Head And Neck Cancer

Overview

The term "head and neck cancer" refers to a variety of malignancies that affect the throat, larynx, nose, sinuses, and mouth.
Squamous cell carcinomas make up the majority of head and neck malignancies. The cells of the epithelium, a small layer of surface tissue, are where this form of oncology starts. In some regions of the head and neck, a layer of moist tissue known as the mucosa lies directly underneath the epithelium. It is known as carcinoma in situ if the cancer is only present in the squamous layer. It is referred to as invasive squamous cell carcinoma if the cancer has spread further into the tissues than this cell layer.
If head and neck cancer starts in the salivary glands, the tumor is usually classified as adenocarcinoma, adenoid cystic carcinoma, or mucoepidermoid carcinoma.

Types of head and neck cancer:
There are five basic forms of head and neck cancer, each called by the location of the disease in the body.

Laryngeal cancer and hypopharyngeal carcinoma are two types of cancer. The larynx is an essential component of the vocal system. This tubular organ located in the neck is responsible for breathing, speaking, and swallowing. It is positioned at the top of the windpipe, also known as the trachea. The lower region of the throat, encompassed by the larynx, is known as the hypopharynx (oesophagus).

Nasal cavity and paranasal sinus cancer. The nasal cavity is the area behind the nose that allows air to enter the throat. The paranasal sinuses are pockets of air that surround the nasal cavity.
Nasopharyngeal cancer.  The nasopharynx is the air chamber behind the nose at the top of the throat.
Oral cavity and oropharyngeal cancer. The oral cavity consists of the mouth and tongue. The oropharynx is the area of the throat between the tonsils and the tip of the vocal apparatus.
Cancer of the salivary gland. Saliva is produced by the salivary gland. Saliva is a fluid released in the mouth that includes enzymes that help break down meals.
Staging and classification:

The TNM classification of primary cancer is the most commonly used for head and neck tumors. The gradation of the symbol T is given in the description of individual tumor localizations. In view of the increasing surgical activity, often quite justified even with advanced tumors, the stage of the T4 process
It is customary to divide into T4a - resectable tumors, T4b - non-resectable locally advanced tumors and T4c - locally advanced tumors in the presence of distant metastases.
To assess the prevalence of the tumor, histological verification of the process is necessary. The characteristic of regional and distant metastasis (symbols N and M) is the same for all localizations of malignant tumors in the head and neck, except for tumors of the thyroid gland and skin. We present these classifications.
N - regional lymph nodes.
Nx - There is inadequate information to evaluate regional lymph nodes.

N0 - no signs of metastatic lesion of regional lymph nodes.
N1 - metastases in one lymph node on the side of the lesion before3 cmin the largest dimension.
N2 - metastases in one lymph node on the side of the lesion before6 cmin greatest dimension or metastases in several lymph nodes on the side of the lesion before6 cmin the greatest dimension, or metastases in the lymph nodes of the neck on both sides, or from the opposite side to6 cm in the largest dimension.
N2a - metastases in one lymph node on the side of the lesion before6 cmin the largest dimension.
N2b - metastases in several lymph nodes on the side of the lesion before6 cmin the largest dimension.
N2c - metastases in the lymph nodes on both sides or from the opposite side to6 cm in the largest dimension.
N3 - metastases in the lymph nodes more6 cmin the largest dimension.
In the prognosis of the disease, the level of localization of the affected lymph nodes is undoubtedly important, therefore, the U index is used to designate the affected regional lymph nodes of the upper third of the neck, and the L index is used for the lower part of the neck. The conditional border between them runs at the level of the lower edge of the cricoid cartilage of the larynx. With the lower variant of the location of metastases, the survival of patients is significantly lower than with the upper variant.
M - Distant metastases.
Mx - it is impossible to establish the presence of distant metastases. 
M0 - no distant metastases. 
M1 - there are distant metastases.



