What are head and neck cancer tumors and how are they treated?

Head and neck cancers include oncological tumors of the oral and nasal cavity, pharynx, sinuses, larynx, neck, face, head, and salivary glands. However, eye and cranial cavity, tumors do not belong to this group, they are considered separately. They account for about a fifth of the total incidence of various oncological pathologies.

In general, head and neck tumors can be cancerous, intermediate (locally destructive), and benign.  In the majority of cases, malignant tumors of the head and neck are induced by squamous cell carcinoma which is believed to be caused by alcohol abuse and smoking.

Often, before the tumor is detected, the patient has an enlarged gland in the neck. When the disease is timely detected and necessary treatment is received, it is most often possible to achieve complete cure. The average age of people diagnosed with head and neck cancerous tumors (excluding brain, eye and spine cancer) is 59 years. Typically, salivary glands, thyroid, or paranasal sinuses cancers affect people under the age of 59, and mouth, pharynx, and larynx cancers affect people over 59.

Short information about head and neck cancers

Approximately 85% of people with head or neck cancers have consumed or consume alcohol and smoke.  Oral cancer can also result from poor oral hygiene, wearing a poorly made denture and using snuff or chewing tobacco. Another risk factor is the Epstein-Barr virus that is related to upper pharynx cancer.

The symptoms depend on the location of the tumor. For instance, cancer of the tongue can cause some slurred speech.

Common symptoms of head and neck cancer:

- Ulceration of the oral mucosa that persists for more than a few weeks;
- Difficulty swallowing or painful sensations when chewing or swallowing;
- Disturbed speech or breathing (hoarseness or constant noisy breathing);
- Persistent sore throat or one ear;
- Swelling or bloating in the mouth or neck.
Less common symptoms:
- Numbness of the lips or oral mucosa;
- Unexplained tooth loss;
- Nosebleeds or persistent nasal congestion;
- Hearing impairment or ringing in the ears;
- Pain in the upper jaw or face;
- Precancerous changes in the mucous membrane of the mouth or tongue that take the form of non-disappearing white spots (leukoplakia) or red spots (erythroplakia). In some cases, the spots are accompanied by pain and bleeding.

These symptoms can occur in other, benign conditions, but you definitely need to visit your doctor and consult about these symptoms. This is especially important when symptoms persist.

Enlargement of one or more lymph nodes in the neck is a crucial sign of head and neck cancer that must not be neglected.
Sometimes lymph nodes can be felt in the neck, armpits, and groin as small bean-shaped formations and in normal health, but if this symptom is present, consult a specialist.

Oral neoplasms

Tongue cancer is the most common oral cancer. Non-epithelial and epithelial benign neoplasms are very rare, but if we talk about epithelial tumors, papillomas are the most common. Papillomas are subject to constant injury, and therefore, they can ulcerate and acquire a malignant character. As for non-epithelial benign neoplasms, they are represented mainly by lymphangioma, hemangioma, neurofibroma, lipoma, fibroma, as well as granular cell tumor.

Among the reasons for tongue tumors are chronic viral diseases, alcohol, smoking, as well as states of immune deficiency.

Oropharyngeal neoplasms

As in the previous case, oropharyngeal tumors are proven to be caused mainly by smoking, papillomavirus and alcohol abuse. The disease often affects young people, and early onset of metastases to the lymph nodes of the neck is diagnosed.

In some cases, cancer can affect the nasopharynx and eye sockets. To detect this disease early, in addition to ultrasound, a biopsy of the affected areas, X-ray and special microscopic testing of cancer cells, a patient needs to undergo CT scanning. Early diagnosis of head and neck neoplasms, like other cancers, can improve the prognosis, as well as greatly facilitate treatment.

Cancer of the upper jaw

This disease is very life-threatening for the patient. Early diagnosis of jaw cancer is incredibly important. In the first two stages of the disease, the extension of cancer can be stopped until it has spread into the eye socket and further (pharynx or neck).

Larynx cancer

Laryngeal cancer is the most frequent malignant tumor of the larynx - 50-60% of cases. It accounts for around three percent of all human malignant tumors. Mostly found in men 40-60 years old, who make up 80-95% of patients.

The majority of individuals with laryngeal cancer are heavy smokers (a pack of cigarettes per day and for a long time). The risk of laryngeal cancer is raised by the consumption of alcoholic beverages, work in dusty conditions, high temperatures, tobacco smoke, benzene, oil products, soot, phenolic resins in the atmosphere.

Laryngeal cancer is often preceded by chronic perennial laryngitis.

Diagnostics

Diagnosis of head and neck tumors is unique in that in these areas, the modified cells can be clearly seen. For this, a rhinoscope, an endoscope, and multiple magnification devices, such as a dermatoscope, are used.

The best way to understand the configuration and depth of tumor penetration is provided by three-dimensional CT scans.

The final diagnosis is made after a biopsy. It allows distinguishing benign tumors and identifying the histological nature of the formation.

Stages

All oncopathologies of the head and neck go through four main stages in their development.

At the initial stage, the formation does not leave the mucous membrane. It is no more than one centimeter and often does not even cause discomfort.

During the second stage, there is an enlargement of the tumor, spreading to adjacent areas. By the end of the stage, the diameter of the formation is up to 4 centimeters.

From third stage on, size doesn't matter but the number of metastases is important. At the same stage, severe pain develops, and the tumor is ulcerated.

By the fourth stage, cancer is called diffuse neoplasm because it penetrates many structures of the head and it can be difficult to find the primary focus. At the very last stage, there may be blood metastasis, but usually the tumor is detected earlier than this moment.
Cancer of the salivary glands has a more favorable course, since it affects the lymph nodes only to the last stage.

Treatment

For head and neck tumors, surgery is not the first choice. This is due to the fact that all resections are traumatic, require cutting the jaw, damage to the facial nerve and lead to changes in the face. Surgical intervention is resorted to only at the very first stage, when a small area of the mucous and submucous layer can be removed, or when conventional therapy does not work.

Head and neck tumors respond well to radiation. In 70% of cases, it is possible to destroy tumor cells. The most effective manipulations are with a cyber knife.

Chemotherapy (for instance, with Hydrea) is also used to reduce the size of the lesion before surgery.

Forecast

Head and neck cancer is the most favorable in prognostic terms. At the first and second stages, 80-95% of patients can be saved. At the third stage, 60-70% of people survive, and even at the fourth final stage, about 40% of patients overcome the disease.

Post by: Emma Ager, MD, Copenhagen, Denmark