Head and neck cancer
Encyclopedia
Head and neck cancer refers to a group of biologically similar cancers that start in the upper aerodigestive tract, including the lip
, oral cavity (mouth), nasal cavity
(inside the nose), paranasal sinuses, pharynx
, and larynx
. 90% of head and neck cancers are squamous cell carcinoma
s (SCCHN), originating from the mucosal lining (epithelium
) of these regions. Head and neck cancers often spread to the lymph node
s of the neck
, and this is often the first (and sometimes only) sign of the disease at the time of diagnosis. Head and neck cancer is strongly associated with certain environmental and lifestyle risk factors, including tobacco smoking
, alcohol
consumption, UV light, particular chemicals used in certain workplaces, and certain strains of virus
es, such as human papillomavirus
. These cancers are frequently aggressive in their biologic behavior; patients with these types of cancer are at a higher risk of developing another cancer in the head and neck area. Head and neck cancer is highly curable if detected early, usually with some form of surgery
although chemotherapy
and radiation therapy
may also play an important role.
The 2009 estimated number of head and neck cancer in the US is of 35,720 new cases.
, paranasal sinuses, oral cavity, nasopharynx
, oropharynx
, hypopharynx
, and larynx
.
, floor of mouth, gingiva
e, and hard palate
. Cancers of the oral cavity are strongly associated with tobacco
use, especially use of chewing tobacco
or "dip", as well as heavy alcohol
use. Cancers of this region, particularly the tongue, are more frequently treated with surgery
than are other head and neck cancers.
Surgeries for oral cancers include
The defect is covered/improved by using another part of the body and/or skin grafts and/or wearing a prosthesis
.
arises in the nasopharynx
, the region in which the nasal cavities
and the Eustachian tube
s connect with the upper part of the throat. While some nasopharyngeal cancers are biologically similar to the common HNSCC, "poorly differentiated" nasopharyngeal carcinoma is distinct in its epidemiology
, biology, clinical behavior, and treatment, and is treated as a separate disease by many experts.
, the middle part of the throat that includes the soft palate
, the base of the tongue
, and the tonsil
s. Squamous cell cancers of the tonsils are more strongly associated with human papillomavirus
infection than are cancers of other regions of the head and neck.
early due to the extensive lymphatic network around the larynx
.
or "voice box." Cancer may occur on the vocal folds
themselves ("glottic" cancer), or on tissues above and below the true cords ("supraglottic" and "subglottic" cancers respectively). Laryngeal cancer is strongly associated with tobacco smoking
.
Surgery can include partial laryngectomy (removal of part of the larynx) and total laryngectomy (removal of the whole larynx). If the whole larynx has been removed the person is left with a permanent tracheostomy and can learn to speak again in a new way with the help of intensive teaching and speech therapy and/or an electronic device.
is a rare malignancy which can be biologically similar in many ways to head and neck cancer, and is sometimes classified as such.
Most tumors of the salivary glands differ from the common carcinomas of the head and neck in etiology
, histopathology
, clinical presentation, and therapy, Other uncommon tumors arising in the head and neck include teratoma
s, adenocarcinomas, adenoid cystic carcinoma
s, and mucoepidermoid carcinoma
s. Rarer still are melanomas and lymphomas of the upper aerodigestive tract.
on the outside of the neck, a sore throat or a hoarse sounding voice. However, in the case of throat cancer, these conditions may persist and become chronic. There may be a lump or a sore in the throat or neck that does not heal or go away. There may be difficult or painful swallowing. Speaking may become difficult. There may be a persistent earache. Other possible but less common symptoms include some numbness or paralysis
of the face muscles.
Presenting symptoms include
and tobacco
use are the most common risk factors for head and neck cancer in the United States. Alcohol and tobacco are likely synergistic in causing cancer of the head and neck.
Smokeless tobacco is an etiologic agent for oral and pharyngeal cancers (oropharyngeal cancer).
Cigar
smoking is an important risk factor for oral cancers as well.
Other potential environmental carcinogens include occupational exposures such as nickel refining, exposure to textile fibers, and woodworking. In one large, controlled study, marijuana use was shown to be associated with oral squamous cell carcinoma. In another study, marijuana use was shown to be a potential protective factor against the development of head and neck squamous cell carcinoma. However, cigarette
smokers have a lifetime increased risk for head and neck cancers that is 5- to 25-fold increased over the general population.
The ex-smoker's risk for squamous cell cancer of the head and neck begins to approach the risk in the general population twenty years after smoking cessation. The high prevalence of tobacco and alcohol use worldwide and the high association of these cancers with these substances makes them ideal targets for enhanced cancer prevention.
Vitamin E
was not found to prevent the development of leukoplakia
, the white plaques that are the precursor for carcinomas of the mucosal surfaces, in adult smokers.
Another study examined a combination of Vitamin E and beta carotene in smokers with early-stage cancer of the oropharynx, and found a worse prognosis
in the vitamin users.
Recent evidence is accumulating pointing to a viral origin for some head and neck cancers.
(HPV), in particular HPV16, is a causal factor for some head and neck squamous cell carcinoma (HNSCC). Approximately 15 to 25% of HNSCC contain genomic DNA from HPV, and the association varies based on the site of the tumor, especially HPV-positive oropharyngeal cancer
, with highest distribution in the tonsils, where
HPV DNA is found in (45 to 67%) of the cases, less often in the hypopharynx (13%–25%), and least often in the oral cavity (12%–18%) and larynx (3%–7%).
Some experts estimate that while up to 50% of cancers of the tonsil may be infected with HPV, only 50% of these are likely to be caused by HPV (as opposed to the usual tobacco
and alcohol
causes). The role of HPV in the remaining 25-30% is not yet clear.
(EBV) infection is associated with nasopharyngeal cancer
. Nasopharyngeal cancer occurs endemically in some countries of the Mediterranean and Asia, where EBV antibody
titers can be measured to screen high-risk populations.
Nasopharyngeal cancer has also been associated with consumption of salted fish, which may contain high levels of nitrites.
(GERD - gastroesphogeal reflux disease) or larynx reflux disease can also be a major factor. In the case of acid reflux disease, stomach acids flow up into the esophagus
and damage its lining, making it more susceptible to throat cancer.
suppression and chronic oral graft-versus-host disease
.
or chewing
tobacco
or other things, such as gutkha, or paan
, heavy alcohol
consumption, poor diet resulting in vitamin
deficiencies (worse if this is caused by heavy alcohol intake), weakened immune system
, asbestos
exposure, prolonged exposure to wood dust or paint fumes, exposure to petroleum
industry chemicals, and being over the age of 55 years. Another risk factor includes the appearance of white patches or spots in the mouth, known as leukoplakia
; in about ⅓ of the cases this develops into cancer.
, surgical oncologist
, and medical oncologist.
or cell structure, and are commonly referred to by their location in the oral cavity and neck. This is because where the cancer appears in the throat affects the prognosis - some throat cancers are more aggressive than others depending upon their location. The stage at which the cancer is diagnosed is also a critical factor in the prognosis of throat cancer.
(tissue layer) that is the surface cells of much of the body. Skin
and mucous membranes are squamous cells. This is the most common form of larynx cancer, accounting for over 90% of throat cancer. Squamous cell carcinoma is most likely to appear in males over 40 years of age with a history of heavy alcohol use coupled with smoking.
is a cancer of the columnar epithelium typical of the lower esophagus
. It is typical of Barrett's esophagus but may be at another location. Adenocarcinoma is thought of as a product of Barrett's esophagus.
When diagnosed early, oral, head and neck cancers can be treated more easily and the chances of survival increase tremendously.
It is expected that HPV vaccine
s may reduce the risk of HPV induced head and neck cancer.
, have led to improvements in quality of life and survival for head and neck cancer patients since 1992.
After a histologic diagnosis has been established and tumor extent determined, the selection of appropriate treatment for a specific cancer depends on a complex array of variables, including tumor site, relative morbidity of various treatment options, patient performance and nutritional status, concomitant health problems, social and logistic factors, previous primary tumors, and patient preference. Treatment planning generally requires a multidisciplinary approach involving specialist surgeons and medical and radiation oncologists.
Several generalizations are useful in therapeutic decision making, but variations on these themes are numerous. Surgical resection and radiation therapy are the mainstays of treatment for most head and neck cancers and remain the standard of care in most cases. For small primary cancers without regional metastases (stage I or II), wide surgical excision alone or curative radiation therapy alone is used. More extensive primary tumors, or those with regional metastases (stage III or IV), planned combinations of pre- or postoperative radiation and complete surgical excision are generally used. More recently, as historical survival and control rates are recognized as less than satisfactory, there has been an emphasis on the use of various induction or concomitant chemotherapy regimens.