Symptoms

Tumors of the head and neck are distinguished by obvious symptoms that a person can detect on their own, suspecting oncology, and start treatment on time.
Pay attention to the following signs of the disease and, if they are found, immediately sign up for a consultation with an oncologist:
•    A wound inside the mouth or nose that lasts up to 2-3 weeks;
•    Persistent rashes or plaque inside the mouth or in the throat;
•    Discomfort during eating (soreness or difficulty at the time of swallowing food);
•    Distortion of the timbre of the voice or other changes;
•    Persistent pain in the upper respiratory tract without signs of sars;
•    Asymmetrical pain in the ears;
•    Local swelling or bump on the face or head;
•    Local numbness of the soft tissues of the head;
•    Persistent nosebleeds.
Also, a wake-up call for the development of oncology, and in particular tumors of the head and neck, may be an increase in cervical lymph nodes for a month, especially if this is accompanied by the symptoms described above. In such a situation, you should immediately consult a doctor to determine the causes of such manifestations and start treatment as soon as possible.
Risk factors:
There are 2 substances that significantly increase the risk of developing head and neck cancer:
•    Tobacco. Tobacco use includes: smoking cigarettes, cigars or pipes; chewing or snuff tobacco. It is the most significant risk factor for developing head and neck cancer.
•    Alcohol. The abuse of alcoholic beverages increases the risk of developing malignant neoplasms. .

The combined use of alcohol and tobacco increases this risk even more.
Factors that may increase your risk of developing head and neck cancer also include:
•    Prolonged exposure to the sun.  This is especially true for cancers of the lips, as well as cancers of the scalp and neck.
•    Human papillomavirus (HPV).  Sexual intercourse with a person with HPV is the most common way to become infected with HPV. There are different types of HPV called strains.
•    Epstein-Barr virus (EBV).  Exposure to EBV (the virus that causes mononucleosis or "mono") plays a significant role in the development of nasopharyngeal cancer.
•    Floor.  Men are 2 to 3 times more likely to develop head and neck cancer. However, head and neck cancer rates in women have been on the rise for decades.
•    Age: People over the age of 45 are more at risk of cancer.
•    Poor oral and dental hygiene.
•    Ecological or professional inhalants: Inhalation of various chemical compounds (paints, asbestos) can increase the risk of developing a dangerous disease.
•    Marijuana use.
•    Wrong nutrition:  A diet low in vitamins A and B increases the risks.
•    Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LERD): Reflux is associated with tumor growth in the area.
•    Weakened immune system.
•    Exposure to radioactive radiation:  It is directly related to the development of the oncoprocess.
•    History of head and neck cancer:  People who have had head and neck cancer once have a higher chance of developing another cancer in the future.
 



Causes

Chronic tobacco and alcohol dependence; Head and neck tumors are provoked not only by cigarette smoking, but also by chewing tobacco.

•    Floor; Head and neck tumors are more commonly diagnosed in men.

•    Age; People over 45 (both men and women) are more susceptible to the disease.

•    Epstein-Barr virus and human papilloma; Identification of strains of these viruses in the human body can become a factor influencing the formation of head and neck tumors.

•    Excessively long exposure to the open sun during a period of strong UV radiation activity;

•    Regular presence in a room with a high concentration of harmful chemical elements in the air.
This type of cancer, such as head and neck tumors, can be prevented by taking preventive measures. Analyze your lifestyle, regularly undergo a preventive medical examination and, if in doubt, consult a doctor for timely diagnosis and successful treatment.



Prevention

Tobacco cessation is an essential part of prevention.
•    Refusal to use alcohol and marijuana.
•    Regular use of sunscreen, including a lip balm with adequate sun protection factor (SPF)
•    Reducing the risk of HPV infection through HPV vaccination or by limiting the number of sexual partners. Using a condom during intercourse cannot fully protect against HPV.
•    Maintain proper care of dentures. Poorly fitting dentures can trap carcinogens from tobacco and alcohol. Dentures should be removed every night, cleaned and rinsed thoroughly every day.
 



Treatment

Many head and neck cancers can be cured, especially if they are found early. Eliminating the cancer is the primary goal of treatment, but preserving the function of nearby nerves, organs, and tissues is just as important. When planning treatment, doctors consider how the treatment may affect a person's quality of life.
The main treatment options are surgery, radiation, targeted, chemotherapy. Surgery or radiation therapy alone or in combination may be part of a treatment plan.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, personal preference, and overall health.



Tests Required for Diagnosis

The primary diagnosis of a head and neck tumor involves consulting a specialized oncologist, taking an anamnesis and identifying patient complaints about concomitant symptoms.
Further, based on the results obtained, the doctor determines what studies need to be carried out in each specific case to determine the type of tumor formation - benign or malignant.
Basic diagnostic methods:
•    Examination of the patient;
•    Endoscopic examination ;
•    Biopsy (different methods are used based on the location of the tumor process);
•    X-ray examination ;
•    Screening MRI, CT, PET-CT .
Please note that the list of necessary studies is determined by the oncologist after consultation and examination.



