Head and Neck Oncology

Head and neck oncology focuses on the diagnosis, treatment, and management of cancers occurring in the head and neck region. These cancers often arise from the squamous epithelium of the mucosal surfaces and are collectively referred to as head and neck squamous cell carcinoma (HNSCC).

Common Sites of Head and Neck Cancers

1. Oral Cavity:

   • Lips, tongue, floor of mouth, buccal mucosa, hard palate, and retromolar trigone.

   • Common cancer: Oral squamous cell carcinoma (OSCC).

2. Pharynx:

   • Nasopharynx: Upper part of the throat behind the nose.

   • Oropharynx: Includes the base of the tongue, tonsils, and soft palate.

   • Hypopharynx: Lower part of the throat.

   • HPV is a significant risk factor for oropharyngeal cancers.

3. Larynx:

   • Includes the glottis (vocal cords), supraglottis, and subglottis.

4. Salivary Glands:

   • Includes the parotid, submandibular, and sublingual glands.

   • Common cancer: Mucoepidermoid carcinoma, adenoid cystic carcinoma.

5. Nasal Cavity and Paranasal Sinuses:

   • Rare, often associated with occupational exposures.

6. Thyroid Gland:

   • Includes papillary, follicular, medullary, and anaplastic thyroid cancers.

Risk Factors for Head and Neck Cancers

1. Tobacco Use:

   • Smoking and smokeless tobacco are the most significant risk factors.

2. Alcohol Consumption:

   • Synergistic effect with tobacco, increasing cancer risk.

3. Human Papillomavirus (HPV):

   • Strongly associated with oropharyngeal cancers, especially HPV-16.

4. Epstein-Barr Virus (EBV):

   • Linked to nasopharyngeal carcinoma.

5. Betel Quid and Areca Nut Chewing:

   • Associated with oral cancers and oral submucous fibrosis.

6. Occupational Exposures:

   • Inhalation of wood dust, chemicals, or heavy metals.

7. Poor Oral Hygiene:

   • Chronic irritation and infection can contribute to cancer risk.

8. Radiation Exposure:

   • Associated with thyroid and salivary gland cancers.

Symptoms of Head and Neck Cancers

1. General Symptoms:

   • Lump or swelling in the neck or face.

   • Persistent pain or numbness.

2. Site-Specific Symptoms:

   • Oral Cavity: Non-healing ulcer, red or white patches, difficulty chewing or swallowing.

   • Pharynx: Persistent sore throat, dysphagia (difficulty swallowing), ear pain.

   • Larynx: Hoarseness, voice changes, difficulty breathing.

   • Nasal Cavity/Sinuses: Nasal obstruction, epistaxis (nosebleeds), facial pain.

   • Thyroid: Neck swelling, difficulty breathing or swallowing, voice changes.

Diagnosis of Head and Neck Cancers

1. Clinical Examination:

   • Detailed history and physical examination, including visual and tactile inspection of the oral cavity, pharynx, and neck.

2. Imaging Studies:

   • CT Scan: Useful for assessing tumor extent and bony involvement.

   • MRI: Better for soft tissue and nerve involvement.

   • PET-CT: Detects metastases and recurrence.

3. Biopsy:

   • Essential for definitive diagnosis.

   • Techniques include incisional biopsy, fine-needle aspiration (FNA) for neck masses, or core biopsy.

4. Endoscopy:

   • Direct visualization of the pharynx, larynx, and esophagus using laryngoscopy or nasoendoscopy.

5. Molecular Testing:

   • HPV and EBV testing for specific cancers.

   • Genetic profiling in thyroid and salivary gland cancers.

Staging of Head and Neck Cancers

• Follows the TNM Classification:

  • T: Size and extent of the primary tumor.

  • N: Involvement of regional lymph nodes.

  • M: Presence of distant metastases.

• Imaging and clinical findings guide staging, which influences treatment decisions.

Treatment Options

1. Surgery:

   • Primary treatment for early-stage cancers.

   • Includes tumor resection, neck dissection (for lymph nodes), and reconstruction using flaps.

2. Radiotherapy:

   • Definitive or adjuvant therapy, especially for oropharyngeal and laryngeal cancers.

3. Chemotherapy:

   • Used in combination with radiation (chemoradiotherapy) for advanced cancers.

   • Common agents: Cisplatin, 5-fluorouracil (5-FU), paclitaxel.

4. Targeted Therapy:

   • Cetuximab: Targets the epidermal growth factor receptor (EGFR).

5. Immunotherapy:

   • Immune checkpoint inhibitors (e.g., pembrolizumab, nivolumab) for recurrent or metastatic cancers.

6. Thyroid Cancer-Specific Treatments:

   • Radioactive iodine therapy (for differentiated thyroid cancers).

   • Targeted therapy (e.g., tyrosine kinase inhibitors) for advanced thyroid cancers.

Rehabilitation and Supportive Care

1. Speech and Swallowing Therapy:

   • To address functional deficits post-surgery or radiotherapy.

2. Nutritional Support:

   • Enteral feeding (e.g., via nasogastric or PEG tube) if swallowing is impaired.

3. Pain Management:

   • Use of analgesics and palliative care in advanced cases.

4. Psychosocial Support:

   • Counseling and support groups for coping with cancer diagnosis and treatment.