Patients with head and neck cancer can be categorized into three clinical groups: those with localized disease, those with locally or regionally advanced disease, and those with recurrent and/or metastatic disease. Comorbidities (medical problems in addition to the diagnosed cancer) associated with tobacco and alcohol abuse can affect treatment outcome and the tolerability of aggressive treatment in a given patient.
Many different treatments and therapies are used in the treatment of throat cancer. The type of treatment and therapies used are largely determined by the location of the cancer in the throat area and also the extent to which the cancer has spread at time of diagnosis. Patients’ also have the right to decide whether or not they wish to consent to a particular treatment. For example, some may decide to not undergo radiation therapy which has serious side effects if it means they will be extending their lives by only a few months or so. Others may feel that the extra time is worth it and wish to pursue the treatments.
as a treatment is sometimes used in cases of throat cancer. In such cases an attempt is made to remove the cancerous cells. This can be particularly tricky if the cancer is near the larynx
and can result in the patient being unable to speak. Surgery is more commonly used to resection
(remove) some of the lymph nodes to prevent further spread of the disease.
A novel approach uses harvested hematopoietic stem cells (blood stem cells) and other harvested cells (if necessary, a silicon alloy can also be used or can be used in place of the cells) from the lining of the patient's stomach to form a new section of a trachea or esophagus.
CO2 laser surgery is also another form of treatment. Transoral laser microsurgery
allows surgeons to remove tumors from the voice box with no external incisions. It also allows access to tumors that are not reachable with robotic surgery. A microscope helps the surgeon clearly view the margins of the tumor, minimizing the amount of normal tissue removed or damaged during surgery. This technique helps give the patient as much speech and swallowing function as possible after surgery.
is the most common form of treatment. There are different forms of radiation therapy, including 3D conformal radiation therapy, intensity-modulated radiation therapy, and brachytherapy, which are commonly used in the treatments of cancers of the head and neck. Most patients with head and neck cancer who are treated in the United States and Europe are treated with intensity-modulated radiation therapy using high energy photons.
in throat cancer is not generally used to cure the cancer as such. Instead, it is used to provide an inhospitable environment for metastases so that they will not establish in other parts of the body. Typical chemotherapy agents are a combination of Taxol and Carboplatin
. Erbitux is also used in the treatment of throat cancer.
Taxotere (Docetaxel) based chemotherapy has shown a very good response in locally advanced head and neck cancer. Taxotere is the only taxane
approved by US FDA for Head and neck cancer.
While not specifically a chemotherapy, Amifostine
is often administered intravenously by a chemotherapy clinic prior to a patient's IMRT radiotherapy sessions. Amifostine protects the patient's gums and salivary glands from the effects of radiation. It should be noted that one of the side effects of Amifostine is that it could protect tumors. Another reason to use the newer more precise and better tumor damaging PMRT
treatments.
may have promise in treating mucosal dysplasia and small head and neck tumors. Amphinex
is giving good results in early clinical trials for treatment of advanced head and neck cancer.
, according to the National Cancer Institute
, is "a type of treatment that uses drugs or other substances, such as monoclonal antibodies, to identify and attack specific cancer cells without harming normal cells." Some targeted therapy
used in squamous cell cancers of the head and neck include cetuximab
, bevacizumab
, erlotinib
, and reovirus.
The best quality data are available for cetuximab
since the 2006 publication of a randomized clinical trial comparing radiation treatment plus cetuximab versus radiation treatment alone. This study found that concurrent cetuximab
and radiotherapy improves survival and locoregional disease control compared to radiotherapy alone, without a substantial increase in side effects
, as would be expected with the concurrent chemoradiotherapy, which is the current gold standard treatment for advanced head and neck cancer. Whilst this study is of pivotal significance, interpretation is difficult since cetuximab-radiotherapy was not directly compared to chemoradiotherapy. The results of ongoing studies to clarify the role of cetuximab
in this disease are awaited with interest.
Another study evaluated the impact of adding cetuximab
to conventional chemotherapy (cisplatin
) versus cisplatin
alone. This study found no improvement in survival or disease-free survival with the addition of cetuximab
to the conventional chemotherapy.
However, another study which completed in March 2007 found that there was an improvement in survival.
The EXTREME (Erbitux in First-Line Treatment of Recurrent or Metastatic Head & Neck Cancer) study is a European multicenter phase III trial to determine whether adding cetuximab improves the impact of platinum-based chemotherapy.
Between December 2004 and March 2007, researchers enrolled 442 patients in 17 countries who had stage III or IV recurrent and/or metastatic SCCHN, and who were not candidates for further surgery or radiation. About half of the patients had cancer in their pharynx (throat), and a quarter in their larynx (voice box), but none in the nasopharynx (upper part of the throat). The patients averaged 57 years of age. Only about 10 percent were women.
Patients were randomly assigned to receive either chemotherapy (222 patients) or the same chemotherapy with cetuximab (220 patients). Chemotherapy consisted of 5-fluorouracil plus either carboplatin or cisplatin.
Results: Patients treated with cetuximab reduced their risk of dying by 20 percent, surviving a median of 10.1 months compared to 7.4 months for those receiving chemotherapy alone.
A 2010 review concluded that the combination of cetuximab and platin/5-fluorouracil should be considered the current standard first-line regimen.
Head and neck cancer clinical trials employing bevacizumab
, an inhibitor of the angiogenesis
receptor VEGF
, were recruiting patients .
Erlotinib
is an oral EGFR inhibitor, and was found in one Phase II clinical trial to retard disease progression.
Scientific evidence for the effectiveness of erlotinib
is otherwise lacking to this point. A clinical trial evaluating the use of erlotinib
in metastatic head and neck cancer is recruiting patients as of March, 2007.
Reovirus is an oncolytic virus that targets RAS activated cancer cells. Trial update on November 2008 showed stable disease or better in the first eight of nine patients with refractory head and neck cancer http://media.integratir.com/T.ONC/ppt/iSBTc%20San%20Diego%202008%20Final.pdf. Phase II trials are ongoing in England and the USA with phase III trials planned.
Cure rates decrease in locally advanced cases, whose probability of cure is inversely related to tumor size and even more so to the extent of regional node involvement.
Consensus panels in America (AJCC) and Europe (UICC
) have established staging systems for head and neck squamous cancers. These staging systems attempt to standardize clinical trial criteria for research studies, and attempt to define prognostic categories of disease. Squamous cell cancers of the head and neck are staged according to the TNM classification system, where T is the size and configuration of the tumor, N is the presence or absence of lymph node metastases, and M is the presence or absence of distant metastases. The T, N, and M characteristics are combined to produce a “stage” of the cancer, from I to IVB.
to 23%
at 20 years. Second primary tumors are the major threat to long-term survival after successful therapy of early-stage HNSCC. Their high incidence results from the same carcinogenic exposure responsible for the initial primary process, called field cancerization.
Throat cancer has numerous negative effects on the body systems.
on their food in the early stages of digestion and interfere with the food’s smooth travels down into the esophagus
and beyond.
The treatments for throat cancer can also be harmful to the digestive system as well as other body systems. Radiation therapy can lead to nausea
and vomiting
, which can deprive a body of vital fluids (although these may be obtained through intravenous fluids if necessary). Frequent vomiting can lead to an electrolyte imbalance which has serious consequences for the proper functioning of the heart. Frequent vomiting can also upset the balance of stomach acids which has a negative impact on the digestive system, especially the lining of the stomach and esophagus.
and behind the nose
may become blocked from lumps or the swelling from the open sores. If the throat cancer is near the bottom of the throat it has a high likelihood of spreading to the lung
s and interfering with the person’s ability to breathe; this is even more likely if the patient is a smoker, because they are highly susceptible to lung cancer
.
, metastasization affects many areas of the body, as the cancer spreads from cell to cell and organ to organ. For example, if it spreads to the bone marrow
, it will prevent the body from producing enough red blood cell
s and affects the proper functioning of the white blood cell
s and the body's immune system
; spreading to the circulatory system
will prevent oxygen from being transported to all the cells of the body; and throat cancer can throw the nervous system
into chaos, making it unable to properly regulate and control the body.
2. Karni R, Haughey B, Transoral Laser Microsurgery: A New Approach for Occult Primaries of the Head and Neck, Laryngoscope, In Press February 2011.
