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Who's at risk?
What are the symptoms?
How is it diagnosed?
What are the stages?
How is it treated?
How to prevent head and neck cancer
Cancers of the head and neck include cancer of the larynx, or what we know as the voice box, and cancers of the mouth and throat, and nose and lips, which are also known as oral cancers. The American Cancer Society predicts that approximately 50,380 Americans will develop cancer of the head and neck (most of which is preventable) this year; nearly 12,000 of them will die from it.
Who's at risk?
Here are a few factors doctors are aware of that contribute to head and neck cancer growth:
- Tobacco. The use of tobacco, either smoking or smokeless forms, increases the risk of laryngeal (head and neck) cancer to five to 35 times.
- Alcohol. If you drink alcohol, you are two to five times more likely to develop laryngeal cancer than if you don't drink alcohol. Those who smoke and drink have as much as 100 times the likelihood to develop laryngeal cancer than nonsmokers who don't drink.
- Diet. It may be that alcohol abuse raises the risk of laryngeal cancer because people who abuse alcohol often have poor eating habits. Eating too little of foods high in B vitamins, vitamin A, and retinoids may play a role.
- HPV (human papilloma virus). These common viruses cause warts on the hands, feet, and other parts of the body, and some cause cancers of the sex organs. HPV may also be a risk factor for laryngeal cancers.
- Gender. Men get cancer of the larynx more frequently than women.
- Race. African-Americans are at greater risk than Caucasians.
- Age. People 60 and older are at greater risk for laryngeal cancer. Oral cancers usually appear in people during their 40s, but can occur at any age.
- Occupational exposure. Exposure to paint fumes, wood dust, asbestos and some chemicals used in the textile and metalworking industries can increase the risk.
What are the symptoms?
The most common symptoms of laryngeal cancer are:
- Hoarseness
- Sore throat
- Cough
- Pain, or difficulty swallowing or breathing
- Change in voice quality
- Enlarged lymph nodes in the neck or behind the ear, with or without pain
- The feeling of a lump in the throat
Watch for these symptoms in cancers of the oral cavity, lips or tongue:
- A sore on the lip or in the mouth that does not heal.
- A lump on the lip, or in the mouth or throat.
- A white (leukoplakia) or red (erythroplakia) patch on the gums, tongue, or lining of the mouth. Leukoplakia is a white, patchy area on the inside of the lips or cheeks. About 5 percent of leukoplakia is cancerous or can develop into cancer within 10 years if not treated. Erythroplakia is a slightly raised, red area that bleeds easily. About 51 percent of erythroplakia cases are cancerous.
- Unusual bleeding, pain, or numbness in the mouth.
- A sore throat that does not go away, or a feeling that something is caught in the throat.
- Difficulty or pain with chewing or swallowing.
- Swelling in or around the jaw.
- A feeling that dentures don't fit correctly or are uncomfortable.
If you have any of these symptoms, or notice unusual swelling that lasts longer than two weeks, make sure to see your dentist or your doctor. Any of these problems should be looked at as soon as possible. It's also a good idea to see your dentist regularly for routine preventive care!
How is it diagnosed?
An examination for head and neck cancer begins with a doctor's review of a patient's medical history as well as a physical examination. If there is a suspicion of any head or neck cancer, a doctor may recommend an examination by an otolaryngologist, a specialist in the head and neck.
To perform a complete and thorough work-up for diagnosis, special tests may be ordered. Since the throat is very difficult to see, some special instruments are used to help a doctor see the area involved, and possibly take samples of tissue for examination. Fiber-optic instruments (endoscopes) with TV capabilities now allow doctors to look at the entire mouth, throat, nasal and laryngeal areas for evidence of any growth, tumor or cancer that has spread.
- Biopsy
Any suspicious areas will have small tissue samples taken from them through the scope. A pathologist will review the samples to identify tissue cell types.
- Imaging tests
Computerized tomography (CT scan). This procedure takes a series of X-rays across various sections of the body, and uses a computer to enhance the resulting pictures. Sometimes a dye is injected to help provide extra detail, which allows doctors to see the size, shape and location of any tumor and the surrounding area.
Magnetic resonance imaging (MRI). MRI pictures use magnets and radiowaves to allow computers to assemble very detailed pictures of cancers, particularly in the soft tissues of the head and neck.
Positron emission tomography (PET scan). PET scan is an imaging technique that detects subtle changes in the body's metabolism. A PET scan can determine if a tumor is benign or malignant and can show if a malignant tumor has spread. It can also determine the staging of cancers.
What are the stages?
By performing exams and tests, doctors learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. Knowing the stage of the disease helps doctors plan the best treatment. The staging system for head and neck cancers is a bit complicated. Generally, the stages range from:
Stage 0, in which cancer cells have not become invasive, to Stage IV, when a tumor has invaded the surrounding area and has spread beyond it.
If you have an operable type and stage of head and neck cancer, an oral or maxillofacial surgeon does the surgery. If the tumor has extended itself or spread, a radiation oncologist and a medical oncologist may be consulted to treat cancer in other areas.
