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For Patient - Head Cancer and Neck Cancer |
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Cancer |
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CANCER : Head and Neck
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Head and neck cancer actually includes many different malignancies. The way a particular head and neck cancer behaves depends on the site in which it arises (the primary site). For example, cancers that begin on the vocal cords behave very differently than do those that arise in the hypopharynx, just an inch or less from the vocal cords.
The most common type of cancer in the head and neck in Singapore is Nasophargeal carcinoma. This is followed by squamous cell carcinoma, which arises in the cells that line the inside of the nose, mouth and throat. Other less common types of head and neck cancers include salivary gland tumors, lymphomas and sarcomas.
he risk of spread to other parts of the body through the bloodstream is closely related to whether the cancer has spread to the lymph nodes in the neck, how many nodes are involved, and their location in the neck. The risk is higher if cancer is in lymph nodes in the lower part of the neck rather than only in those located in the upper neck.
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Nasopharyngeal cancer |
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Nasopharynx is the area in the back of the nose toward the base of skull. It lies just above the soft palate, just in back of the entrance into the nasal passages. Nasopharyngeal cancer is different from most oral cancers. It tends to spread widely, is not often treated by surgery, and has different risk factors. |
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| Risk-factors: |
Scientists have identified certain risk factors that make a person more likely to develop nasopharyngeal cancer (NPC). |
| Diet: |
People who live in areas of Asia and the Arctic region, where NPC is common, typically eat diets very high in salt-cured fish and meat. |
| Epstein-Barr virus infection: |
Majority nasopharyngeal cancer cells contain the Epstein-Barr virus (EBV). This virus is common throughout the world. In most cases, this infection causes only infectious mononucleosis, commonly known as "mono." But in ways that are not completely understood there is a complex link between EBV infection and NPC. EBV infection alone is not sufficient to cause NPC, Many studies have found high levels of this virus in the blood of people with nasopharyngeal cancer. |
| Genetic factors: |
Recent studies have found that people with certain inherited tissue types are at increased risk of developing NPC. Also, family members of people with NPC are more likely to get this cancer. Whether this is due to environmental factors or genetic ones, or both, is not known. |
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Symptoms and Signs |
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Some patients with NPC have no symptoms at all. But as many as 75% of patients complain of a lump or tumour mass in the neck area when they first see their doctor, due to the cancer spreading to lymph nodes in the neck. In about one third of NPC patients, a neck mass is the only apparent sign of cancer. Other common symptoms of NPC include hearing loss (especially on one side only), nasal blockage or stuffiness, facial pain, nosebleeds, difficulty opening the mouth, and blurred or double vision (related to invasion of the nerves that control eye movement).
In some cases, NPC may not produce any signs of the disease that can be seen.
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Diagnosis |
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Since, the nasopharynx is located deep inside the head and not easily seen, special techniques are needed to examine this area. Direct nasopharyngoscopy is done with fiberoptic scopes, allowing the doctor to look inside the nasopharynx for abnormal growths, bleeding, or other signs of disease.
If a suspicious growth is found, a sample of tissue is obtained, called a biopsy and is sent to the laboratory for diagnosis.
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Imaging Tests |
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Chest x-ray: |
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Computed tomography (CT) and Magnetic resonance imaging (MRI): CT and MR scans provides information about the size, shape, and position of a tumor and can help find enlarged lymph nodes that might contain cancer. CT scans or MRIs are important for finding cancer that has spread into the bones at the base of the skull. This is a common place for nasopharyngeal cancer to grow.
Positron emission tomography (PET): PET scan is useful to stage the disease, as it can easily determine if cancer has spread to nodes or elsewhere in body. Many studies have shown that a PET/CT scan is better method for staging cancer than other tests. It is also useful for follow-up in cases if suspicious of local or distant recurrence after treatment.
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Other Tests |
Blood tests: |
In some patients, the blood level of EBV before and after treatment may be useful to determine a patient's outcome. Also, routine blood tests help determine a patient's overall physical condition. These tests can help diagnose malnutrition, anemia, liver disease, and kidney disease. |
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| Fine needle aspiration (FNA): |
| In patients with enlarged lymph nodes in the neck area, FNA can be useful in deciding whether the cause is the spread of cancer from somewhere else (such as the nasopharynx), a different cancer that begins in lymph nodes called a lymphoma, or lymph node swelling in response to an infection (reactive hyperplasia). |
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Staging |
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The degree / estimation of spread of cancer is called staging. The extent of spread of nasopharyngeal cancer (NPC) is the most important factor in selecting treatment options and estimating outlook for recovery from treatment and for survival. The most common system is TNM, used by American Joint Committee on Cancer.