3. Rich J, Liu J, Haughey B, Swallowing Function after Transoral Laser Microsurgery (TLM) ± Adjuvant Therapy for Advanced Stage Oropharyngeal Cancer, Laryngoscope, In Press February 2011.
4. Haughey BH, Hinni ML, Salassa JR, Grant DG, Rich JT, Milov S, Lewis Jr JS, Krishan M, Transoral Laser Microsurgery as Primary Treatment of Advanced Stage Oropharynx Cancer: A United States Multicenter Study, Head and Neck, Epub ahead of print February 2011. http://onlinelibrary.wiley.com/doi/10.1002/hed.21669/pdf
5. Rich JT, Milov S, Lewis Jr, JS, Thorstad WL, Adkins DR, Haughey BH, Transoral Laser Microsurgery (TLM) ± Adjuvant Therapy for Advanced Stage Oropharyngeal Cancer: Outcomes and Prognostic Factors, Laryngoscope, Volume 119, No. 9, pp 1709–1719, September 2009. http://onlinelibrary.wiley.com/doi/10.1002/lary.20552/pdf
6. Hinni M, Salassa J, Grant D, Pearson B, Hayden R, Martin A, Christiansen H, Haughey B, Nussenbaum B, Steiner W, Transoral Laser Microsurgery for Advanced Laryngeal Cancer, Archives of Otolaryngology-Head and Neck Surgery, Volume 133, No 12, pp 1198–1204, December 2007. http://archotol.ama-assn.org/cgi/reprint/133/12/1198
Lip
Lips are a visible body part at the mouth of humans and many animals. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech...
, oral cavity (mouth), nasal cavity
Nasal cavity
The nasal cavity is a large air filled space above and behind the nose in the middle of the face.- Function :The nasal cavity conditions the air to be received by the other areas of the respiratory tract...
(inside the nose), paranasal sinuses, pharynx
Human pharynx
The human pharynx is the part of the throat situated immediately posterior to the mouth and nasal cavity, and anterior to the esophagus and larynx. The human pharynx is conventionally divided into three sections: the nasopharynx , the oropharynx , and the laryngopharynx...
, and larynx
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
. 90% of head and neck cancers are squamous cell carcinoma
Squamous cell carcinoma
Squamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
s (SCCHN), originating from the mucosal lining (epithelium
Epithelium
Epithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the cavities and surfaces of structures throughout the body, and also form many glands. Functions of epithelial cells include secretion, selective...
) of these regions. Head and neck cancers often spread to the lymph node
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s of the neck
Neck
The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective signifying "of the neck" is cervical .-Boner anatomy: The cervical spine:The cervical portion of the human spine comprises seven boney...
, and this is often the first (and sometimes only) sign of the disease at the time of diagnosis. Head and neck cancer is strongly associated with certain environmental and lifestyle risk factors, including tobacco smoking
Tobacco smoking
Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
, alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
consumption, UV light, particular chemicals used in certain workplaces, and certain strains of virus
Virus
A virus is a small infectious agent that can replicate only inside the living cells of organisms. Viruses infect all types of organisms, from animals and plants to bacteria and archaea...
es, such as human papillomavirus
Human papillomavirus
Human papillomavirus is a member of the papillomavirus family of viruses that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes...
. These cancers are frequently aggressive in their biologic behavior; patients with these types of cancer are at a higher risk of developing another cancer in the head and neck area. Head and neck cancer is highly curable if detected early, usually with some form of surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
although chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
and radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
may also play an important role.
The 2009 estimated number of head and neck cancer in the US is of 35,720 new cases.
Classification
Head and neck squamous cell carcinomas (HNSCC's) make up the vast majority of head and neck cancers, and arise from mucosal surfaces throughout this anatomic region. These include tumors of the nasal cavitiesNasal cavity
The nasal cavity is a large air filled space above and behind the nose in the middle of the face.- Function :The nasal cavity conditions the air to be received by the other areas of the respiratory tract...
, paranasal sinuses, oral cavity, nasopharynx
Nasopharynx
The nasopharynx is the uppermost part of the pharynx. It extends from the base of the skull to the upper surface of the soft palate; it differs from the oral and laryngeal parts of the pharynx in that its cavity always remains patent .-Lateral:On its lateral wall is the pharyngeal ostium of the...
, oropharynx
Oropharynx
The Oropharynx reaches from the Uvula to the level of the hyoid bone.It opens anteriorly, through the isthmus faucium, into the mouth, while in its lateral wall, between the two palatine arches, is the palatine tonsil....
, hypopharynx
Hypopharynx
In human anatomy, the hypopharynx is the bottom part of the pharynx, and is the part of the throat that connects to the esophagus....
, and larynx
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
.
Oral cavity
Squamous cell cancers are common in the oral cavity, including the inner lip, tongueTongue
The tongue is a muscular hydrostat on the floors of the mouths of most vertebrates which manipulates food for mastication. It is the primary organ of taste , as much of the upper surface of the tongue is covered in papillae and taste buds. It is sensitive and kept moist by saliva, and is richly...
, floor of mouth, gingiva
Gingiva
The gingiva , or gums, consists of the mucosal tissue that lies over the mandible and maxilla inside the mouth.-General description:...
e, and hard palate
Hard palate
The hard palate is a thin horizontal bony plate of the skull, located in the roof of the mouth. It spans the arch formed by the upper teeth.It is formed by the palatine process of the maxilla and horizontal plate of palatine bone....
. Cancers of the oral cavity are strongly associated with tobacco
Tobacco
Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
use, especially use of chewing tobacco
Chewing tobacco
Chewing tobacco Chewing tobacco Chewing tobacco (also known colloquially as hoobastank, backy, tobac, doogooos,Hogleg, chewpoos, chits, chewsky, chawsky, dip, flab, chowers, guy, or a wad, as well as referred to as dipsky, snuff, a pinch, a yopper, a Packing a bomb, a tobbackey or packing a...
or "dip", as well as heavy alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
use. Cancers of this region, particularly the tongue, are more frequently treated with surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
than are other head and neck cancers.
Surgeries for oral cancers include
- Maxillectomy(can be done with or without Orbital exenteration)
- Mandibulectomy (removal of the mandible or lower jaw or part of it)
- GlossectomyGlossectomyA glossectomy is the surgical removal of all or part of the tongue. It is performed in order to curtail malignant growth such as oral cancer. Often only a portion of the tongue needs to be removed, in which case the procedure is called a hemiglossectomy....
(tongue removal, can be total, hemi or partial) - Radical neck dissectionNeck dissectionThe neck dissection is a surgical procedure for control of neck lymph node metastasis from Squamous cell carcinoma and Merkel cell carcinoma of the head and neck. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated...
- Moh's procedureMohs surgeryMohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer. It is one of the many methods of obtaining complete margin control during removal of a skin cancer using frozen section...
- Combinational e.g., glossectomy and laryngectomy done together.
The defect is covered/improved by using another part of the body and/or skin grafts and/or wearing a prosthesis
Prosthesis
In medicine, a prosthesis, prosthetic, or prosthetic limb is an artificial device extension that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control...
.
Nasopharynx
Nasopharyngeal cancerNasopharyngeal carcinoma
Nasopharyngeal carcinoma is the most common cancer originating in the nasopharynx, the uppermost region of the pharynx , behind the nose where the nasal passages and auditory tubes join the remainder of the upper respiratory tract. NPC differs significantly from other cancers of the head and neck...
arises in the nasopharynx
Nasopharynx
The nasopharynx is the uppermost part of the pharynx. It extends from the base of the skull to the upper surface of the soft palate; it differs from the oral and laryngeal parts of the pharynx in that its cavity always remains patent .-Lateral:On its lateral wall is the pharyngeal ostium of the...
, the region in which the nasal cavities
Nasal cavity
The nasal cavity is a large air filled space above and behind the nose in the middle of the face.- Function :The nasal cavity conditions the air to be received by the other areas of the respiratory tract...
and the Eustachian tube
Eustachian tube
The Eustachian tube is a tube that links the nasopharynx to the middle ear. It is a part of the middle ear. In adult humans the Eustachian tube is approximately 35 mm long. It is named after the sixteenth-century anatomist Bartolomeo Eustachi...
s connect with the upper part of the throat. While some nasopharyngeal cancers are biologically similar to the common HNSCC, "poorly differentiated" nasopharyngeal carcinoma is distinct in its epidemiology
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
, biology, clinical behavior, and treatment, and is treated as a separate disease by many experts.
