Introduction to Head and Neck Cancer

A six-to-one ratio exists between men and women who suffer from head and neck cancer. Fludeoxyglucose (FDG) PET/CT imaging has been used in several studies to stage, monitor, plan radiation therapy, and assess long-term follow-up in head and neck squamous cell carcinoma (SCC). This chapter discusses evidence-based recommendations regarding PET/CT examinations in head and neck cancers in addition to clinical information, benign findings, and risks of FDG PET/CT reading.

What is Head and Neck Cancer?

Cancer that appears in the mouth, throat, nose, salivary glands, oral cavity, and other parts of the head and neck is referred to as “head and neck cancer.” The most common type of head and neck cancer is squamous cell carcinoma. It comes from the tissues that border the throat, mouth, and nose.
Human papillomavirus (HPV) exposure or a history of smoking are usually linked to squamous cell carcinoma. Salivary gland tumors, lymphomas, and sarcomas are a few less prevalent kinds of head and
neck cancer. These malignancies can begin in any of the following locations:
• The larynx, or voice box.
• The nasal cavity is the space behind the nose where air travels.
during breathing before reaching the throat.
• mouth or oral cavity, which includes your tonsils, tongue, gums, and
lips.
• The gaps surrounding the nose that are coated with mucus-producing cells prevent the nose from drying out. Additionally, whether you sing or speak, they provide the space for your voice to resound.
• The pharynx or the throat.
• salivary glands, which produce saliva to keep meals wet and aid in digestion.

Types Of Head and Neck Cancer

There are five primary forms of head and neck cancer, each of which is identified by the region of the body in which it manifests. Let’s have a look at a particular types of head and neck cancer for further details.

Cancer of the Larynx and Hypopharynx

The voice box is another name for the larynx. This neck-based tube-shaped organ is crucial for speaking, swallowing, and breathing. It is situated at the very top of the trachea, the windpipe. The gullet is
another name for the hypopharynx. The larynx is covered by the bottom portion of the neck.

Cancer of the paranasal sinuses and nasal cavity

The area just behind the nose through which air travels on its journey to the throat is known as the nasal cavity. The air-filled regions that surround the nasal cavity are known as the paranasal sinuses.

Cancer of Nasopharynx

The airway behind the nose in the top region of the throat is called the nasopharynx.

Cancer Of the Thyroid And Parathyroid

The mouth and tongue are parts of the oral cavity. The center of the throat, from the tonsils to the tip of the voice box, is referred to as the oropharynx.

Cancer Of The Salivary Glands

Saliva is produced by the salivary gland. Saliva, which includes enzymes that start breaking down food, is the fluid that is secreted into the mouth to keep it moist.

Skin Cancer Of Head Neck Region

Skin cancer is a type of cancer that occurs when skin cells undergo abnormal growth and division. Generally, it occurs on exposed skin areas, such as the head and neck, where it is most prevalent.

Symptoms of Head and Neck Cancer

Head and neck cancer is rarely symptomatic when it is in its early stages. Symptoms of cancer can, however, appear when it spreads. Depending on where in the head or neck the cancer is located,
symptoms might include:
• Bleeding from the throat or mouth.
• Breathing difficulties or loud breathing
• Headaches.
• Issues with hearing or earache.

• Your mouth may have lumps, pimples, or swelling.
• a nodule or bump on your neck.
• Nosebleeds.
• You feel numb in your mouth.
• persistent discomfort or numbness in your neck, head, upper jaw, or
face.
• difficulty chewing or swallowing, or both.
• patches of red or white on the tongue, gums, or mouth lining.
• persistent sinus or nasal discomfort or obstruction.
• continuous hoarseness or other vocal abnormalities, such as slurred
speaking
• Hearing ringing.
• a mouth ulcer or sore that doesn’t go away after a few weeks.
• either double vision or eye swelling
• neck lymph nodes that are swollen.

