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Head and Neck Cancer

Head and neck cancers include a variety of cancers that arise in the head and neck region. There are four main areas where these cancers occur which are described and depicteHead and Neckd in the next section.

There are over 50 different types of cancers that can occur in this region but the most common type of cancer is squamous cell carcinoma (commonly referred to as SCC).

Most of the surfaces in the head and neck region are lined by mucosa. Cells within the mucosa can grow abnormally and at uncontrolled rates giving rise to SCC.

    • Location of Head and Neck Cancers

      • Nasal cavity and sinuses: The nasal cavity refers to the nose and the structures within it. The sinuses are air-filled spaces within the bones of the face.
      • Oral cavity: This area includes all the structures with the mouth, from the lips to the base of the tongue.
      • Throat: This is an area that includes the pharynx and larynx. The pharynx is the area at the back of the nose, mouth and neck that is divided into three separate regions – the nasopharynx, oropharynx and hypopharynx. The nasopharynx is a passage behind the nasal cavity. The oropharynx lies behind the oral cavity. The hypopharynx refers to the lowest part of the pharynx. The larynx is the area that contains the vocal cords and other surrounding structures.
      • Salivary glands: These glands are important in producing saliva that help to digest food. The main salivary glands are called the parotid glands, submandibular and sublingual glands.

      Cancers can arise within any of the above sites and/or structures.

    • What Are the Causes of Head and Neck Cancers?

      The most common type of cancer seen in the head and neck region is squamous cell carcinoma (commonly referred to as SCC). Risk factors for developing a head and neck cancer include:

      • Smoking: This is the most important risk factor. Smoking, especially with alcohol consumption, increases the chance of developing head and neck cancer.
      • Alcohol consumption
      • Genetic and ethnic differences
      • Viruses such as the human papillomavirus (HPV): Cancers associated with this virus occur mainly within the tonsils and tongue base. These cancers behave differently to SCC and have different treatment outcomes. A test can be performed to determine if a cancer is HPV related.
      • Betel- nut chewing
      • Radiation exposure
      • Vitamin deficiencies
    • What Are the Symptoms of Head and Neck Cancers?

      The symptoms of head and neck cancer will vary depending upon where the cancer is located. General symptoms may include:

      • loss of appetite,
      • weight loss and

      A lump in the neck is a common symptom that can be associated with all types of head and neck cancers. The common symptoms for each specific area are listed below:

      Nasal cavity or nasopharyngeal cancers: A common symptom is a lump in the neck. Other symptoms may be:

      • nose bleeds,
      • persistent blocked nose or
      • changes to hearing which could be either hearing loss or a ringing sensation in the ears.

      Pain may also be present at the back of the nose or in the ear.

      Oral cavity or oropharynx cancers:  Common symptoms include

      • an ulcer of the lining of the mouth,
      • tongue or lip that doesn’t heal,
      • pain or difficulty on swallowing,
      • bleeding from the lining of the mouth or gums,
      • difficulty speaking or numbness of the chin.

      Tumours in the oropharynx can result in snoring at night, bleeding from the mouth or a lump in the neck.

      Hypopharynx cancers: Symptoms can include difficulty or pain with swallowing or a lump in the neck.

      Larynx cancers: Common symptoms include:

      • a hoarse voice,
      • difficulty or pain on swallowing,
      • chronic dry cough,
      • pain in the ear,
      • coughing up blood,
      • difficulty breathing or shortness of breath and
      • a lump in the neck.

      Sinus cancers: These cancers may result in bleeding from the nose or a chronically blocked nose.

    • What Are the Treatments for Head and Neck Cancer?

      Head and neck cancers vary a lot in terms of where they arise as well as the specific type. Treatment for head and neck cancers will depend upon the location and type of cancer as well as the person’s individual features and risk factors. Broadly speaking, treatment options include radiation therapy, surgery and chemotherapy.

      The type and sequence of treatment recommended for a particular patient will be decided by a team of different specialist doctors and other health professionals.

      This team includes radiation oncologists, surgeons (ear, nose and throat surgeons, oral surgeons and plastic/reconstructive surgeons), medical oncologists, dentists, dieticians and speech pathologists.

      Radiation Therapy (also called radiotherapy) is often used as the primary treatment for cancers in the head and neck region. In particular, cancers of the throat are often treated with curative radiation therapy alone, especially if they are early stage cancers.

      This approach can allow the preservation of normal organ function such as speech, whilst maintaining acceptable cosmetic results. Chemotherapy may be used during radiation therapy treatment to enhance the cancer killing effect of radiation therapy. Cancers in the nasal cavity may be treated with either radiation therapy or surgery.

      In some cases, radiation therapy may be required in addition to surgery. Cancers that arise in the sinuses are treated primarily with surgery with or without radiation therapy and chemotherapy. Similarly, cancers arising the in salivary glands are typically treated with surgery alone with or without radiation therapy afterwards.

      External beam radiation therapy is the most common type of radiation therapy used in head and neck cancers and requires a meticulous planning process. Intensity-modulated radiation therapy (IMRT) or volumetric arc therapy (VMAT) utilizes advanced technology to precisely deliver the radiation to the specific areas that need to be treated. This reduces the dose of radiation reaching or damaging important structures such as the salivary glands in the head and neck region.

