One of the most noticeable symptoms of head and neck cancer is a persistent lump in the head or the neck.
“With at least 800 new cases every year, it is one of the most common cancers in Singapore,” observes Dr Tan Hiang Khoon, Senior Consultant, Surgical Oncology at the National Cancer Centre Singapore (NCCS). Worldwide, this cancer is on the rise in young patients, possibly due to an increased incidence of human papillomavirus (HPV) infection-associated cancer in young females and the increased incidence of thyroid carcinoma.
“Usually, the patient would complain of seemingly harmless symptoms, like an enlarged lymph node on the neck, an ulcer in the mouth, a sore throat or a hoarse voice,” says Dr Tan. “But if it is head and neck cancer, these symptoms will not heal or go away with time. There is also a common mis-conception that cancer must cause pain. The truth is that early stage cancers are often painless!”
Head and neck cancer symptoms may include:
- A raised growth, swelling or lump in the neck
- Red or dark spots, redness with white or rough patches in the mouth
- Bleeding from the nose or mouth
- A sore that does not heal
- Persistent sore throat or hoarseness
- Burning or numbness in the tongue, lip or mouth
- Painful, sensitive or loose teeth
- Difficulty in chewing, swallowing or talking
Dr Tan says recognising the symptoms of head and neck cancer early can greatly improve cure rates. So play it safe: If you notice warning signs, seek treatment immediately.
An unhealthy lifestyle amongst the main culprits
Generally, those who are male and over the age of 40 are more likely to contract head and neck cancer.
But certain lifestyle habits and environmental factors can also play a part in some head and neck cancers involving the mucosa of the mouth and the throat.
“The major risk factors of oral and throat cancer are the use of tobacco, chewing betel nut leaves, oral sex with multiple partners, and frequent, heavy consumption of alcohol,” says Dr Tan. “Combining alcohol and tobacco further increases the risk.”
Other factors that raise a person’s risk of head and neck cancer are:
“To help prevent head and neck cancer, avoid smoking or drinking excessively,” advises Dr Tan. “Load up on fruits and vegetables, as well as iron, vitamins A and B. Practising good dental habits – like brushing twice a day and flossing – can also help keep this cancer at bay.”
- Poor oral health and hygiene, including dental caries and ill-fitting dentures
- Exposure to the Epstein-Barr virus (EBV), a herpes virus
- Human papillomavirus (HPV) infection, usually transmitted during sexual activity, in particular oral sex
- Exposure to wood, metal dust, asbestos, paint fumes and other chemical inhalants
- Exposure to radiation
- Excessive sun exposure, in the case of skin cancers
- Genetic factors, especially for thyroid carcinomas
At NCCS, the treatment of head and neck cancer involves a judicious combination of surgery, radiotherapy and chemotherapy as determined by a multidisciplinary team. Patients have access to cutting-edge technologies such as minimally invasive robotic surgery, as well as highly targeted radiation therapy and chemotherapy.
“Every decision is made by a panel of 10 to 15 oncologists, all sub-specialised in their own fields. This fact can be reassuring for patients. It actually removes the need to seek a second opinion, as the individualised treatment, tailored both to the patient and the cancer, is based on the consensus of a large panel of sub-specialists, including surgical, radiation and medical oncologists,” says Dr Tan.
At various stages, dentists, therapists, dietitians and social workers can also be part of the management team.
NCCS is currently leading a multinational phase 3 trial to investigate one of the roles of a targeted chemotherapy agent nimotuzumab. As many as 19 centres from 11 countries are participating in this trial that is the first head and neck cancer trial of its kind in the Asia-Pacific region. “That truly puts NCCS at the forefront of head and neck cancer treatment,” says Dr Tan.
Here’s an overview of the main types of head and neck cancer:
- Squamous cell carcinoma: Most head and neck cancers such as oral cancer, laryngeal (voice box) cancer and pharyngeal (throat) cancer fall in this category.
- Oral cancer can begin in the lips, gums, behind the molars or wisdom teeth, inside the mouth and cheeks, as well as the tongue. Many oral cancers are discovered during routine dental checks.
- Laryngeal (voice box) cancer: The second most common type of head and neck cancer, it occurs in the larynx (or the “voice box”), which is located at the top of the trachea (or “windpipe”). Most cases of this cancer occur in men.
- Pharyngeal (throat) cancer: This type of head and neck cancer occurs in the pharynx, which is the hollow tube in the neck that starts behind the nose and finishes at the top of the oesophagus. Hollywood actor Michael Douglas suffered from this cancer.
- Nasopharyngeal cancer: This type of head and neck cancer affects the nasopharynx region, which is the upper part of the throat behind the nose. It is linked to the Epstein-Barr virus. Singapore has one of the highest incidence of nasopharyngeal carcinomas in the world.
- Thyroid carcinoma: The incidence of this type of head and neck cancer has tripled in the last three decades. Doctors are still researching the causes of this increase.
- Salivary glands carcinoma: This is a rare type of cancer. US Senator and 2008 Republican presidential nominee John McCain is a survivor of salivary gland carcinoma.
- Skin cancers and sarcomas arising from the head and neck region: This type of cancer is more common in the Caucasian population and is linked to excessive sun exposure.