Risk Factors and Causes of Head and Neck Cancer

Cancers of the head and neck are associated with a number of risk factors. Alcohol and cigarette use are the primary risk factors. Head and neck cancer is more likely to occur in people over 40, and men are nearly three times more likely than women to get it. Compared to other Australians, those who identify as Aboriginal or Torres Strait Islander are more likely to acquire head and neck cancer. Other danger signs consist of:
• The human papillomavirus (HPV) and the Epstein-Barr virus, among
other viruses, have been connected to head and neck cancers.
• a lowered immunological response
• Gum disease and poor oral hygiene have both been associated with
oral cavity cancers.
• being fat or overweight
• betel nut, areca nut, gutka, or pan smoking or eating
• using the sun (for head and neck skin cancer)

• having received head and neck radiation treatment in the past
• inheriting a disease like Fanconi anemia or Li-Fraumeni syndrome
that is connected to head and neck cancer.

How to Diagnose Head and Neck Cancer?

Your healthcare professional will examine you and perhaps recommend diagnostic testing.
These examinations and testing might involve:
• a physical examination to assess the tongue, throat, neck, and nasal
and oral canals. Additionally, your doctor may feel lumps on your neck, lips, gums, and cheeks.
• Endoscopy: To inspect your voice box, throat, nasal cavity, or any other location where you are having symptoms, your doctor uses an endoscope, a thin, lighted tube. During the procedure, there is no pain
and it is done in a clinic setting.
• tests in a lab using blood, urine, or other bodily samples
• neck and head images of the regions within your head and neck can be produced using X-rays, CAT scans, MRIs, or PET scans. Which tests will best assess your symptoms will be decided by your doctor.
Your doctor performs a biopsy, removing tissue for a pathologist to examine under a microscope. Cancer can only be accurately diagnosed in this way. Using a local anesthetic and often a needle, this might be
done at the doctor’s office. Or it could need to be done in the operation
room while you’re asleep.

Possible Treatment Options for Head and Neck Cancer

The type of treatment depends on the cancer’s location, whether it is confined or has spread to other bodily areas, and other considerations.

Surgery

Most head and neck cancers are treated surgically. It can be used independently or in conjunction with chemotherapy and radiation therapy. Some treatments include the removal of surrounding lymph
nodes. Speech, swallowing, and appearance-related structures may be removed during head and neck cancer surgery. Reconstruction may comprise the transfer of bone, muscle, and/or skin, as well as the related blood arteries, to repair regions destroyed by cancer and cancer therapy.

Radiation Treatment

By subjecting cancer cells to radiation, this treatment, which is frequently used to treat head and neck cancers, destroys cancer cells. The treatment can be performed on its own or in conjunction with surgery.
Additionally, it can be used either before or after surgery to reduce the tumor or eradicate any cancer cells that may still be present. Radiation therapy is commonly used in conjunction with surgery, chemotherapy, and/or other treatments for advanced cancer.

Chemotherapy

Chemotherapy uses medication to kill or harm cancer cells. It is typically used in conjunction with surgery, radiation treatment, or both for head and neck malignancies. It can be administered both before and after
surgery. It may be used in combined radiation treatment for advanced stage cancer (known as chemoradiation).

Targeted Treatment

Some head and neck cancers may be treated using medications made to target the epidermal growth factor receptor (EGFR), a protein located on the surface of cells that promotes cell development.

Immunotherapy

These medications boost the patient’s immune system so that it can more effectively combat cancer.
There may be a need for reconstructive surgery to repair structures destroyed by illness or medical intervention. Patients may occasionally require speech and swallowing rehabilitation therapy.

Staging of Head and
neck Cancer

A method of defining the location of cancer, whether or not it has spread, and if it is impacting other sections of the body is called staging. The stage of the cancer is determined by diagnostic testing, therefore staging may not be complete until all of the tests have been completed.
Knowing the stage aids the doctor in recommending the best course of action and can assist in determining the prognosis, or likelihood of recovery, for a patient.