      Radiation therapy is usually delivered once a day, five days a week from Monday to Friday and requires a multidisciplinary approach. Towards the end of a patient’s radiation therapy, some patients may receive two treatments a day. The total length of treatment time will vary from 5-7 weeks.

    • What Are the Side Effects of Radiation Therapy?

      The potential side effects from radiation therapy of the head and neck region can be divided in to early (during or immediately after treatment and usually temporary) or late (approximately six months after treatment and can be persistent).

      Generally speaking, radiation therapy can cause tiredness, lethargy and skin reaction that usually settles within four to six weeks. Other, more specific side effects include throat or mouth pain, dry mouth, altered taste, thick mucous secretions, swallowing issues and dental problems.

      Side effects during/soon after treatment (Early or ‘acute’ side effects)

      General – Fatigue is a common side effect of radiotherapy and is more likely to occur in the second half of treatment and is variable between patients. This may persist for a few weeks after treatment and usually settles within 4-6 weeks once radiation therapy is completed.

      Local – All other side effects of radiation therapy come from the structures/organs in and just next to where the radiation is being targeted.

      Mouth and throat soreness – pain in the mouth and throat can sometimes occur a few weeks into radiation therapy which may relate to skin changes including ulcer formation. This may have an impact on nutrition due to swallowing difficulty. Involvement of a dietitian will be important during the treatment course. Your treating team can advise you on oral care including mouth washes that may assist in this area. In some cases, a feeding tube maybe recommended. This problem can take 4-6 weeks following treatment to improve.

      Dry mouth or thick saliva – the glands that produce oral saliva can be affected by radiation resulting in a dry mouth or thick secretions. A dry mouth can be either temporary or permanent. It will be important to keep the mouth moist either by drinking water, using artificial saliva or a small water spray bottle. If you develop thick mucous secretions, salt water mouth washes can help this temporary problem.

      Altered taste – some patients report either loss of taste or altered taste eg sweet foods may taste salty or metallic. This can have an affect one’s ability to enjoy food and consequently affect appetite. This is usually a temporary problem but for some may be permanent.

      Skin changes – redness or tanning of the skin can occur in the area which is receiving treatment. Some patients may notice some itching associated. This temporary problem usually settles down 2-4 weeks after treatment and can be relieved by creams on advice from the treating team. Hair loss can also occur in the area that is being treated.

      Breathing Difficulty – the airway can become inflamed and swollen within the neck. Rarely, this swelling can be significant resulting in noisy breathing which requires a review by your treating team as soon as possible.

      Side effects well after treatment (Late or long-term side effects)

      Late side effects may occur a few months or years after treatment though they are much more rare than early side effects. Depending on the problem these may occur once and then go or may be more persistent over the long term or may come and go over time.

      Dry mouth – for some patients having a dry mouth may persist, although most centres employ a technique called IMRT to reduce the chance of this occurring. It will be important to keep the mouth moist by drinking water regularly or using an artificial saliva.

      Thyroid problems – an underactive thyroid gland due to radiation therapy can make patients feel tired and lethargic. This can be determined by a blood test and if confirmed can usually be rectified by having thyroid medication prescribed by your doctor.

      Neck stiffness or swelling – sometimes the soft tissues of the neck can become hard and stiff. This may have some impact on your neck range of movement and physiotherapy can help if this is the case. Some patients notice a swelling that may occur just under the chin. This may improve with time and is usually a cosmetic problem.

      Teeth and jaw issues – the teeth are more at risk of developing caries. It is important to maintain good oral hygiene and regular dental check ups after treatment. In rare situations, there may be changes to the jaw bone. Your dentist should always be made aware that you have had radiation therapy.

      Narrowing of the arteries – there may be an increased risk of developing a stroke in the future if the arteries to the brain are affected by radiation therapy. To reduce the risk of this occurring, patients should address risk factors such as controlling blood pressure, regular exercise and stopping smoking.

      Swallowing complications – some patients may develop problems with swallowing after treatment due to a combination of radiation therapy, surgery and/or the cancer itself. Early referral to a speech pathologist will assist with this issue.

How Do I Enquire About Radiation Therapy with My Healthcare Professional?

The best person to discuss radiation therapy for head and neck cancer with is a Radiation Oncologist. Your general practitioner or surgeon can refer you to a radiation oncologist (specialist doctor) to discuss whether radiation therapy is appropriate for you.

Visit ‘For GPs and other Health Professionals’ and ‘Talking to your doctor’ sections for further information.

Find your closest radiation oncology Treatment Centre

Useful Resources:

Head and Neck Cancer Patient Support Book produced by ‘The Swallows’ Head & Neck Cancer Support Group

Julie McCrossin, our new Ambassador shares the story about treatment for her oropharyngeal cancer.

Visit Julie’s facebook page which contains encouraging & helpful information for Head & Neck Cancer patients, families, friends & clinicians https://m.facebook.com/headandneckcanceraustralia/

www.beyondfive.org.au