Nasopharynx is fifth most common cancer in Malaysian males (MNCR 2012-2016). Ear Nose Throat (ENT) cancers, also known as Head and Neck cancers where a group of cancers that affect the soft tissue organs in the head and neck region. It is inclusive of the nasopharynx, oral cavity, lips, nose and paranasal sinuses, larynx, oropharynx, hypopharynx, thyroid and salivary gland cancers.
The most common sites of head and neck cancer are:
- Oral cavity
Less common sites include:
- Nasal cavity
- Paranasal sinuses
- Salivary glands
Types of head and neck cancer
There are several types of head and neck cancer:
- Oral cavity cancer– starts in the mouth
- Oropharyngealcancer – starts in the back of the mouth or the throat
- Nasal cavity cancer– starts in the opening behind the nose, a space that runs along the top of the roof of the mouth and then turns downward to join the back of the mouth and the throat
- Paranasalsinus cancer – starts in the openings around or near the nose called sinuses
- Nasopharyngealcancer – starts in the upper part of the throat behind the nose
- Laryngealcancer – starts in the voice box
- Hypopharyngealcancer – starts in the lower part of the throat beside and behind the voice box
There are several signs and symptoms for Head and Neck cancer. A doctor should be consulted if a lump in the neck persists for more than two weeks, is painless, and keeps growing.
- Lumps in the neck
Lumps in the neck may occur in the nose, thyroid and lymphoid cancers, as well as other ENT cancers. The position of the lump in the neck may give a clue to its cause.
Nosebleeds can also be a sign of cancer, in particular, nose cancer. Especially if bleeding is persistent, scanty, or associated with a headache or unusual smell, then it is important to get checked.
- A swelling, ulcer or sore area in the mouth
A swelling, ulcer or sore area in the mouth that does not go away within a week should be evaluated by a doctor. This is particularly important if accompanied by a lump in the neck.
- Hoarseness in the voice
Hoarseness in the voice can occur with cancers of the voice box. It can also be a sign of thyroid cancer. This is because nerves to the vocal cords run closely behind the thyroid gland and can be affected by cancer within the gland.
- Difficulty swallowing food
Difficulty swallowing food can be a sign of cancer of the throat and should be evaluated by a doctor. A swallowing x-ray or an oesophagoscopy may be necessary to find the cause.
- Pain or blockage in the ear
Pain or blockage in the ear can be due to disease or a tumour in the nose or throat. Nose cancers can present with a blocked ear or sometimes unexplained pain or discomfort around the ear as the only symptom.
Among the risk factors include:
- Alcohol and tobacco consumption – Increase cancers of the oral cavity, oropharynx, hypopharynx and larynx.
- Infection with cancer-causing types of human papillomavirus (HPV), especially HPV type 16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue.
Other risk factors for nasopharyngeal cancer include:
- Chewing betel quid – increases oral cancer
- Consuming preserved or salted foods – increases nasopharyngeal cancer
- Poor oral health – increases oral cancer
- Occupational exposure to wood dust – increases nasopharyngeal cancer
- Radiation exposure – Increases salivary cancer
- Epstein-Barr virus infection – Increases nasopharyngeal & salivary cancer
- Ancestry – Increases nasopharyngeal cancer
You can lower your risk of getting head and neck cancer in several ways include:
- Stop smoking.
- Don’t use smokeless tobacco products.
- Limit the amount of alcohol consumption.
- Consider to get a human papillomavirus (HPV) vaccination. The HPV vaccine can prevent new infections causing oropharyngeal and other cancers.
- Use condoms and dental dams consistently and correctly during oral sex, which may help lower the chances of getting human papillomavirus (HPV).
- Use lip balm that contains sunscreen and avoid indoor tanning.
- Visit the dentist regularly for early detection of head and neck cancers.
If an individual has any of the above symptoms, a full ENT examination is recommended.
- Nasal endoscopy is usually necessary if nose cancer is suspected or needs to be excluded. Nasal endoscopy involves passing a thin flexible camera into the nose to examine the nose and throat. The examination only takes a few minutes and is usually painless. Nasal endoscopy can examine the throat down to the level of the voice box; if an examination is required further into the food passage, then oesophagoscopy may be recommended.
- Biopsy is the removal of cells or sample of tissues that can be looked under a microscope by a pathologist. If any abnormalities found, cells taken from the patches will be checked for signs of cancer.
- Magnetic resonance imaging (MRI) scan is a method that uses a magnet, radio waves, and a computer to produce a series of detailed pictures of areas inside the body. It can also be called as nuclear magnetic resonance imaging (NMRI).