How is it treated?
The treatment you have for your cancer depends on your overall physical health, the type and stage of your cancer, the probability of recovery (prognosis), and the impact of treatment on your ability to function. Some of the treatment options are:
Surgery
For cancer of the larynx, either part of, or the entire larynx needs to be removed. The most frequent operations for this form of cancer are:
- Laser surgery - Removal of the tumor using a high-intensity laser beam. This procedure is used only for early-stage cancers.
- Partial laryngectomy - Removal of the tumor and part of the larynx. The amount removed is the smallest possible to rid the area of cancer.
- Total laryngectomy - The entire larynx is removed, and a hole, called a stoma, is cut in the neck for breathing purposes. Without a voice box, speaking must be done in one of several ways:
- Swallowing air to create a belching speech.
- Inserting a valve to allow air into the mouth to produce sounds.
- Using a horn to produce a mechanical voice.
- An electronic larynx that is pressed against the neck using the mouth and tongue to form words.
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Neck dissection - An additional procedure used when the tumor has spread beyond the larynx to lymph glands or tissues in the area.
In cases of oral cancers, other operations may be performed to remove the tumors from the lip, tongue, cheek, back of the nose or throat, or the jawbone itself. The nature of the surgery often involves some alterations in appearance, voice, swallowing or breathing capacity, usually on a temporary basis.
- Tumor resection - This procedure involves removing the whole tumor and some of the tissue surrounding it. Depending on the location and size of the tumor, this procedure is done through the mouth, through an incision in the neck, or by splitting the jawbone to provide access -- a procedure known as mandibulotomy.
- Full or partial mandible resection - If your tumor cannot be easily moved or has grown into the jawbone, this operation involves removing part of or the entire jawbone.
- Maxillectomy - This procedure is used when cancer on the roof of the mouth has spread to the bone, and the cancer and bone are removed. The bone is replaced with a prosthesis, an artificial device.
- Mohs' surgery - The procedure involves removing and examining small slices of tissue under a microscope, one at a time, until all the cancer has been removed.
- Neck dissection - If oral cancer spreads to the lymph nodes of the neck, they must be removed.
Since these operations are specifically designed to cure cancer, it is very important to discuss the type and nature of the surgery, and the recovery required with regard to eating, breathing, speech and appearance. There are very extensive resources available for your support and recovery after treatment for head and neck cancer.
Medical
Both radiation therapy (RT) and chemotherapy can be used either separately or together in the treatment of head and neck cancers.
- Radiation - Radiation therapy uses high-energy particles to destroy or slow cancer cells. It is commonly used to treat small cancers, or as a follow-up to surgery to kill any remaining cancer cells that could not be removed. Radiation therapy for laryngeal cancer most often involves focusing a beam of radiation from outside the body, known as external beam radiation. There is also a form of internal RT, where small, radioactive seeds or pellets are placed in the area of the tumor or metastases to kill remaining cells. Usually, internal RT requires a short hospital stay to make sure radiation levels are low enough for discharge from the hospital.
- Chemotherapy - The drugs used for chemotherapy are either injected or taken by mouth, absorbed into your bloodstream and distributed all over your body. Cancer cells are most sensitive, but chemotherapy can also affect the rapidly growing or dividing normal cells of your body. Examples are the cells lining your gut and those in hair follicles. That is why the gastrointestinal side effects are most common, along with hair loss. Chemotherapy may be a treatment option for you, either alone or in combination with RT.
- Immune therapy - Recently immune therapy has shown promise. Erbitux®, a new monoclonal antibody, slows cancer growth by targeting a protein found on the surface of some cells. This protein is called EGFR (epidermal growth factor receptor). The FDA approved Erbitux in February 2004 to treat colorectal cancers that have metastasized. It is administered intravenously either alone or with chemotherapy. The FDA also approved Erbitux in 2006 for use in combination with radiation therapy to treat certain patients with head and neck cancers.
How to prevent head and neck cancers
The chances of developing head and neck cancer can be reduced by taking some of the following measures:
- Avoid tobacco use. Because most cases of oral cancer are caused by tobacco use, including smokeless tobacco, avoiding tobacco use can significantly reduce your risk. Do not start smoking. If you already smoke, quit. Avoid secondhand smoke as well.
- Limit the amount of alcohol you drink, or don't drink at all.
- Maintain proper dental hygiene. Brush your teeth at least twice a day, and use dental floss to remove food particles from between your teeth. If you wear dentures, clean them every day, especially if you smoke or drink. Have a dentist regularly check the denture fit to ensure they don't irritate your mouth.
- Limit exposure to the sun. Wear hats and sunscreen to avoid exposing your mouth to the ultraviolet light of the sun. Stay indoors during the middle of the day.
- Eat a balanced diet. Eat some foods rich in vitamin A. But do not overdo it or take a supplement without your doctor's approval. A healthy, balanced diet is good for overall health and may help prevent other cancers.
This article was reviewed and updated June 2007.
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