Cancer Treatment Singapore - Dr Natascha Putri
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icon 1 head and neck cancer symptoms | Dr Natascha Putri

Understanding Head and Neck Cancers

Head and neck cancer symptoms | Dr Natascha Putri

Head and neck cancers encompass a wide spectrum of disease, ranging from carcinomas of the upper aerodigestive tract (oral cavity, pharynx, larynx), to tumours of the skin and salivary glands, to sinonasal malignancies. Additionally, thyroid cancer also falls into the practice realm of the head and neck specialist. The most common type of cancer found along the aerodigestive tract is squamous cell carcinoma (SCC); others include adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma.

According to the Singapore Cancer Registry 2015, head and neck cancers are among the top ten most common cancers in the population, especially skin cancers such as cutaneous SCC and melanoma which often occur in the head and neck region, and specifically nasopharyngeal carcinoma for men and thyroid cancer for women.

 

Common Types of Head and Neck Cancer:

  1. Oral Cavity Cancer:
    • Affects the lips, tongue, gums, inner cheeks, floor of the mouth, and hard palate. Out of all these subsites, tongue cancer is the most common location of head and neck tumours.
  2. Pharyngeal Cancer:
    • Nasopharyngeal (Nose) Cancer: Originates in the area where the back of the nose meets the upper part of the throat.
    • Oropharyngeal Cancer: Affects the middle throat, including the tonsils and base of the tongue.
    • Hypopharyngeal Cancer: Develops in the lower part of the throat.
  3. Laryngeal Cancer:
    • Cancer of the larynx (voice box), affecting the vocal cords and nearby areas.
  4. Salivary Gland Cancer:
    • Affects the salivary glands that produce saliva, including parotid, submandibular, sublingual, and minor glands.
  5. Paranasal Sinus Cancer:
    • Starts in the nasal cavity (inside the nose) or sinuses around the nose.
  6. Thyroid Cancer:
    • Cancer that begins in the thyroid gland which is located in the front of the neck.
  7. Lymph Node Cancer (Metastatic):
    • Cancer that arises primarily within the lymph node itself eg. lymphoma or involved by metastatic spreads to the lymph nodes in the neck from other regions.

icon 2 head and neck cancer symptoms | Dr Natascha Putri

Head and Neck Cancer Symptoms

lump on side of neck singapore | Dr Natascha Putri

Many of these head and neck cancer conditions can be identified in primary care, and early diagnosis is essential to ensure the best possible treatment outcome for the patient. Red flag signs of head and neck cancer symptoms include:

i) lymph nodes or other palpable lumps on the neck

ii) a non-healing white or red patch or ulcer in the mouth

iii) blood stained saliva, sputum, or nasal secretions

iv) voice hoarseness or persistent sore throat

v) difficulty or painful chewing and swallowing

vi) frequent nasal congestion or difficulty breathing

vii) new onset cranial nerve palsies manifested as facial asymmetry, muscle weakness, or numbness of the skin

viii) eye swelling, double vision, or sustained headaches

ix) unilateral tinnitus or decreased hearing acuity

x) suddenly ill-fitting dentures or loose teeth

xi) unexplained fatigue or unintentional weight loss

Some of these may be caused by other benign conditions, but it is still prudent to seek specialist input early, especially if the patient is at high risk for developing head and neck cancer, or if the head and neck cancer symptoms persist despite symptomatic treatment or after a period of close observation.

Symptoms of Nose Cancer (Nasopharyngeal Cancer):

Symptoms may mimic sinus infections or other common conditions. If they persist for more than 2-3 weeks, consult a head and neck cancer surgeon for further evaluation. Early detection improves treatment outcomes.

  1. Nasal Symptoms:
    • Persistent one-sided nasal congestion or blockage.
    • Frequent nosebleeds.
    • Runny nose with blood-streaked mucus.
  2. Ear-Related Symptoms:
    • Hearing loss or a blocked ear (often one-sided).
    • Ringing in the ears (tinnitus).
    • Frequent ear infections.
  3. Neck and Throat Symptoms:
    • A lump or swelling in the neck (enlarged lymph nodes).
    • Sore throat or persistent throat discomfort.
    • Difficulty swallowing or speaking.
  4. Other Symptoms:
    • Headaches or facial pain/numbness.
    • Blurred or double vision.
    • Fatigue or unexplained weight loss.

Symptoms of Tongue Cancer:

  1. Persistent Sores:
    • A non-healing sore or ulcer on the tongue lasting more than 2 weeks.
  2. Tongue Pain:
    • Pain or discomfort in the tongue, which may worsen when eating or speaking.
  3. Red or White Patches:
    • Red (erythroplakia) or white (leukoplakia) patches on the tongue that don’t go away.
  4. Lump or Thickening:
    • A noticeable lump, swelling, or thickened area on the tongue.
  5. Bleeding:
    • Unexplained bleeding from the tongue, not caused by injury.
  6. Difficulty Chewing or Swallowing:
    • Trouble moving the tongue, chewing, or swallowing food.
  7. Numbness:
    • Tingling or numbness in the tongue or mouth.
  8. Bad Breath:
    • Persistent bad breath (halitosis) not linked to oral hygiene.