Oropharynx
Oropharyngeal squamous cell carcinomas (OSCC) begins in the oropharynxOropharynx
The Oropharynx reaches from the Uvula to the level of the hyoid bone.It opens anteriorly, through the isthmus faucium, into the mouth, while in its lateral wall, between the two palatine arches, is the palatine tonsil....
, the middle part of the throat that includes the soft palate
Soft palate
The soft palate is the soft tissue constituting the back of the roof of the mouth. The soft palate is distinguished from the hard palate at the front of the mouth in that it does not contain bone....
, the base of the tongue
Tongue
The tongue is a muscular hydrostat on the floors of the mouths of most vertebrates which manipulates food for mastication. It is the primary organ of taste , as much of the upper surface of the tongue is covered in papillae and taste buds. It is sensitive and kept moist by saliva, and is richly...
, and the tonsil
Tonsil
Palatine tonsils, occasionally called the faucial tonsils, are the tonsils that can be seen on the left and right sides at the back of the throat....
s. Squamous cell cancers of the tonsils are more strongly associated with human papillomavirus
Human papillomavirus
Human papillomavirus is a member of the papillomavirus family of viruses that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes...
infection than are cancers of other regions of the head and neck.
Hypopharynx
The hypopharynx includes the pyriform sinuses, the posterior pharyngeal wall, and the postcricoid area. Tumors of the hypopharynx frequently have an advanced stage at diagnosis, and have the most adverse prognoses of pharyngeal tumors. They tend to metastasizeMetastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
early due to the extensive lymphatic network around the larynx
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
.
Larynx
Laryngeal cancer begins in the larynxLarynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
or "voice box." Cancer may occur on the vocal folds
Vocal folds
The vocal folds, also known commonly as vocal cords, are composed of twin infoldings of mucous membrane stretched horizontally across the larynx...
themselves ("glottic" cancer), or on tissues above and below the true cords ("supraglottic" and "subglottic" cancers respectively). Laryngeal cancer is strongly associated with tobacco smoking
Tobacco smoking
Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
.
Surgery can include partial laryngectomy (removal of part of the larynx) and total laryngectomy (removal of the whole larynx). If the whole larynx has been removed the person is left with a permanent tracheostomy and can learn to speak again in a new way with the help of intensive teaching and speech therapy and/or an electronic device.
Trachea
Cancer of the tracheaVertebrate trachea
In tetrapod anatomy the trachea, or windpipe, is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells that produce mucus...
is a rare malignancy which can be biologically similar in many ways to head and neck cancer, and is sometimes classified as such.
Most tumors of the salivary glands differ from the common carcinomas of the head and neck in etiology
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
, histopathology
Histopathology
Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...
, clinical presentation, and therapy, Other uncommon tumors arising in the head and neck include teratoma
Teratoma
A teratoma is an encapsulated tumor with tissue or organ components resembling normal derivatives of all three germ layers. There are rare occasions when not all three germ layers are identifiable...
s, adenocarcinomas, adenoid cystic carcinoma
Adenoid cystic carcinoma
Adenoid cystic cancer is a rare type of cancer that can exist in many different body sites. It most often occurs in the areas of the head and neck, in particular the salivary glands; but has also been reported in the breast, lacrimal gland of the eye, lung, brain, bartholin gland, trachea, and...
s, and mucoepidermoid carcinoma
Mucoepidermoid carcinoma
Mucoepidermoid carcinoma is the most common type of salivary gland malignancy in children. Mucoepidermoid carcinoma can also be found in other organs, as bronchi, lacrimal sac and thyroid.Mucicarmine staining is one stain used by pathologist for detection....
s. Rarer still are melanomas and lymphomas of the upper aerodigestive tract.
Signs and symptoms
Throat cancer usually begins with symptoms that seem harmless enough, like an enlarged lymph nodeLymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
on the outside of the neck, a sore throat or a hoarse sounding voice. However, in the case of throat cancer, these conditions may persist and become chronic. There may be a lump or a sore in the throat or neck that does not heal or go away. There may be difficult or painful swallowing. Speaking may become difficult. There may be a persistent earache. Other possible but less common symptoms include some numbness or paralysis
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
of the face muscles.
Presenting symptoms include
- MassTumorA tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
in the neck - Neck pain
- Bleeding from the mouth
- Sinus congestion, especially with nasopharyngeal carcinomaNasopharyngeal carcinomaNasopharyngeal carcinoma is the most common cancer originating in the nasopharynx, the uppermost region of the pharynx , behind the nose where the nasal passages and auditory tubes join the remainder of the upper respiratory tract. NPC differs significantly from other cancers of the head and neck...
- Bad breath
- Sore tongue
- Painless ulcer or sores in the mouth that do not heal
- White, red or dark patches in the mouth that will not go away
- EaracheOtalgiaOtalgia or an earache is ear pain. Primary otalgia is ear pain that originates inside the ear. Referred otalgia is ear pain that originates from outside the ear.Otalgia is not always associated with ear disease...
- Unusual bleeding or numbness in the mouth
- Lump in the lip, mouth or gumsGingivaThe gingiva , or gums, consists of the mucosal tissue that lies over the mandible and maxilla inside the mouth.-General description:...
- Enlarged lymph glandsLymph nodeA lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
in the neck - Slurring of speech (if the cancer is affecting the tongue)
- Hoarse voice which persists for more than six weeks
- Sore throat which persists for more than six weeks
- Difficulty swallowing food
- Change in diet or weight loss
Causes
AlcoholEthanol
Ethanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug and one of the oldest recreational drugs. Best known as the type of alcohol found in alcoholic beverages, it is also used in thermometers, as a...
and tobacco
Tobacco
Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
use are the most common risk factors for head and neck cancer in the United States. Alcohol and tobacco are likely synergistic in causing cancer of the head and neck.
Smokeless tobacco is an etiologic agent for oral and pharyngeal cancers (oropharyngeal cancer).
Cigar
Cigar
A cigar is a tightly-rolled bundle of dried and fermented tobacco that is ignited so that its smoke may be drawn into the mouth. Cigar tobacco is grown in significant quantities in Brazil, Cameroon, Cuba, the Dominican Republic, Honduras, Indonesia, Mexico, Nicaragua, Philippines, and the Eastern...
smoking is an important risk factor for oral cancers as well.
Other potential environmental carcinogens include occupational exposures such as nickel refining, exposure to textile fibers, and woodworking. In one large, controlled study, marijuana use was shown to be associated with oral squamous cell carcinoma. In another study, marijuana use was shown to be a potential protective factor against the development of head and neck squamous cell carcinoma. However, cigarette
Cigarette
A cigarette is a small roll of finely cut tobacco leaves wrapped in a cylinder of thin paper for smoking. The cigarette is ignited at one end and allowed to smoulder; its smoke is inhaled from the other end, which is held in or to the mouth and in some cases a cigarette holder may be used as well...
smokers have a lifetime increased risk for head and neck cancers that is 5- to 25-fold increased over the general population.
The ex-smoker's risk for squamous cell cancer of the head and neck begins to approach the risk in the general population twenty years after smoking cessation. The high prevalence of tobacco and alcohol use worldwide and the high association of these cancers with these substances makes them ideal targets for enhanced cancer prevention.
Dietary factors
Dietary factors may contribute. Excessive consumption of processed meats and red meat were associated with increased rates of cancer of the head and neck in one study, while consumption of raw and cooked vegetables seemed to be protective.Vitamin E
Vitamin E
Vitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols. There are many different forms of vitamin E, of which γ-tocopherol is the most common in the North American diet. γ-Tocopherol can be found in corn oil, soybean oil, margarine and dressings...
was not found to prevent the development of leukoplakia
Leukoplakia
Leukoplakia is a clinical term used to describe patches of keratosis. It is visible as adherent white patches on the mucous membranes of the oral cavity, including the tongue, but also other areas of the gastro-intestinal tract, urinary tract and the genitals. The clinical appearance is highly...
, the white plaques that are the precursor for carcinomas of the mucosal surfaces, in adult smokers.
Another study examined a combination of Vitamin E and beta carotene in smokers with early-stage cancer of the oropharynx, and found a worse prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
in the vitamin users.
Betel-nut
Betel-nut chewing is associated with an increased risk of squamous cell cancer of the head and neck.Recent evidence is accumulating pointing to a viral origin for some head and neck cancers.
Human papillomavirus
Human papillomavirusHuman papillomavirus
Human papillomavirus is a member of the papillomavirus family of viruses that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes...
