Head & Neck Cancer

Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat). These squamous cell cancers are often referred to as squamous cell carcinomas of the head and neck. Head and neck cancers can also begin in the salivary glands, but salivary gland cancers are relatively uncommon. Salivary glands contain many different types of cells that can become cancerous, so there are many different types of salivary gland cancers. Head and neck cancers account for approximately four percent of all cancers in the United States. It is the fourth most prevalent cancer in Nepal. These cancers are more than twice as common among men as they are among women. Head and neck cancers are also diagnosed more often among people over age fifty.
Cancers of the head and neck are further categorized by the area of the head or neck in which they begin. These areas are described below and labeled in the image of head and neck cancer regions.
Oral cavity: Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor (bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area of the gum behind the wisdom teeth.

Pharynx: The pharynx (throat) is a hollow tube about five inches long that starts behind the nose and leads to the esophagus. It has three parts: the nasopharynx (the upper part of the pharynx, behind the nose); the oropharynx (the middle part of the pharynx, including the soft palate [the back of the mouth], the base of the tongue, and the tonsils); and the hypopharynx (the lower part of the pharynx).

Larynx: The larynx, also called the voice box, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.

Paranasal sinuses and nasal cavity: The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.

Salivary glands: The major salivary glands are in the floor of the mouth and near the jawbone. The salivary glands produce saliva.

Thyroid Cancer
Thyroid cancer occurs in the cells of the thyroid—a butterfly-shaped gland located at the base of the neck, just below Adam’s apple. Thyroid produces hormones that regulate your heart rate, blood pressure, body temperature and weight. Although thyroid cancer was not common in Nepal before, the rate seem to be increasing. This is because new technology is allowing them to find small thyroid cancers that may not have been found in the past.

Alcohol and tobacco use (including smokeless tobacco, sometimes called “chewing tobacco” or “snuff”) are the two most important risk factors for head and neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx, and larynx . At least 75% of head and neck cancers are caused by tobacco and alcohol use. People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone. Tobacco and alcohol use are not risk factors for salivary gland cancers.

Infection with cancer-causing types of human papillomavirus (HPV), especially HPV type 16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue. Other factors that may put you at a greater risk of head and neck cancer include:
 a diet low in fruits and vegetables
 a diet high in salt-cured fish and meat
 a diagnosis of plummer-vinson syndrome
 exposure to the epstein-barr virus
 asian ancestry
 drinking yerba mate, a caffeinated drink from south america
 poor oral hygiene
 workplace exposure to inhalants such as asbestos, wood dust, nickel alloy dust, and silica dust
 gastroesophageal reflux disease (gerd)
 a weakened immune system
 graft versus host disease, a condition that sometimes occurs after a stem cell transplant
 lichen planus, a disease that often affects the skin
 certain genetic syndromes, such as fanconi anemia and dyskeratosis congenital
.
The symptoms of head and neck cancer vary according to where the cancer began. Some general signs of head and neck cancer include the following:

Mouth ulcer: A broken area of skin (ulcer) that will not heal can be a sign of oral cancer. Most people with mouth cancer have this symptom.

Lump in the neck, jaw, or mouth: A lump in the jaw or mouth is a common sign of head and neck cancer. Lumps can also form in the lips.

Lump in the neck: May be a sign of thyroid cancer, or it may be caused by an enlarged lymph node. Swelling in one or more lymph nodes in the neck is a common symptom of head and neck cancer, including mouth cancer and salivary gland cancer. Lumps that come and go are not typically due to cancer. Cancer usually forms a lump that slowly gets bigger.

Pain or weakness in the face: Pain or discomfort in the face that doesn’t go away is a common symptom of salivary gland cancer and mouth cancer.

Neck pain: People with thyroid cancer sometimes notice swelling or small painless lumps called thyroid nodules in the front of the neck.

Difficulty moving the jaw: A head and neck tumor that involves the bones, muscles, or nerves of the jaw can make it difficult to open your mouth. Most people are able to open their mouth about the width of three fingers. If you are having trouble opening your mouth this wide, see your doctor. This condition is known as trismus. Chances are that you don’t have cancer, but it can lead to other serious health problems.

Difficulty swallowing: Head and neck cancer can cause pain or a burning sensation when chewing and swallowing food. You might feel like food is stuck in your throat. You may cough or feel like food or liquid are going into the airway (windpipe).

Speech problems: Head and neck cancer can affect your voice. It might sound different. It may be quieter or husky. It may sound as if you have a cold all the time. Or you might slur some of your words or have trouble pronouncing certain sounds.

Ear pain or hearing loss: Ear pain is common with throat cancer. You may experience ringing in the ears.

Trouble breathing: Throat cancer can affect breathing. Nasal congestion is a common sign of sinus cancer and other head and neck cancers. Some people may experience nosebleeds.

Sore throat: Pain or discomfort in the throat that doesn’t go away is one of the most common symptoms of throat cancer.

White or red patches in the mouth or throat: An abnormal-looking patch could be a sign of cancer or precancerous changes.
 White patches are called leukoplakia.
 Red patches are called erythroplakia.

These patches are not cancer. If left untreated, however, they may lead to cancer. A fungal infection called oral thrush can also cause red and white patches.

Weight loss: Weight loss is a common symptom of many different types of cancer. Head and neck cancer can make it painful to eat and difficult to swallow, which can cause weight loss.

Other Signs of Head and Neck Cancer

These can include one or more of the following:
 a lump or thickening in the lips
 unusual bleeding or numbness in the mouth
 loose teeth for no clear reason
 dentures that no longer fit
 difficulty moving the jaw
 frequent nosebleeds, ongoing nasal congestion, or chronic sinus infections that do not respond to treatment
 difficulty chewing, swallowing, or moving the jaws or tongue
 numbness in the tongue or other areas
 changes or discoloration in a mole, or a skin sore that is crusted or fails to heal (these are also signs of skin cancer)

The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person’s age and general health. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments.
People who are diagnosed with HPV-positive oropharyngeal cancer may be treated differently than people with oropharyngeal cancers that are HPV-negative. Recent research has shown that patients with HPV-positive oropharyngeal tumors have a better prognosis and may do just as well on less intense treatment. An ongoing clinical trial is investigating this question.

Here are the top ways to reduce your head and neck cancer risk:
1. If you smoke or use other tobacco products, if you drink alcohol, do so in moderation.
2. Protect yourself against HPV infection by practicing safe sex and getting the HPV vaccine.
3. Do not use tanning beds and avoid extended periods of time in the sun.
4. Wear a protective face mask if you are exposed to toxic fumes and dust. Companies can install air-filtration systems to minimize employees’ exposure to harmful fumes and dust.