Staying Ahead Of Head And Neck Cancers

Identifying node, head and neck cancers in an early stage ensures a high survival rate. In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope.

Signs and symptoms

• Blood-stained sputum upon waking up
• A ‘blocked’ sensation in the ear
• Slow-growing, often painless lump(s) below the jaw and in the upper neck
• Stuffy nose
• Bleeding from the nose
• Deep-seated headache
• Double vision

Treatment

• IMRT (Intensity Modulated Radiotherapy), where the radiation is focused on the cancer (sparing the surrounding normal tissue)
• Chemotherapy
• Surgical removal of tumour or metastatic nodes in the neck (usually after failed IMRT/chemotherapy)

Early-stage NPC has a cure rate of over 90% whereas late-stage NPC has a cure rate of less than 20%.

Thyroid Cancer

This is the ninth most common cancer among women in Singapore. Only 5% of all thyroid tumours or cysts are cancerous. Susceptibility to thyroid cancer is high if the patient has had radiation therapy (especially during childhood) and/or has a family history of this cancer, or previously suffered from a thyroid disease.

Signs and Symptoms

• Usually occurs as a slowgrowing, painless lump in the lower neck
• Hoarseness, if the larynx or the nerve to the vocal cord is involved
• Respiratory airways and swallowing may be affected if there is a large tumour

Treatment

• Surgical resection of the thyroid and involved lymph nodes
• Radio-iodine therapy after surgery

Most thyroid cancers are readily curable when diagnosed and treated early.

Other Head And Neck Cancers

Squamous cell carcinoma (SSC) is usually found in the lining of the mouth, tongue, pharynx, larynx and hypopharynx.

Causes of SSC

• Cigarette-and cigar-smoking
• Alcohol consumption
• Tobacco or betel nut-chewing
• Poor oral hygiene and dental caries
• Sharp and abrasive edges on teeth or dentures
• Human papillomavirus (HPV)
• Chronic reflux
• Exposure to wood and metal dust, and chemical inhalants for sinus cancer

Signs and Symptoms

• Hoarseness
• Throat or oral discomfort
• Difficulty swallowing and/or breathing
• Chronic cough
• Blood-stained sputum
• Ulcers or growths in the mouth or oropharynx that fail to heal
• Unexplained referred pain to the ear
• Enlarged lymph nodes in the neck
• Poor appetite and weight loss

Prevention

Prevention starts with avoidance of the above-mentioned causes of SSC. Those who are sexually active should take HPV vaccinations. As HPV infection is implicated as a common cause, HPV vaccinations should be given to teenagers of both sexes, prior to their becoming sexually active. Currently, this vaccination is recommended only to teenage girls before they become sexually active.

Treatment

• IMRT
• Transoral or endonasal surgery
• Chemotherapy. If located in a region where surgery may cause loss of an important function, chemotherapy combined with IMRT would be the first choice of treatment, hence leaving surgery to salvage any failure.