(HPV), in particular HPV16, is a causal factor for some head and neck squamous cell carcinoma (HNSCC). Approximately 15 to 25% of HNSCC contain genomic DNA from HPV, and the association varies based on the site of the tumor, especially HPV-positive oropharyngeal cancer
HPV-positive oropharyngeal cancer
Human papillomavirus -positive oropharyngeal cancer also known as HPV16+ oropharyngeal cancer or HPV+ OPC is a recognized subtype of Oropharyngeal squamous cell carcinomas , associated with the HPV type 16 virus.-Causes:...
, with highest distribution in the tonsils, where
HPV DNA is found in (45 to 67%) of the cases, less often in the hypopharynx (13%–25%), and least often in the oral cavity (12%–18%) and larynx (3%–7%).
Some experts estimate that while up to 50% of cancers of the tonsil may be infected with HPV, only 50% of these are likely to be caused by HPV (as opposed to the usual tobacco
Tobacco
Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
and alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
causes). The role of HPV in the remaining 25-30% is not yet clear.
Epstein-Barr virus
Epstein-Barr virusEpstein-Barr virus
The Epstein–Barr virus , also called human herpesvirus 4 , is a virus of the herpes family and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis...
(EBV) infection is associated with nasopharyngeal cancer
Nasopharyngeal carcinoma
Nasopharyngeal carcinoma is the most common cancer originating in the nasopharynx, the uppermost region of the pharynx , behind the nose where the nasal passages and auditory tubes join the remainder of the upper respiratory tract. NPC differs significantly from other cancers of the head and neck...
. Nasopharyngeal cancer occurs endemically in some countries of the Mediterranean and Asia, where EBV antibody
Antibody
An antibody, also known as an immunoglobulin, is a large Y-shaped protein used by the immune system to identify and neutralize foreign objects such as bacteria and viruses. The antibody recognizes a unique part of the foreign target, termed an antigen...
titers can be measured to screen high-risk populations.
Nasopharyngeal cancer has also been associated with consumption of salted fish, which may contain high levels of nitrites.
Gastroesophageal reflux disease
The presence of acid reflux diseaseGastroesophageal reflux disease
Gastroesophageal reflux disease , gastro-oesophageal reflux disease , gastric reflux disease, or acid reflux disease is chronic symptoms or mucosal damage caused by stomach acid coming up from the stomach into the esophagus...
(GERD - gastroesphogeal reflux disease) or larynx reflux disease can also be a major factor. In the case of acid reflux disease, stomach acids flow up into the esophagus
Esophagus
The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...
and damage its lining, making it more susceptible to throat cancer.
Hematopoietic stem cell transplantation
Patients after hematopoietic stem cell transplantation (HSCT) are at a higher risk for oral squamous cell carcinoma. Post-HSCT oral cancer may have more aggressive behavior with poorer prognosis, when compared to oral cancer in non-HSCT patients. This effect is supposed to be owing to the continuous life-long immuneImmune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
suppression and chronic oral graft-versus-host disease
Graft-versus-host disease
Graft-versus-host disease is a common complication after a stem cell transplant or bone marrow transplant from another person . Immune cells in the donated marrow or stem cells recognize the recipient as "foreign". The transplanted immune cells then attack the host's body cells...
.
Other possible causes
There are a wide variety of factors which can put someone at a heightened risk for throat cancer. Such factors include smokingTobacco smoking
Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
or chewing
Chewing tobacco
Chewing tobacco Chewing tobacco Chewing tobacco (also known colloquially as hoobastank, backy, tobac, doogooos,Hogleg, chewpoos, chits, chewsky, chawsky, dip, flab, chowers, guy, or a wad, as well as referred to as dipsky, snuff, a pinch, a yopper, a Packing a bomb, a tobbackey or packing a...
tobacco
Tobacco
Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
or other things, such as gutkha, or paan
Paan
Paan, from the word pān is an Indian, Pakistani, Uttarvarshi and Southeast Asian tradition of chewing betel leaf with areca nut and slaked lime paste, and katha brown powder paste, with many regional and local variations...
, heavy alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
consumption, poor diet resulting in vitamin
Vitamin
A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. In other words, an organic chemical compound is called a vitamin when it cannot be synthesized in sufficient quantities by an organism, and must be obtained from the diet. Thus, the term is conditional both on...
deficiencies (worse if this is caused by heavy alcohol intake), weakened immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
, asbestos
Asbestos
Asbestos is a set of six naturally occurring silicate minerals used commercially for their desirable physical properties. They all have in common their eponymous, asbestiform habit: long, thin fibrous crystals...
exposure, prolonged exposure to wood dust or paint fumes, exposure to petroleum
Petroleum
Petroleum or crude oil is a naturally occurring, flammable liquid consisting of a complex mixture of hydrocarbons of various molecular weights and other liquid organic compounds, that are found in geologic formations beneath the Earth's surface. Petroleum is recovered mostly through oil drilling...
industry chemicals, and being over the age of 55 years. Another risk factor includes the appearance of white patches or spots in the mouth, known as leukoplakia
Leukoplakia
Leukoplakia is a clinical term used to describe patches of keratosis. It is visible as adherent white patches on the mucous membranes of the oral cavity, including the tongue, but also other areas of the gastro-intestinal tract, urinary tract and the genitals. The clinical appearance is highly...
; in about ⅓ of the cases this develops into cancer.
Diagnosis
A patient usually presents to the physician complaining of one or more of the above symptoms. The patient will typically undergo a needle biopsy of this lesion, and a histopathologic information is available, a multidisciplinary discussion of the optimal treatment strategy will be undertaken between the radiation oncologistRadiation oncologist
A radiation oncologist is a doctor who specializes in the treatment of cancer patients, using radiation therapy as the main modality of treatment. Radiation can be given as a curative modality, either alone or in combination with surgery and/or chemotherapy. It may also be used palliatively, to...
, surgical oncologist
Surgical oncology
Surgical oncology is the branch of surgery which focuses on the surgical management of cancer.The specialty of surgical oncology has evolved in steps similar to medical oncology, which grew out of hematology, and radiation oncology, which grew out of radiology...
, and medical oncologist.
Histopathology
Throat cancers are classified according to their histologyHistology
Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...
or cell structure, and are commonly referred to by their location in the oral cavity and neck. This is because where the cancer appears in the throat affects the prognosis - some throat cancers are more aggressive than others depending upon their location. The stage at which the cancer is diagnosed is also a critical factor in the prognosis of throat cancer.
Squamous cell carcinoma
Squamous cells are the epitheliumEpithelium
Epithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the cavities and surfaces of structures throughout the body, and also form many glands. Functions of epithelial cells include secretion, selective...
(tissue layer) that is the surface cells of much of the body. Skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
and mucous membranes are squamous cells. This is the most common form of larynx cancer, accounting for over 90% of throat cancer. Squamous cell carcinoma is most likely to appear in males over 40 years of age with a history of heavy alcohol use coupled with smoking.
Adenocarcinoma
AdenocarcinomaAdenocarcinoma
Adenocarcinoma is a cancer of an epithelium that originates in glandular tissue. Epithelial tissue includes, but is not limited to, the surface layer of skin, glands and a variety of other tissue that lines the cavities and organs of the body. Epithelium can be derived embryologically from...
is a cancer of the columnar epithelium typical of the lower esophagus
Esophagus
The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...
. It is typical of Barrett's esophagus but may be at another location. Adenocarcinoma is thought of as a product of Barrett's esophagus.
Prevention
Avoidance of recognised risk factors (as described above) is the single most effective form of prevention. Regular dental examinations may identify pre-cancerous lesions in the oral cavity.When diagnosed early, oral, head and neck cancers can be treated more easily and the chances of survival increase tremendously.
It is expected that HPV vaccine
HPV vaccine
The human papilloma virus vaccine prevents infection with certain species of human papillomavirus associated with the development of cervical cancer, genital warts, and some less common cancers...
s may reduce the risk of HPV induced head and neck cancer.
General considerations
Improvements in diagnosis and local management, as well as targeted therapyTargeted therapy
Targeted therapy is a type of medication that blocks the growth of cancer cells by interfering with specific targeted molecules needed for carcinogenesis and tumor growth, rather than by simply interfering with rapidly dividing cells...
, have led to improvements in quality of life and survival for head and neck cancer patients since 1992.