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stands for tumor (its size and how far it has spread locally within the nasopharynx and to nearby tissues). |
| N |
stands for spread to lymph nodes |
| M |
is for metastasis (distant spread) |
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| To help guide treatment decisions, several of these T, N, and M combinations can be grouped together into a simpler set of stages, which are described by Roman numerals 0 to IV. Patients with lower stage cancer have a better prognosis for a cure or long-term survival. Here are the grouped stages and the TNM combinations that define them. |
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Stage 0:
Tis, N0, M0: |
The cancer is "in situ." It has not yet penetrated to a deeper layer of nasopharyngeal tissue and has not spread to lymph nodes or distant sites.
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Stage I:
T1, N0, M0: |
The tumor is only in the nasopharynx and has not spread to lymph nodes or distant sites.
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Stage IIA:
T2a, N0, M0: |
The tumor has spread to soft tissues of the nasal cavity and/or the oropharynx but no farther and has not spread to lymph nodes or distant sites.
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Stage IIB:
T2b, N0 or N1, M0, T1or 2 or 2a, N1, M0: |
The tumor has spread to soft tissues of the nasal cavity and the oropharynx, but not into bone. It has spread to one or more single lymph nodes, not larger than 6 cm (about 2½ inches), in the same side of the neck as the original cancer. The cancer has not spread to distant sites.
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Stage III:
T1or 2, N2, M0, T3, N0-2, M0: |
The tumor has spread to soft tissues of the nasal cavity and/or the oropharynx and to lymph nodes, not larger than 6 cm, on both sides of the neck but not to distant sites. Or the tumor has spread to the sinuses or the bones near the nasopharynx and may or may not have spread to lymph nodes but not to distant sites
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Stage IVA:
T4, N0-2, M0: |
The tumor has spread to the skull and/or cranial nerves (nerves in the head that lie near the nasopharynx and have special functions such as vision, smell, eye movement), the hypopharynx (lower part of the throat), the eye, or its nearby tissues and may or may not have spread to lymph nodes smaller than 6 cm but not to distant sites.
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Stage IVB:
Any T, N3, M0: |
The tumor is of any size but has spread to one or more lymph nodes that are larger than 6 cm and/or located above the collarbone area but not to distant sites.
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Stage IVC:
Any T, any N, M1: |
The tumor is of any size and may or may not have spread to lymph nodes but has spread to distant sites.
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| Recurrent: |
Cancer that has come back (recurred) after treatment has taken place is called recurrent disease. Recurrent NPC may return in the nasopharynx, neck, or another part of the body, often the lung.
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| Survival by stage: |
Listed below is the 5-year relative survival for each of the 4 main stages. Keep in mind that 5-year survival rates are based on patients diagnosed and initially treated more than 5 years ago. Improvements in treatment often result in a more favorable outlook for recently diagnosed patients.
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| Stage |
Survival based on radiation therapy only |
| I |
91% |
| IIA |
95% |
| IIB |
82% |
| III |
67% |
| IV |
46-50% (T Leung et al., from Hong Kong) |
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With modern chemotherapy the survival rates are expected to improve. |
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Diagnostic and Follow-up Tests:
X-ray sinuses.
Biopsy;
PET/CT Scan:
MRI
Bone scan
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Squamous Cell Carcionma Of Head And Neck |
Metastatic squamous neck cancer with occult primary is a disease in which squamous cell cancer spreads to lymph nodes in the neck and it is not known where the cancer first formed in the body. Possible signs of metastatic squamous neck cancer with occult primary include a lump or pain in the neck or throat.
A diagnosis of occult primary tumor is made if the primary tumor is not found during testing or treatment.
Certain factors affect prognosis (chance of recovery) and treatment options. |
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The prognosis (chance of recovery) and treatment options depend on the following:
- The number and size of lymph nodes that have cancer in them.
- Whether the cancer has responded to treatment or has recurred.
- How different from normal the cancer cells look under a microscope.
- The patient's age and general health.
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Treatment options also depend on the following:
- Which part of the neck the cancer is in.
- Whether certain tumor markers are found.
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Identifying High Risk of Head and Neck Cancer |
As many as 90 percent of head and neck cancers arise after prolonged exposure to specific factors. Use of tobacco (cigarettes, cigars, chewing tobacco or snuff) and alcoholic beverages are closely linked with cancers of the mouth, throat, voice box and tongue (In adults who neither smoke nor drink, cancer of the mouth and throat are nearly nonexistent). Prolonged exposure to sunlight is linked with cancer of the lip and is also an established major cause of skin cancer. |
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Investigations:
- Endoscopy and biopsy
- Gastroscopy if suspicious of primary from gastrointestinal tract and biopsy
- Bronchscopy for lung cancer
- PET CT scan
- MRI Scan
- CT scan
- Serum Tumour markers: alphafoetoprotein, CEA, Beta-human chorionic gonadotropin (b-HCG)
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Prognosis:
- The survival / chance of recovery and treatment options depend on the following:
- The number and size of lymph nodes that have cancer in them.
- Whether the cancer has responded to treatment or has recurred.
- How different from normal the cancer cells look under a microscope.
- The patient's age and general health
Your treating doctor would be best person to discuss various treatment options with you.
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