- CT scan is a method that produce a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to assist the clarity of the organs or tissues image.
- PET scan ia a method of indentifying malignant tumor cells in the body. A small amount of radioactive glucose is injected into a vein. The PET scanner rotates around the body and produce an image of where glucose is being used in the body. Malignant tumor cells appear up brighter in the images because they are more active in taking up more glucose than normal cells do.
- Bronchoscopy is a method used to look inside the trachea and large airways in the lung for abnormalities.It is inserted through the nose or mouth into the trachea and lungs.
- Exfoliative cytology is a method used to collect cells from the lip or oral cavity. The cells are viewed under a microscope to find out if there are presence of abnormalities.
Several treatments for head and neck cancer are:
- Surgery may be used to remove cancer and edges of healthy tissue around it and to take out lymph nodes in the neck that haven’t gotten better with other treatments.
- Radiotherapy uses external beam radiation to kill cancer or to shrink it for the ease of surgery process. External Beam Radiation Therapy (EBRT), which is usually delivered by a machine called a linear accelerator that focuses high-energy X-rays from the outside of the body to the tumour.
Halcyon Radiotherapy System at Beacon Hospital enables:
- Fast and precise X-ray dose delivered to each tumour with high accuracy over a minimum number of treatment sessions
- Reduces unwanted radiation dose, thus, minimizing side effects
Unlike any other radiation delivery system, the Halcyon technology’s beam-on time could be as fast as 1-minute plus. Its gantry rotates 4 times faster than a standard linear accelerator and its multi-leaf collimator (MLC) can move twice faster than traditional MLCs. All of these features help in improving the time it takes to treat the patients. cancer cells from outside the body to kill cancer cells.
TrueBeam 2.7 Radiosurgery/Radiotherapy System at Beacon Hospital offers:
- HyperArc™ High-Definition Radiotherapy and Radiosurgery
HyperArc™ high-definition Radiotherapy system represents a significant step forward for high quality Linac-based Radiosurgery, with an easy delivery of non-coplanar Stereotactic Radiosurgery (SRS) treatments. HyperArc™ could irradiate multiple tumours at the same time without repositioning the patient, which provides better management of patient motions while saving time for the patient and the clinical team. HyperArc™ ensures the planners achieve extremely compact dose distributions consistently and efficiently while maintaining patient safety.
- Stereotactic Radiosurgery (SRS)
Stereotactic radiosurgery (SRS) is a non-surgical radiation therapy used to treat functional abnormalities and small tumours of the brain. It can deliver precisely-targeted radiation in fewer high-dose treatments than traditional therapy, which can help preserve healthy tissue.
- Stereotactic Body Radiotherapy (SBRT/SRT)
Stereotactic Radiotherapy (SBRT/SRT) gives radiotherapy from many different angles around the body. The beams meet at the tumour, this means the tumour receives a high dose of radiation and the tissues around it receive a much lower dose. This lowers the risk of side effects. Stereotactic Radiotherapy (SBRT/SRT) is mainly used to treat smaller size tumour in lung, liver, lymph nodes, spinal cord and brain.
- Chemotherapy is the use of drugs to kill cancer and often used along with radiotherapy. Chemotherapy drugs circulate in the bloodstream around the body. Thus, chemotherapy can treat cells that have spread away from the lung tumour and spread to other parts of the body.
Type of chemotherapy drugs:
– Alkylating agent is a type of chemo drug that is capable of damaging the DNA of a cancer cell to ensure that the cell doesn’t make more copies of them.
– Topoisomerase inhibitor is a compound that can block the human enzymes that contributes to the growth of cancer cells.
– Antitumor antibiotic is an anticancer drug that is capable of slowing down or stop the growth of cancer cells.
– Antimetabolites is a chemo drug that is capable of interfering more than one enzyme that’s necessary for the growth of DNA inside the cancer cell.
– Mitotic inhibitor is a type of chemo drug that is capable of stopping the body from producing the protein which contributes to the cancer cell growth.
– Corticosteroids is man-made steroids used to help reduce the side effects of chemotherapy.
- Targeted therapy uses drugs to identify and attack cancer cells. Targeted therapy could be used in combination with other treatments, such as chemotherapy, surgery, or radiotherapy.
- Immunotherapy – Immunotherapy stimulate the body’s immune system to recognize, attack and kill cancer cells. Immunotherapy may not be suggested for all patients, and responses to the treatment may vary widely. Immunotherapy may also be used in combination with other treatments such as radiotherapy or chemotherapy. Immune checkpoint inhibitors are used to track ‘checkpoints’ proteins on immune cells that need to be triggered to start an immune response.