After a histologic diagnosis has been established and tumor extent determined, the selection of appropriate treatment for a specific cancer depends on a complex array of variables, including tumor site, relative morbidity of various treatment options, patient performance and nutritional status, concomitant health problems, social and logistic factors, previous primary tumors, and patient preference. Treatment planning generally requires a multidisciplinary approach involving specialist surgeons and medical and radiation oncologists.
Several generalizations are useful in therapeutic decision making, but variations on these themes are numerous. Surgical resection and radiation therapy are the mainstays of treatment for most head and neck cancers and remain the standard of care in most cases. For small primary cancers without regional metastases (stage I or II), wide surgical excision alone or curative radiation therapy alone is used. More extensive primary tumors, or those with regional metastases (stage III or IV), planned combinations of pre- or postoperative radiation and complete surgical excision are generally used. More recently, as historical survival and control rates are recognized as less than satisfactory, there has been an emphasis on the use of various induction or concomitant chemotherapy regimens.
Patients with head and neck cancer can be categorized into three clinical groups: those with localized disease, those with locally or regionally advanced disease, and those with recurrent and/or metastatic disease. Comorbidities (medical problems in addition to the diagnosed cancer) associated with tobacco and alcohol abuse can affect treatment outcome and the tolerability of aggressive treatment in a given patient.
Many different treatments and therapies are used in the treatment of throat cancer. The type of treatment and therapies used are largely determined by the location of the cancer in the throat area and also the extent to which the cancer has spread at time of diagnosis. Patients’ also have the right to decide whether or not they wish to consent to a particular treatment. For example, some may decide to not undergo radiation therapy which has serious side effects if it means they will be extending their lives by only a few months or so. Others may feel that the extra time is worth it and wish to pursue the treatments.
Surgery
SurgerySurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
as a treatment is sometimes used in cases of throat cancer. In such cases an attempt is made to remove the cancerous cells. This can be particularly tricky if the cancer is near the larynx
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
and can result in the patient being unable to speak. Surgery is more commonly used to resection
Segmental resection
Segmental resection is a surgical procedure to remove part of an organ or gland. It may also be used to remove a tumor and normal tissue around it. In lung cancer surgery, segmental resection refers to removing a section of a lobe of the lung.- External links :* entry in the public domain NCI...
(remove) some of the lymph nodes to prevent further spread of the disease.
A novel approach uses harvested hematopoietic stem cells (blood stem cells) and other harvested cells (if necessary, a silicon alloy can also be used or can be used in place of the cells) from the lining of the patient's stomach to form a new section of a trachea or esophagus.
CO2 laser surgery is also another form of treatment. Transoral laser microsurgery
Transoral laser microsurgery
Transoral laser microsurgery is another form of minimally invasive surgery used by several medical centers, including Washington University Siteman Cancer Center and Mayo Clinic to remove small and medium tumors through the mouth. It's occasionally used for larger tumors. Transoral laser...
allows surgeons to remove tumors from the voice box with no external incisions. It also allows access to tumors that are not reachable with robotic surgery. A microscope helps the surgeon clearly view the margins of the tumor, minimizing the amount of normal tissue removed or damaged during surgery. This technique helps give the patient as much speech and swallowing function as possible after surgery.
Radiation therapy
Radiation therapyRadiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
is the most common form of treatment. There are different forms of radiation therapy, including 3D conformal radiation therapy, intensity-modulated radiation therapy, and brachytherapy, which are commonly used in the treatments of cancers of the head and neck. Most patients with head and neck cancer who are treated in the United States and Europe are treated with intensity-modulated radiation therapy using high energy photons.
Chemotherapy
ChemotherapyChemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
in throat cancer is not generally used to cure the cancer as such. Instead, it is used to provide an inhospitable environment for metastases so that they will not establish in other parts of the body. Typical chemotherapy agents are a combination of Taxol and Carboplatin
Carboplatin
Carboplatin, or cis-Diammineplatinum is a chemotherapy drug used against some forms of cancer...
. Erbitux is also used in the treatment of throat cancer.
Taxotere (Docetaxel) based chemotherapy has shown a very good response in locally advanced head and neck cancer. Taxotere is the only taxane
Taxane
The taxanes are diterpenes produced by the plants of the genus Taxus . As their name suggests, they were first derived from natural sources, but some have been synthesized artificially. Taxanes include paclitaxel and docetaxel . Paclitaxel was originally derived from the Pacific yew tree.Taxanes...
approved by US FDA for Head and neck cancer.
While not specifically a chemotherapy, Amifostine
Amifostine
Amifostine is a cytoprotective adjuvant used in cancer chemotherapy and radiotherapy involving DNA-binding chemotherapeutic agents. It is marketed by MedImmune under the trade name Ethyol.-Indications:...
is often administered intravenously by a chemotherapy clinic prior to a patient's IMRT radiotherapy sessions. Amifostine protects the patient's gums and salivary glands from the effects of radiation. It should be noted that one of the side effects of Amifostine is that it could protect tumors. Another reason to use the newer more precise and better tumor damaging PMRT
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
treatments.
Photodynamic therapy
Photodynamic therapyPhotodynamic therapy
Photodynamic therapy is used clinically to treat a wide range of medical conditions, including malignant cancers, and is recognised as a treatment strategy which is both minimally invasive and minimally toxic...
may have promise in treating mucosal dysplasia and small head and neck tumors. Amphinex
Amphinex
Amphinex is a photosensitising agent used in photodynamic therapy for treating superficial cancers.It has had promising preliminary results in early trials on patients with advanced head and neck cancer...
is giving good results in early clinical trials for treatment of advanced head and neck cancer.
Targeted therapy
Targeted therapyTargeted therapy
Targeted therapy is a type of medication that blocks the growth of cancer cells by interfering with specific targeted molecules needed for carcinogenesis and tumor growth, rather than by simply interfering with rapidly dividing cells...
, according to the National Cancer Institute
National Cancer Institute
The National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...
, is "a type of treatment that uses drugs or other substances, such as monoclonal antibodies, to identify and attack specific cancer cells without harming normal cells." Some targeted therapy
Targeted therapy
Targeted therapy is a type of medication that blocks the growth of cancer cells by interfering with specific targeted molecules needed for carcinogenesis and tumor growth, rather than by simply interfering with rapidly dividing cells...
used in squamous cell cancers of the head and neck include cetuximab
Cetuximab
Cetuximab is a chimeric monoclonal antibody, an epidermal growth factor receptor inhibitor, given by intravenous infusion for treatment of metastatic colorectal cancer and head and neck cancer.- Distribution :Cetuximab is manufactured and distributed in North America by ImClone and Bristol-Myers...
, bevacizumab
Bevacizumab
Bevacizumab is a drug that blocks angiogenesis, the growth of new blood vessels. It is commonly used to treat various cancers, including colorectal, lung, breast, kidney, and glioblastomas....
, erlotinib
Erlotinib
Erlotinib hydrochloride is a drug used to treat non-small cell lung cancer, pancreatic cancer and several other types of cancer. It is a reversible tyrosine kinase inhibitor, which acts on the epidermal growth factor receptor . It is marketed in the United States by Genentech and OSI...
, and reovirus.
The best quality data are available for cetuximab
Cetuximab
Cetuximab is a chimeric monoclonal antibody, an epidermal growth factor receptor inhibitor, given by intravenous infusion for treatment of metastatic colorectal cancer and head and neck cancer.- Distribution :Cetuximab is manufactured and distributed in North America by ImClone and Bristol-Myers...
since the 2006 publication of a randomized clinical trial comparing radiation treatment plus cetuximab versus radiation treatment alone. This study found that concurrent cetuximab
Cetuximab
Cetuximab is a chimeric monoclonal antibody, an epidermal growth factor receptor inhibitor, given by intravenous infusion for treatment of metastatic colorectal cancer and head and neck cancer.- Distribution :Cetuximab is manufactured and distributed in North America by ImClone and Bristol-Myers...
and radiotherapy improves survival and locoregional disease control compared to radiotherapy alone, without a substantial increase in side effects
Adverse effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
, as would be expected with the concurrent chemoradiotherapy, which is the current gold standard treatment for advanced head and neck cancer. Whilst this study is of pivotal significance, interpretation is difficult since cetuximab-radiotherapy was not directly compared to chemoradiotherapy. The results of ongoing studies to clarify the role of cetuximab
Cetuximab
Cetuximab is a chimeric monoclonal antibody, an epidermal growth factor receptor inhibitor, given by intravenous infusion for treatment of metastatic colorectal cancer and head and neck cancer.- Distribution :Cetuximab is manufactured and distributed in North America by ImClone and Bristol-Myers...
in this disease are awaited with interest.