Useful info

Surgical intervention:
The goal of surgery is to remove the cancerous tumor and some healthy tissue during surgery. The following surgeries are used for head and neck cancer:
•    Laser operations. This method can be used to treat a tumor at an early stage, especially if it was found in the larynx. Removal. This is an operation to remove the cancerous tumor and some of the healthy tissue surrounding it, known as the margin.
•    Lymph node dissection, or neck dissection. If the doctor suspects that the cancer has spread, they may remove the lymph nodes in the neck. This can be done at the same time that the tumor is removed.
•    Reconstructive (plastic) surgery. If surgical treatment of cancer requires the removal of an important piece of tissue, such as the removal of the jaw, skin, throat, or tongue, reconstructive or plastic surgery may be required to replace the missing tissue. This operation helps to restore the appearance of a person and the functionality of individual organs. A speech therapist will be required to re-teach the patient to swallow and communicate using the latest techniques.
Based on the location, size, type of cancer, the treatment process will be carried out in stages with several operations. If it is impossible to completely eliminate the tumor, additional procedures are recommended. If cancer cells remain after surgery, other types of oncological care (radiotherapy, chemotherapy) are prescribed in combined or isolated form.
Radiation therapy:
Radiation therapy (radiotherapy) is the use of ionizing radiation to treat cancer. The treatment regimen contains several cycles of procedures carried out at certain time intervals. Radiotherapy can be given alone or in conjunction with surgery.
External radiation therapy is the best option. It implies the effect on the tumor of radiation emanating from an apparatus located outside the body. A special type of external beam radiation therapy is intensity-modulated radiation therapy (IMRT). It uses cutting-edge technology to accurately target the neoplasm with radiation beams. IMRT significantly reduces the likelihood of damage to healthy areas, minimizing possible negative consequences.
Proton therapy is a type of external beam beam therapy using protons. Modern medicine practically does not use proton therapy.
Brachytherapy is a contact method of radiotherapy using implants. According to the method of application, it can be manual and automated.
Other unpleasant consequences of radiotherapy can be redness, swelling of the skin in contact with radiation, loss of appetite, stomatitis (ulcers on the inner surface of the cheeks). Patients complain of dry mouth, aching bones, fatigue. Most symptoms disappear shortly after the end of the course of treatment. If the lymph nodes are damaged during treatment, soft tissue swelling (lymphedema) may occur.
Medical therapy:
Systemic therapy is the use of drugs to eliminate the oncological process. Such drugs are injected into the bloodstream to eliminate cancer cells. The scheme of systemic treatment is made by a chemotherapist.
The usual methods of systemic treatment are the insertion of an intravenous (IV) catheter into a vein or swallowing (oral administration) of the drug.
The following types of drug therapy are used for head and neck cancer:
Chemotherapy:
The use of drugs that prevent the development and division of tumor cells is called chemotherapy.
The scheme of chemotherapy is similar to radiotherapy: several stages for a certain amount of time. The number of drugs taken individually and depends on many factors.
Negative consequences are also purely individual. First of all, depression, hair loss, nausea and vomiting are observed.

Targeted therapy:
Each tumor has its own characteristics, targets. A type of oncological treatment based on the destruction of target molecules (specific genes) and enzymes that fuel the vital activity of malignant cells. Targeted therapy prevents the death of normal cells and tissues by affecting only targeted molecules.
To select the necessary drug, the doctor conducts an analysis to determine protein fractions, neoplasm genes.
•    EGFR inhibitors . For head and neck cancer, treatment may be given that targets a specific tumor protein, the epidermal growth factor receptor (EGFR). Researchers have found that drugs that block EGFR help stop or slow the growth of certain head and neck cancers.
•    Agnostic anticancer therapy.  Larotrectinib (Vitraqui) is a certified targeted therapy that focuses on altered NTRK genes. Larotrectinib is relevant for the elimination of metastases that, for various reasons, cannot be removed by surgery.
Immunotherapy:
Mandatory stage of treatment, designed to increase the body's natural resistance, strengthen the immune system. Substances produced by immune cells or produced in the laboratory are used.
Pembrolizumab (Keytruda) and nivolumab (Opdivo) are the newest effective immunotherapies for the treatment of recurrent or metastatic head and neck squamous cell carcinoma. Pembrolizumab may be given alone if the tumor expresses a certain amount of the PD-L1 protein. Or it can be used in combination with chemotherapy regardless of the level of PD-L1 expressed by the tumor. Nivolumab may be used if the cancer continued to grow or spread during treatment with platinum-based chemotherapy.
Different types of immunotherapy can provoke different negative consequences. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes.



Disclaimer

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