Oral, Head and Neck Cancers can be easily treated via early detection, awareness, support, and education, says Dr. Mangesh B. Patil, Consultant Radiation Oncologist at American Oncology Institute, Nagpur.
The month of April brings oral, head, and neck cancer into focus. Often ranked in the top five cancers worldwide, the cancers of the head and neck region are very common in India, especially because of the prevalence of tobacco addiction in various forms in the country.
Through this article, let’s try and understand the possible causes, symptoms, and treatments available.
Oral cancer means cancer of the oral cavity which includes sub-sites namely lip, tongue, buccal or cheek mucosa, mucosa around gums, the floor of the mouth and hard palate.
Apart from oral cancer, other sites for head and neck cancers include the nasal cavity, nasopharynx, oropharynx, larynx (Voicebox), hypopharynx, salivary glands, neck lymph nodes and other miscellaneous cancers.
Among many oral and head & neck cancer symptoms, the common ones include the ulcer or growth over lips, tongue or mucosa inside oral cavity, pain and bleeding from ulcer or growth, loose tooth, pain/ difficulty while swallowing, change or hoarseness in voice, ear pain and a lump in neck, etc. Sometimes an individual may even experience precancerous changes like red or white patch inside the mouth, difficulty in opening mouth, etc., before the development of cancer.
Consumption of tobacco is considered to be the major risk factor for the development of oral, head & neck cancer. Tobacco chewing in the form of gutkha, kharra, khaini or application of masheri to gums is responsible for oral cavity cancer. Similarly, smoking which is the most common cause of laryngeal cancer can cause oral and other head and neck cancers. Consumption of alcohol is also responsible for head and neck cancer.
Besides, some strains of the Human Papilloma Virus (HPV) increase the risk for the development of oropharyngeal cancer and Epstein- Barr Virus (EBV) infection causes the development of nasopharyngeal cancer. Prolonged exposure to sunlight is the risk factor for lip and skin cancer. Poor oral and dental hygiene is A risk factor for oral cancer.
It should be noted that head and neck cancer can be easily prevented by following the below-mentioned strategies:
Avoiding consumption of tobacco (in any form) and alcohol is the best strategy for oral and head & neck cancer prevention. Also, the HPV vaccine is now available that helps in the prevention of HPV-associated oropharyngeal cancer.
Maintenance of good oral hygiene and avoiding ill-fitting dentures or prolonged exposure to sunlight and using sunscreen with the adequate sun protection factor (SPF) regularly are some of the common ways to prevent oral, head, and neck cancers.
Diagnosis and Treatment
Head and neck cancers are suitable for early detection but despite that patients usually present themselves with the advanced stage of cancer.
Clinical examination is required for the detection of head and neck cancer which involves inspection and palpation of the oral cavity and oropharynx. It may also include examination of different anatomic structures in head and neck region using the light source containing scopes/instruments. In some cases Examination Under Anesthesia (EUA) is done for thorough mapping of the disease. The biopsy should be taken from the suspicious lesion to establish the diagnosis of cancer using histopathology examination. Sometimes, Fine Needle Aspiration Cytology (FNAC) examination is also done for the diagnosis.
Imaging studies, such as Ultrasonography (USG), CT, MRI, and PETCT are used to know the extent and the stage of cancer. HPV testing should be performed in oropharyngeal cancer to detect HPV-associated oropharyngeal cancers which are sensitive to radiation and chemotherapy and have a good prognosis.
It is mandatory to establish a diagnosis and get an idea of the stage of cancer before making a treatment plan.
Given the complexities of oral, head & neck cancers, it requires an integrated and multidisciplinary approach combining the expertise of a Surgical oncologist, Radiation Oncologist, Medical oncologist, Radiologist and Pathologist. It has been proven that outcomes of cancer treatment are much better when the treatment plans and made and executed by the team of oncologists in a specialized cancer hospital.
Surgery, radiotherapy, chemotherapy, or their combinations are required for the effective oral and head & neck cancer cure.
While Surgery, also the main modality of treatment for the oral cavity involves the use of a scalpel for the excision of the tumor and removal of lymph nodes in the neck, Radiotherapy, on the other hand, utilizes energy from X rays that are targeted towards the cancerous region for the destruction of cancer cells. Energy from X-rays brings about DNA damage in cancerous cells causing the death of abnormal cells and cure cancer.
Radiotherapy is the definitive treatment modality for oropharyngeal, nasopharyngeal, laryngeal (voice box), hypo-pharyngeal, nasal cavity cancers and carcinoma of the unknown primary (CUP) with neck nodes.
Radiotherapy is the treatment of choice for the above-mentioned cancers because of its potential of organ preservation and inaccessibility of these sites for surgery or both.
Also, during surgical intervention, the involved organ/part needs to be sacrificed partially or completely which often leads to the loss of function of the organ causing morbidity or disfigurement. However, radiotherapy, on the other hand, is a non-invasive treatment in which the organ remains intact and thus the function of the organ is preserved causing less morbidity. For instance, radiotherapy helps in preserving voice function, speech and swallowing function.
Radiotherapy can be used as a definitive treatment in oral cavity cancers but it is a treatment of choice in cases that are inoperable due to co-morbidities and other medical conditions. Sometimes, radiotherapy is used as an adjuvant (supportive) treatment to surgery where it is utilized to treat residual/microscopic disease after surgery.
Radiotherapy treatment is performed on a machine called linear accelerator which has a couch on which patient is made to lie down for 5-10 minutes wearing a comfortable immobilization device called thermoplastic masks so that he/she does not move during the procedure and radiation beams are accurately directed towards the target region on the body.
Among many benefits, radiotherapy treatment can be made more precise and accurate using onboard imaging devices like cone beam CT which takes CT images of the target region, known as image-guided radiotherapy IGRT.
That said, complications of radiotherapy in the modern era of IMRT and IGRT are less, and radiotherapy treatment is tolerated well with good compliance.
Chemotherapy is a treatment modality in which drugs are administered in the blood through veins. Though in some cases chemotherapy drugs are to be taken orally.
In head and neck cancers chemotherapy is used for its radiosensitizing property during radiotherapy.
Radiosensitization means chemotherapy enhances the effect of radiotherapy. Whereas sometimes it is used to shrink the tumor before the surgery, also known as neo-adjuvant chemotherapy.
Immunotherapy is a new treatment technique in which immune system altering agents are administered to fight cancer cells. In very advanced stages of cancer and metastatic cancers, radiotherapy, chemotherapy, immunotherapy or their combinations are used for palliation of symptoms, prolong life and improve the quality of life.
Cancer care also involves nutritionists and experts in Physiotherapy and Occupational therapy so as to improve the patient’s quality of life.
In essence, oral, head and neck cancer is not only preventable but is also suitable for early detection and can be cured with modern treatment techniques without significant toxicity. Public awareness can help to identify cancer in the early stages and reduce the burden of morbidity and mortality due to oral and head and neck cancer.
At American Oncology Institute we offer the best Oral, Head, and Neck cancer treatment in Nagpur. For queries or appointments related to oral and head & neck cancer treatment in Nagpur, contact us immediately.
Author: (Dr. Mangesh Patil)