Another study evaluated the impact of adding cetuximab
Cetuximab
Cetuximab is a chimeric monoclonal antibody, an epidermal growth factor receptor inhibitor, given by intravenous infusion for treatment of metastatic colorectal cancer and head and neck cancer.- Distribution :Cetuximab is manufactured and distributed in North America by ImClone and Bristol-Myers...
to conventional chemotherapy (cisplatin
Cisplatin
Cisplatin, cisplatinum, or cis-diamminedichloroplatinum is a chemotherapy drug. It is used to treat various types of cancers, including sarcomas, some carcinomas , lymphomas, and germ cell tumors...
) versus cisplatin
Cisplatin
Cisplatin, cisplatinum, or cis-diamminedichloroplatinum is a chemotherapy drug. It is used to treat various types of cancers, including sarcomas, some carcinomas , lymphomas, and germ cell tumors...
alone. This study found no improvement in survival or disease-free survival with the addition of cetuximab
Cetuximab
Cetuximab is a chimeric monoclonal antibody, an epidermal growth factor receptor inhibitor, given by intravenous infusion for treatment of metastatic colorectal cancer and head and neck cancer.- Distribution :Cetuximab is manufactured and distributed in North America by ImClone and Bristol-Myers...
to the conventional chemotherapy.
However, another study which completed in March 2007 found that there was an improvement in survival.
The EXTREME (Erbitux in First-Line Treatment of Recurrent or Metastatic Head & Neck Cancer) study is a European multicenter phase III trial to determine whether adding cetuximab improves the impact of platinum-based chemotherapy.
Between December 2004 and March 2007, researchers enrolled 442 patients in 17 countries who had stage III or IV recurrent and/or metastatic SCCHN, and who were not candidates for further surgery or radiation. About half of the patients had cancer in their pharynx (throat), and a quarter in their larynx (voice box), but none in the nasopharynx (upper part of the throat). The patients averaged 57 years of age. Only about 10 percent were women.
Patients were randomly assigned to receive either chemotherapy (222 patients) or the same chemotherapy with cetuximab (220 patients). Chemotherapy consisted of 5-fluorouracil plus either carboplatin or cisplatin.
Results: Patients treated with cetuximab reduced their risk of dying by 20 percent, surviving a median of 10.1 months compared to 7.4 months for those receiving chemotherapy alone.
A 2010 review concluded that the combination of cetuximab and platin/5-fluorouracil should be considered the current standard first-line regimen.
Head and neck cancer clinical trials employing bevacizumab
Bevacizumab
Bevacizumab is a drug that blocks angiogenesis, the growth of new blood vessels. It is commonly used to treat various cancers, including colorectal, lung, breast, kidney, and glioblastomas....
, an inhibitor of the angiogenesis
Angiogenesis
Angiogenesis is the physiological process involving the growth of new blood vessels from pre-existing vessels. Though there has been some debate over terminology, vasculogenesis is the term used for spontaneous blood-vessel formation, and intussusception is the term for the formation of new blood...
receptor VEGF
Vascular endothelial growth factor
Vascular endothelial growth factor is a signal protein produced by cells that stimulates vasculogenesis and angiogenesis. It is part of the system that restores the oxygen supply to tissues when blood circulation is inadequate....
, were recruiting patients .
Erlotinib
Erlotinib
Erlotinib hydrochloride is a drug used to treat non-small cell lung cancer, pancreatic cancer and several other types of cancer. It is a reversible tyrosine kinase inhibitor, which acts on the epidermal growth factor receptor . It is marketed in the United States by Genentech and OSI...
is an oral EGFR inhibitor, and was found in one Phase II clinical trial to retard disease progression.
Scientific evidence for the effectiveness of erlotinib
Erlotinib
Erlotinib hydrochloride is a drug used to treat non-small cell lung cancer, pancreatic cancer and several other types of cancer. It is a reversible tyrosine kinase inhibitor, which acts on the epidermal growth factor receptor . It is marketed in the United States by Genentech and OSI...
is otherwise lacking to this point. A clinical trial evaluating the use of erlotinib
Erlotinib
Erlotinib hydrochloride is a drug used to treat non-small cell lung cancer, pancreatic cancer and several other types of cancer. It is a reversible tyrosine kinase inhibitor, which acts on the epidermal growth factor receptor . It is marketed in the United States by Genentech and OSI...
in metastatic head and neck cancer is recruiting patients as of March, 2007.
Reovirus is an oncolytic virus that targets RAS activated cancer cells. Trial update on November 2008 showed stable disease or better in the first eight of nine patients with refractory head and neck cancer http://media.integratir.com/T.ONC/ppt/iSBTc%20San%20Diego%202008%20Final.pdf. Phase II trials are ongoing in England and the USA with phase III trials planned.
Prognosis
Although early-stage head and neck cancers (especially laryngeal and oral cavity) have high cure rates, up to 50% of head and neck cancer patients present with advanced disease.Cure rates decrease in locally advanced cases, whose probability of cure is inversely related to tumor size and even more so to the extent of regional node involvement.
Consensus panels in America (AJCC) and Europe (UICC
UICC
The UICC is the smart card used in mobile terminals in GSM and UMTS networks. The UICC ensures the integrity and security of all kinds of personal data, and it typically holds a few hundred kilobytes...
) have established staging systems for head and neck squamous cancers. These staging systems attempt to standardize clinical trial criteria for research studies, and attempt to define prognostic categories of disease. Squamous cell cancers of the head and neck are staged according to the TNM classification system, where T is the size and configuration of the tumor, N is the presence or absence of lymph node metastases, and M is the presence or absence of distant metastases. The T, N, and M characteristics are combined to produce a “stage” of the cancer, from I to IVB.
Residual deficits
Even after successful definitive therapy, head and neck cancer patients face tremendous impacts on quality of life. Despite marked advances in reconstructive surgery and rehabilitation, intensity-modulated radiotherapy (IMRT) and conservation approaches to certain malignancies, some patients continue to have significant functional deficits.Problem of second primaries
Survival advantages provided by new treatment modalities have been undermined by the significant percentage of patients cured of head and neck squamous cell carcinoma (HNSCC) who subsequently develop second primary tumors. The incidence of second primary tumors ranges in studies from 9.1%to 23%
at 20 years. Second primary tumors are the major threat to long-term survival after successful therapy of early-stage HNSCC. Their high incidence results from the same carcinogenic exposure responsible for the initial primary process, called field cancerization.
Throat cancer has numerous negative effects on the body systems.
Digestive system
As it can impair a person’s ability to swallow and eat, throat cancer affects the digestive system. The difficulty in swallowing can lead to a person to chokeChoking
Choking is the mechanical obstruction of the flow of air from the environment into the lungs. Choking prevents breathing, and can be partial or complete, with partial choking allowing some, although inadequate, flow of air into the lungs. Prolonged or complete choking results in asphyxia which...
on their food in the early stages of digestion and interfere with the food’s smooth travels down into the esophagus
Esophagus
The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...
and beyond.
The treatments for throat cancer can also be harmful to the digestive system as well as other body systems. Radiation therapy can lead to nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
and vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
, which can deprive a body of vital fluids (although these may be obtained through intravenous fluids if necessary). Frequent vomiting can lead to an electrolyte imbalance which has serious consequences for the proper functioning of the heart. Frequent vomiting can also upset the balance of stomach acids which has a negative impact on the digestive system, especially the lining of the stomach and esophagus.
Respiratory system
In the cases of some throat cancers, the air passages in the mouthMouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....
and behind the nose
Human nose
The visible part of the human nose is the protruding part of the face that bears the nostrils. The shape of the nose is determined by the ethmoid bone and the nasal septum, which consists mostly of cartilage and which separates the nostrils...
may become blocked from lumps or the swelling from the open sores. If the throat cancer is near the bottom of the throat it has a high likelihood of spreading to the lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...
s and interfering with the person’s ability to breathe; this is even more likely if the patient is a smoker, because they are highly susceptible to lung cancer
Lung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
.
Others
Like any cancerCancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
, metastasization affects many areas of the body, as the cancer spreads from cell to cell and organ to organ. For example, if it spreads to the bone marrow
Bone marrow
Bone marrow is the flexible tissue found in the interior of bones. In humans, bone marrow in large bones produces new blood cells. On average, bone marrow constitutes 4% of the total body mass of humans; in adults weighing 65 kg , bone marrow accounts for approximately 2.6 kg...
