthy tissue, known as a margin.
- Lymph node dissection or neck dissection: If the doctor suspects the cancer has spread, the doctor may remove lymph nodes in the neck. This may be done at the same time as an excision.
- Reconstructive (plastic) surgery: If cancer surgery requires major tissue removal, such as removing the jaw, skin, pharynx, or tongue, reconstructive or plastic surgery may be done to replace the missing tissue. This type of operation helps restore a person’s appearance and the function of the affected area.
Surgery
During surgery, the goal is to remove the cancerous tumor and some surrounding healthy tissue during an operation. Types of surgery for head and neck cancer include:
- Physical Examination: Checking for lumps or other changes.
- Endoscopy: Using a scope to look at areas inside the head and neck.
- Imaging Tests: CT scans, MRIs, PET scans, and X-rays.
- Biopsy: Removing a small tissue sample for examination under a microscope.
The reconstruction ladder consists of the following steps starting from the simplest to the most complex option:
- Healing by secondary intention
- Primary closure
- Skin grafting (split or full thickness)
- Composite grafts
- Local flaps
- Regional pedicled flaps
- Free tissue transfer
Transoral endoscopic surgery (TOES)” for oral cancer is a minimally invasive surgical technique used to remove tumors located in the mouth and throat.
It involves the use of an endoscope, which is inserted through the mouth to visualize and access the tumor.
TOES is primarily used for early-stage oral cancers, particularly those located in difficult-to-reach areas of the mouth and throat such as base of tongue,tonsils, epiglottis, parapharyngeal space tumors.
This Minimally invasive way of surgery reduces the need for large incisions and extensive tissue dissection, resulting in less trauma, shorter hospital stays, and faster recovery times.
It aims to preserve surrounding healthy tissue and maintain important functions such as speech and swallowing.
Specialized instruments, such as graspers, scissors, or lasers, are used to dissect and remove the tumor while minimizing damage to nearby tissues. We carefully navigates around critical structures such as nerves and blood vessels to preserve function and minimize complications.
Overall, TOES offers several advantages over traditional open surgery for oral cancer, including reduced morbidity, improved functional outcomes, and better cosmetic results. However, not all patients are suitable candidates for TOES, and treatment decisions should be made based on individual patient factors and tumor characteristics.