In the early phases, symptoms can resemble less serious conditions, but if they persist for more than 2 weeks, seek medical evaluation for early diagnosis and treatment.

Common risk factors of head and neck cancer include smoking, alcohol intake, excessive exposure to sunlight (UV rays specifically), betel nut chewing, chronic excessive exposure to nitrosamine compounds, nickel, or asbestos, and in some cases, genetic or hereditary factors.

 

Risk Factors for Head and Neck Cancer:

  1. Tobacco Use: Smoking cigarettes, cigars, pipes, vapes, or chewing tobacco significantly increases risk.
  2. Alcohol Consumption: Heavy and frequent alcohol use, especially combined with tobacco, raises the risk.
  3. Human Papillomavirus (HPV): Infection with high-risk HPV strains, particularly HPV-16, is a major contributing cause.
  4. Poor Oral Hygiene: Neglecting dental care can contribute to cancer development.
  5. Dietary Factors: A diet low in fruits and vegetables may elevate risk.
  6. Weakened Immune System: Conditions or medications that suppress immunity can make individuals more susceptible.
  7. Exposure to Carcinogens: Workplace exposure to asbestos, wood dust, or chemicals increases risk.
  8. Age and Gender: Head and neck cancers are more common in men over 50 years old.
  9. Genetic Factors: A family history of head and neck cancers may increase susceptibility.

Prevention of Head and Neck Cancers

Preventing head and neck cancer involves reducing risk factors and adopting healthy lifestyle habits. Here are several ways to lower the risk:

  1. Avoid Tobacco Use: Smoking and using smokeless tobacco products are the leading causes of head and neck cancers. Quitting tobacco significantly reduces the risk of these cancers.
  2. Limit Alcohol Consumption: Excessive alcohol consumption is another major risk factor. Limiting alcohol intake or avoiding it altogether can help lower the risk of cancer.
  3. Protect Yourself from HPV: The human papillomavirus (HPV) is linked to several types of head and neck cancers. Vaccination against HPV can help prevent infections that lead to cancer.
  4. Maintain Good Oral Hygiene: Regular brushing, flossing, and dental checkups can help prevent oral infections and reduce the risk of cancers in the mouth and throat.
  5. Eat a Healthy Diet: A diet rich in fruits and vegetables, especially those with high antioxidant content, may help protect against cancer. Avoiding processed meats and focusing on a balanced diet can also reduce the risk.
  6. Avoid Exposure to Harmful Chemicals: Exposure to industrial chemicals, asbestos, and other carcinogens can increase the risk of head and neck cancers. Using protective equipment and following safety guidelines can minimize this risk.
  7. Get Regular Check-ups: Early detection is crucial. Regular visits to a doctor or dentist can help identify any early signs of cancer. This is particularly important if you have risk factors such as a history of smoking or alcohol use.

icon 3 head and neck cancer symptoms | Dr Natascha Putri

Diagnostic Techniques for Head and Neck Cancers

MRI for head and neck cancer symptoms | Dr Natascha Putri

The diagnosis of head and neck cancers would typically require obtaining a tissue sample for histopathological examination. This can be done via fine needle aspiration cytology, core or punch biopsy, or surgical incisional or excisional biopsy. 

Other tests include staging scans with CT, MRI, or PET scans to establish the local extent of disease, or look for regional spread to the lymph nodes or distant metastasis. Occasionally the patient will also have to undergo endoscopic evaluation for tumours located in areas which are difficult to examine clinically such as the nasopharynx and hypopharynx.

At present, routine screening is not recommended for any head and neck cancer, but health practitioners should maintain constant vigilance to detect the head and neck cancer symptoms enlisted above and prompt further investigation. The main challenge in managing conditions of the head and neck is distinguishing benign lesions from pre-malignant ones and recognizing frankly sinister pathologies. Examples would include differentiating a benign melanocytic nevi (mole) from lentigo maligna which may develop into malignant melanoma. Another example is identifying erythroplakia or leukoplakia during an oral cavity examination, as it may become SCC.

A crucial aspect to diagnosing head and neck cancer is thorough physical examination which aside from critical inspection and careful palpation (including the oral cavity), requires otoscopy and evaluation with a laryngeal mirror. GPs can help with early detection of head and neck cancer by staying alert to insidious presentations such as a vague neck lump/mass or voice changes which patients may not notice themselves, and performing a general head and neck survey as part of their routine examination.