, it will prevent the body from producing enough red blood cell
Red blood cell
Red blood cells are the most common type of blood cell and the vertebrate organism's principal means of delivering oxygen to the body tissues via the blood flow through the circulatory system...
s and affects the proper functioning of the white blood cell
White blood cell
White blood cells, or leukocytes , are cells of the immune system involved in defending the body against both infectious disease and foreign materials. Five different and diverse types of leukocytes exist, but they are all produced and derived from a multipotent cell in the bone marrow known as a...
s and the body's immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
; spreading to the circulatory system
Circulatory system
The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...
will prevent oxygen from being transported to all the cells of the body; and throat cancer can throw the nervous system
Nervous system
The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous...
into chaos, making it unable to properly regulate and control the body.
Symptoms and side effects
Patients with head and neck cancer may experience the following symptoms and treatment side effects:- Eating problems
- Pain associated with lesions
- MucositisMucositisMucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer. Mucositis can occur anywhere along the gastrointestinal tract, but oral mucositis refers to the particular...
- NephrotoxicityNephrotoxicityNephrotoxicity is a poisonous effect of some substances, both toxic chemicals and medication, on the kidneys. There are various forms of toxicity. Nephrotoxicity should not be confused with the fact that some medications have a predominantly renal excretion and need their dose adjusted for the...
and ototoxicityOtotoxicityOtotoxicity is damage to the ear , specifically the cochlea or auditory nerve and sometimes the vestibular system, by a toxin. It is commonly medication-induced; ototoxic drugs include antibiotics such as the aminoglycoside gentamicin, loop diuretics such as furosemide, and platinum-based... - XerostomiaXerostomiaXerostomia is the medical term for the subjective complaint of dry mouth due to a lack of saliva. Xerostomia is sometimes colloquially called pasties, cottonmouth, drooth, or doughmouth. Several diseases, treatments, and medications can cause xerostomia. It can also be exacerbated by smoking or...
- Gastroesophageal reflux
- Radiation induced osteonecrosis of the jaw
Epidemiology
The number of new cases of head and neck cancers in the United States was 40,490 in 2006, accounting for about 3% of adult malignancies. 11,170 patients died of their disease in 2006. The worldwide incidence exceeds half a million cases annually. In North America and Europe, the tumors usually arise from the oral cavity, oropharynx, or larynx, whereas nasopharyngeal cancer is more common in the Mediterranean countries and in the Far East. In Southeast China and Taiwan, head and neck cancer, specifically nasopharyngeal cancer is the most common cause of death in young men.- In 2008, there were 22,900 cases of oral cavity cancer, 12,250 cases of laryngeal cancer, and 12,410 cases of pharyngeal cancer in the United States.
- In 2002, 7,400 Americans were projected to die of these cancers.
- More than 70% of throat cancers are at an advanced stage when discovered.
- Men are 89% more likely than women to be diagnosed with, and are almost twice as likely to die of, these cancers.
- African Americans are disproportionately affected by head and neck cancer, with younger ages of incidence, increased mortality, and more advanced disease at presentation. Laryngeal cancer incidence is higher in African Americans relative to white, Asian and Hispanic populations. There is a lower survival rate for similar tumor states in African Americans with head and neck cancer.
- Smoking and tobacco use are directly related to oropharangeal (throat) cancer deaths.
- Head and neck cancer increases with age, especially after 50 years. Most patients are between 50 and 70 years old.
See also
- Adenoid cystic carcinomaAdenoid cystic carcinomaAdenoid cystic cancer is a rare type of cancer that can exist in many different body sites. It most often occurs in the areas of the head and neck, in particular the salivary glands; but has also been reported in the breast, lacrimal gland of the eye, lung, brain, bartholin gland, trachea, and...
- a type of salivary gland cancer - Burkitt's lymphomaBurkitt's lymphomaBurkitt's lymphoma is a cancer of the lymphatic system...
- a type of lymphomaLymphomaLymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
that affects the head and neck - Dermatofibrosarcoma protuberansDermatofibrosarcoma protuberansDermatofibrosarcoma protuberans is a very rare tumor. It is a rare neoplasm of the dermis layer of the skin, and is classified as a sarcoma. There is only about 1 case per million per year. DFSP is a fibrosarcoma, more precisely a cutaneous soft tissue sarcoma...
- a type of sarcomaSarcomaA sarcoma is a cancer that arises from transformed cells in one of a number of tissues that develop from embryonic mesoderm. Thus, sarcomas include tumors of bone, cartilage, fat, muscle, vascular, and hematopoietic tissues...
that may involve the head and neck - Hodgkin's disease - a lymphomaLymphomaLymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
that often involves the lymph nodes in the neck - Cancer of the larynxCancer of the larynxLaryngeal cancer may also be called cancer of the larynx or laryngeal carcinoma. Most laryngeal cancers are squamous cell carcinomas, reflecting their origin from the squamous cells which form the majority of the laryngeal epithelium....
- ParagangliomaParagangliomaA paraganglioma is a rare neuroendocrine neoplasm that may develop at various body sites . About 97% are benign and cured by surgical removal; the remaining 3% are malignant because they are able to produce distant metastases...
- usually found in the head and neck region - Skin cancerSkin cancerSkin neoplasms are skin growths with differing causes and varying degrees of malignancy. The three most common malignant skin cancers are basal cell cancer, squamous cell cancer, and melanoma, each of which is named after the type of skin cell from which it arises...
s - may involve the head and neck - Thyroid cancerThyroid cancerThyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, or it can be a malignant neoplasm , such as papillary, follicular, medullary or anaplastic thyroid cancer. Most patients are 25 to 65 years of age when first diagnosed; women are more affected...
- Metastatic tumor of jawsMetastatic tumor of jawsMetastatic tumor of jaws is the most common form of cancer involving bone. It affects the mandible in 61% of cases, the maxilla in 24% of cases, and soft tissue in 16% of cases. In the majority of cases, the tumor originated in the breast, lung, kidney, colon, or prostate. The original tumor...
Further reading
1. Brook I. (2010) My Voice: A Physician’s Personal Experience with Throat Cancer. Creatspace Publishing. ISBN 1-4392-6386-82. Karni R, Haughey B, Transoral Laser Microsurgery: A New Approach for Occult Primaries of the Head and Neck, Laryngoscope, In Press February 2011.
3. Rich J, Liu J, Haughey B, Swallowing Function after Transoral Laser Microsurgery (TLM) ± Adjuvant Therapy for Advanced Stage Oropharyngeal Cancer, Laryngoscope, In Press February 2011.
4. Haughey BH, Hinni ML, Salassa JR, Grant DG, Rich JT, Milov S, Lewis Jr JS, Krishan M, Transoral Laser Microsurgery as Primary Treatment of Advanced Stage Oropharynx Cancer: A United States Multicenter Study, Head and Neck, Epub ahead of print February 2011. http://onlinelibrary.wiley.com/doi/10.1002/hed.21669/pdf
5. Rich JT, Milov S, Lewis Jr, JS, Thorstad WL, Adkins DR, Haughey BH, Transoral Laser Microsurgery (TLM) ± Adjuvant Therapy for Advanced Stage Oropharyngeal Cancer: Outcomes and Prognostic Factors, Laryngoscope, Volume 119, No. 9, pp 1709–1719, September 2009. http://onlinelibrary.wiley.com/doi/10.1002/lary.20552/pdf
6. Hinni M, Salassa J, Grant D, Pearson B, Hayden R, Martin A, Christiansen H, Haughey B, Nussenbaum B, Steiner W, Transoral Laser Microsurgery for Advanced Laryngeal Cancer, Archives of Otolaryngology-Head and Neck Surgery, Volume 133, No 12, pp 1198–1204, December 2007. http://archotol.ama-assn.org/cgi/reprint/133/12/1198
External links
- Head and Neck Cancer at MedlinePlusMedlinePlusMedlinePlus is a free Web site that provides consumer health information for patients, families, and Health care providers. The site brings together information from the United States National Library of Medicine, the National Institutes of Health , other U.S. government agencies, and...
- Head and Neck Cancer Information
- Head and Neck Cancer: Questions and Answers
- Cancer Management Handbook: Head and Neck Tumors
- RadiologyInfo The radiology information resource for patients: Head and Neck Cancer
- A Video of a Physician who is a Head and Neck Cancer Patient Discusses his Personal Experiences
- Clinically reviewed head and neck cancer information for patients, from Cancer Research UK