Staging System TNM

The TNM system is one method that doctors utilize to specify the stage. These questions are addressed by physicians using the findings of diagnostic exams and scans:
Cancer (T): What size is the main tumor? What location is it in?
Node (N): Have the lymph nodes been affected by the tumor? How many
and where, if so?
The word “metastasis” (M) means “metastasis” in medical terminology. Where and how much, if so?
The combined findings are used to establish each person’s cancer stage. In order for clinicians to collaborate and develop the most effective treatment plans, the stage offers a uniform approach to describing cancer.
For each form of head and neck cancer, a distinct staging approach is used. Each section devoted to a particular cancer type contains comprehensive information on these stages. Head and neck cancer has five stages, with zero being the most advanced and four being the least. I, II, III, and IV are Roman numerals that stand in for them.

Stage 0

This condition, also known as carcinoma in situ, lies at the absolute bottom of the scale. It identifies aberrant cells that have the potential to develop into cancer in the lining of the concerned region.

Stage I

Cancer is said to be at its very early stages at stage I. The tumor is only two millimeters in diameter. The lymph nodes have not been affected by the malignancy.

Stage II

Tumors that are stage II range in size from two centimeters to four centimeters. Lymph nodes have not been affected by stage II cancer.

Stage III

If the tumor is larger than four centimeters in diameter or if a lymph node smaller than three millimeters in diameter on the same side as the tumor has been affected, stage III head and neck cancer is diagnosed.

Stage IV

It is the most advanced form of head and neck cancer that reaches stage
IV. Regardless of size, the tumor has spread to:
• tissues in the area or different parts of the head and neck.
• Multiple lymph nodes of any size on the same side of the neck as
the tumor, one big lymph node (more than three centimeters in size), or
either one on the opposite side.
• the lungs, which are located far from the head and neck, When the head and neck cancer is initially discovered, it may already be in stage IV. There is also the possibility that stage IV head and neck
cancer will recur. Recurrent cancer means that it has returned after being treated. A regional recurrence is when cancer returns to the region of the body where it first appeared, whereas a distant recurrence is when it returns to lymph nodes or another area of the body.
Head and neck cancers in stages III and IV are more likely to return than tumors in the early stages.

When to See a Cancer Doctor in Nepal?

You can visit an oncologist in Nepal if you experience the aforementioned symptoms and have a strong suspicion that you have cancer. To receive quality care, you can choose between visiting a surgical oncologist or a medical oncologist in Nepal. Your cancer expert can assist you in selecting the course of therapy that is best for you. You will receive assistance from the oncologist at every stage of your cancer
therapy.

Best Head & Neck cancer doctor in Nepal?

Dr. Prabhat Chandra Thakur brings his expertise in Remote access Endoscopic Thyroid & Neck surgery, Endoscopic skull base surgery, and Reconstruction in the Head & Neck at Nepal Cancer Hospital & Research center, Harisiddhi, Lalitpur. He also has received the GOLD MEDAL AWARD for the best outgoing resident in PGI CHANDIGARH, INDIA.

Dr. Prabhat Chandra Thakur completed his Graduation (MBBS)
from B.P.KIHS, Dharan. Post-Graduation (MS) in Otolaryngology-Head & Neck Surgery from the prestigious PGI Chandigarh, India. He has done his GOLF fellowship in Head & Neck oncology from the international federation of Head & Neck
oncology society (IFHNOS) & Memorial Sloan Keating, New York.

Also did Minimal Invasive Thyroid Surgery Fellowship from
General Hospital, Bangkok.

Performed More Than 5000 Major & Minor Head And
Neck Cancer Surgery Along With Reconstruction. The
Pioneer Of Scarless Thyroid Surgery (Endoscopic
Thyroidectomy) In Nepal, A Procedure Performed At Only A Few
Centers In The World.
• Head And Neck Onco-Surgery & Reconstruction
• Remote Access Endoscopic Thyroid & Neck Surgery
• Endoscopic Sinus And Skull Base Surgery
• General Otolaryngology

Conclusion

In general, head and neck cancers affect the mouth, throat, nose, salivary glands, oral cavity, and other parts of the head and neck. Squamous cell carcinoma is the most frequent kind of head and neck cancer. It is formed by the tissues that line the throat, Mouth, and nose. Cancers of the head and neck are associated with a number of risk factors. Alcohol and cigarette use are the primary risk factors.
Head and neck cancer has five stages, with zero being the most advanced and four being the least. I, II, III, and IV are Roman numerals that stand in for them.