Head and neck cancers generally refer to cancers that start in the head and neck area, excluding brain cancer and thyroid cancer but including the lips, tongue, oral cavity, salivary glands (parotid glands), tonsils, throat/ larynx, nasopharynx, nasal cavity, and the paranasal sinuses.
There are more than 1,600 new cases of head and neck cancers in Hong Kong each year. More than half of them are nasopharyngeal carcinomas (NPC), and nearly half of the newly diagnosed patients are between 40 and 59 years old. The male to female incidence ratio is 2.7:1.
Risk Factors
- Genetics: family history of head and neck cancer
- Human papilloma virus (HPV) infection
- Smoking
- Drinking excessive amounts of alcohol
- EB (Epstein-Barr) virus infection: risk of nasopharyngeal cancer increases by 30 times
Symptoms
- Paranasal sinuses or nasopharynx: epistaxis (nosebleeds), unilateral hearing loss
- Oral cavity or tongue: persistent ulcers, leukoplakia, bleeding of the gums
- Tonsils: unilateral sore throat or earache, oral bleeding
- Throat: hoarseness, coughing up blood (hemoptysis), difficulty in breathing
- Hypopharynx: neck swelling, difficulty in swallowing, blood stained saliva
Screening and Diagnosis
More than half of head and neck cancer patients do not experience symptoms until the cancer is at an advanced stage. However, early screening allows doctors to diagnose the cancer early and increases the chance of successful treatment for early-stage head and neck cancer.
Head and Neck Cancer Screening and Diagnosis:
- EBV antibody blood test or DNA concentration blood test for nasopharyngeal cancer index
- Endoscopy
- Biopsy tests wheretissue is extractedat the suspected location
Tumor Metastasis and Stage:
- Ultrasound scan
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Positron emission tomography and computed tomography scan (PET-CT Scan)
Treatment
Surgery
Surgery removes the tumor(s) more directly and completely. It can also be performed in combination with other treatments, though not all head and neck cancersare suitable for surgery.
Radiation Therapy (Radiotherapy)
Radiation therapy is the use of high-energy radiation to destroy cancer cells. New systems such as Tomotherapy, a high-speed helical radiation system, direct radiation energy at the tumor(s), minimizing exposure of energy to normal cells and reducing the development of possible side effects. This helps reduce negative effects on the salivary glands, vision, hearing, and spinal nerves.
Chemotherapy
Chemotherapy is treatment with drugs to destroy cancer cells in an effort to shrink the tumors or control their growth. Depending on the patient’s condition, concurrent radiochemotherapy, induction chemotherapy, and palliative chemotherapy may be performed.
Concurrent radiochemotherapy is the regular administration of chemotherapy during the course of radiation therapy to enhance the effect of radiation therapy. It is generally used for treatment of nasopharyngeal carcinoma/cancer, tonsil cancer, and throat cancer. Induction chemotherapy involves multiple administrations of chemotherapy before surgery or radiation therapy. It aims to shrink the tumor(s), reduce the risk of recurrence, and reduce the extent of radiation therapy.
Targeted Therapy
Targeted therapy employs molecular biology techniques that focus on the mechanisms by which cancer cells mutate, proliferate, and spread in an effort to inhibit their ability to grow and repair. Depending on the circumstances, it may be used on its own, or as a method to reinforce the effect of chemotherapy.