Referral to a specialist should be initiated when patients have non-resolving head and neck cancer symptoms or when suspicious lesions are discovered. Certain procedures such as flexible nasoendoscopy, high-resolution ultrasound, or needle biopsies can be performed in the specialist clinic, while hospital admission is required for examination under anaesthesia and rigid endoscopy.

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Treatment Strategies for Head and Neck Cancers

surgery for head and neck cancer symptoms | Dr Natascha Putri

Principles of head and neck cancer treatment can be categorized broadly depending on the stage of presentation. Early stage head and neck cancers (stage I/II) are treated by a single modality alone, usually surgery or radiotherapy. Late stage head and neck cancers (stage III/IV) which are locally invasive or with regional nodal disease involvement require multimodality treatment, frequently with the addition of chemotherapy in combination with radiotherapy. In addition, immunotherapy has recently emerged as an alternative to chemotherapy for palliation of recurrent or metastatic SCC of the head and neck.

The main challenge faced in treating head and neck cancers is early detection, as many tumours can be asymptomatic in the early stages. This is essential because late diagnosis of head and neck cancer tends to be associated with disease in the more advanced stages, which portends a worse prognosis and compounds treatment-related toxicities.

Another challenging aspect of care is managing the sequelae of treatment, such as painful mucositis or xerostomia (dry mouth) secondary to radiotherapy which can severely limit oral intake, or postoperative complications such as wound infection or pneumonia which can prolong hospitalization and significantly reduce quality of life.

Head and neck cancers and their treatment can lead to temporary or permanent impairment in terms of speech and swallowing. As the tumour is in a prominently visible location, a large mass or surgical scars in this area can markedly alter the patient’s appearance and affect their psychosocial function.

GPs and oncologists play a vital role in helping patients cope with the side effects of therapy, from pre-treatment counselling and managing expectations, to titration of medications for pain or nausea, or supporting lifestyle modifications such as the need for nebulizers and humidifiers for patients after laryngectomy. Follow-up care is also very important to monitor for disease recurrence or locoregional or distant metastasis.

The prognosis of the condition is complex to define numerically without specific distribution into cancer subtype, location, and stage at diagnosis. In general, early stage head and neck cancers enjoy better survival rates, for example in the upwards of 70 percent 5-year overall survival for oral cavity SCC (the commonest type) which reduces drastically to approximately 30 percent or less for advanced stages.

Note: While the human papillomavirus (HPV) has been associated with genital lesions and cervical cancers for certain subtypes, there is no strong evidence that vaccination with the current products available can prevent or treat HPV-associated cancers of the oropharynx.

Head and neck cancers are a complex, heterogeneous group of diseases that occur more often than commonly perceived in the community. It is vital to be alert to the red flag head and neck cancer symptoms that these patients present with to increase the rate of detection during the early stages. This affords patients the best chance of cure and minimizes the toxicity associated with multiple lines of therapy. After treatment, ongoing surveillance by primary healthcare teams is crucial to monitor for head and neck cancer recurrence. More importantly, community support is essential for these patients who face ongoing lifestyle adjustments in terms of speech and swallowing, and psychosocial issues after their head and neck cancer diagnosis.

By staying informed and being proactive, you can play a vital role in ensuring the best possible outcomes for yourself or your loved ones. Dr. Natascha is dedicated to providing comprehensive care, from early detection to treatment and beyond, supporting patients every step of the way in their journey toward recovery and improved quality of life. Don’t delay— take the first step towards better health and well-being, and book your consultation today.

FAQs on Head and Neck Cancers

Yes, head and neck cancer is treatable, especially when detected early. Treatment outcomes depend on factors like the type, stage, and location of cancer, as well as the patient’s overall health. Early detection significantly improves survival rates.

The prognosis depends on the cancer’s stage at diagnosis, location, and response to treatment. The survival rate for head and neck cancer varies, with earlier stages generally having a higher survival rate. Regular follow-up care is important to monitor for recurrence.

Side effects vary based on the type of treatment but may include:

  • Surgery: Pain, swelling, difficulty swallowing, or changes in appearance.
  • Radiation: Fatigue, dry mouth, difficulty swallowing, skin irritation, and sore throat.
  • Chemotherapy: Nausea, hair loss, fatigue, and increased risk of infection.
  • Targeted therapy and immunotherapy: Skin rashes, fatigue, and digestive issues.

Research is ongoing, with advancements in immunotherapy, targeted therapy, and robotic surgery offering new options for treatment. These therapies are designed to improve outcomes, reduce side effects, and offer more personalized treatment approaches.

If you or someone you know is experiencing symptoms or has concerns about head and neck cancer, it is important to consult a healthcare provider for further evaluation and advice.

Supporting someone with head and neck cancer involves:

  • Offering emotional support and encouragement
  • Helping with transportation to and from appointments
  • Assisting with meals or managing side effects of treatment
  • Encouraging them to stay active and follow medical advice
  • Helping with daily tasks if they experience physical or emotional difficulties