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In this issue of HealthNews, medical oncologist Dr Lim Hong Liang tells us about the main types of head and neck cancers, the signs and symptoms to look out for, as well as the treatment available for patients at different disease stages.

Head and neck cancers are a group of cancers that begin in the mouth, throat, nose, larynx, and salivary glands. Of this group of cancers, nasopharyngeal cancer (NPC) is the most common head and neck cancer in Singapore, and one of the top causes of cancer death in Singaporean men.

There are five main types of head and neck cancers: oral cavity cancer, pharyngeal cancer, laryngeal cancer, nasal cavity and paranasal sinus cancer, and salivary gland cancer. Each of these types come with its own unique characteristics, and the signs and symptoms to look out for.

5 main types of head and neck cancers

1. Oral cavity cancer

What it is: Oral cavity cancer is cancer affecting the lips and the inside of the mouth, including the gums, inside of the cheeks, tongue and hard palate.

What symptoms to look out for:

• Red or white patches in the mouth, gums and tongue
• Ulcers or areas of hardening that do not go away
• A growth in the oral cavity
• Bleeding or pain in the mouth
• Difficulty chewing or swallowing

2. Pharyngeal cancer

What it is: Pharyngeal cancer is cancer affecting the back of the nasal cavity (nasopharynx) and back of the oral cavity, including the tonsils, back of the tongue, soft palate (oropharynx) down to the beginning of the trachea and esophagus (hypopharynx).

What symptoms to look out for:

• Nasopharyngeal cancer (NPC)
• Nasal obstruction
• Nose bleed
• Ear symptoms e.g. blocked ears, ringing sound, pain in the ears
• Headache, double vision, facial numbness
• Oro- and hypopharyngeal cancers
• Persistent cough
• Throat discomfort, including pain and sensation of something stuck in the throat
• Pain and difficulty swallowing
• Change in voice
• Ear pain that does not go away
  

3. Laryngeal cancer

What it is: Laryngeal cancer is cancer affecting the voice box.

What symptoms to look out for (symptoms of laryngeal cancer may be similar to oro- and hypopharyngeal cancers): 

• Difficulty in speech and changes to the voice
• Persistent cough or urge to clear the throat
• Difficulty breathing
• Difficulty in swallowing, including coughing or choking on swallowing

4. Nasal cavity and paranasal sinus cancer

What it is: Nasal cavity cancer is cancer affecting the nasal cavity (space inside the nose), while paranasal sinus cancer is cancer affecting the bones around the nose).

What symptoms to look out for:

• Facial asymmetry, pain or numbness
• Persistent and unexplained dental pain
• Nasal obstruction, discharge and bleeding
• Persistent chronic sinus infections
• Headaches
• Loss of smell
• Blurred or double vision

5. Salivary gland cancer

What it is: Salivary gland cancer is cancer affecting the glands that produce saliva. Three major ones are the submandibular gland (below the jaw), parotid gland (sides of the face in front of the ears) and sublingual gland (below the tongue).

What symptoms to look out for:

• Painless palpable swelling at the side of the face or below the jaw
• Numbness, abnormal sensation, or pain over the face
• Loss of facial movement
• Other symptoms common to all head and neck cancers include enlarged painless palpable neck nodes, coughing up blood, and unexplained weight loss.

Risk factors for head and neck cancers

The biggest cause of head and neck cancers is tobacco. This includes smoking cigarettes, cigars, pipes and chewing tobacco. Besides tobacco, alcohol consumption, human papillomavirus (HPV) infection, and Epstein-Barr virus infection (for NPC) may also increase the risk of head and neck cancers.

Other risk factors include:

• History of radiation exposure (salivary gland and thyroid cancers)
• Acid reflux
• Excess sun exposure (cancer of the lips and skin cancers of the head and neck)
• Poor oral hygiene
• Male sex
• Age >40

Management of head and neck cancers

Head and neck cancers can be managed with different kinds of treatment, or combination of treatment, depending on the patient’s condition and their individual disease profile. This includes the location of the cancer, stage of the cancer, the age and general health of the patient, and any presence of HPV.

In early stage disease, surgery is usually performed to remove the tumour, surrounding tissue and lymph nodes. Depending on the tumour size and lymph node involvement, patients may require chemotherapy and/or radiation treatment in addition to surgery.

In some early stage head and neck cancers such as NPC, radiation is performed instead of surgery.

In advanced disease where the cancer has spread to the rest of the body, chemotherapy, immunotherapy, targeted agents, or a combination of these therapies, are used for cancer control.

A multidisciplinary approach to treatment, guided by a team of medical and allied health specialists from different disciplines, can offer patients optimal care in the management of head and neck cancers. Fortunately, many head and neck cancers can be cured, especially if it is diagnosed early. Advances in treatment are also offering improved treatment outcomes for patients with the disease.