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ENT , HEAD AND NECK SURGERY DEPARTMENT |
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DEPARTMENT OF HEAD AND NECK ONCOLOGY
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Overview of Head & Neck
cancer
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In
modern era of medical field lot of medical research is going on for early
diagnosis and management of cancer. Although in last few years we progressed
very fast to fight cancer, still we are not able to cure the all cancers
especially of last stage. Cancer is a Latin word meaning 'Crab'. Basically
cancer is the rapid uncontrollable growth of the cells in any part of the body
which do not function normally and not divide & die as normal cells. Cancer
cells develop because of damage to DNA, the substance which directs all activity
of the cells. Most of the time the DNA is damaged by some environmental
irritants like smoking, alcohol, lime, pan, hot spicy food, arsenic etc or by
genetic inheritance. Once DNA is damaged in cancer cell it is not repaired
itself as in usual cell. If cancer is not treated at early stage cancer cell
keeps on multiplying, erodes surrounding structure and spreads to the
surrounding lymph nodes and other organs like lungs, Bones,Liver, Brain, Kidneys
etc.
These tumours may erodes in form of ulcer in neck or form huge swelling (Fig. 1)
and some
time flies may hatch maggots which lead extremely painful condition.Head & Neck
cancer are most common type of the cancers in india. It is estimated that there
are approximately 2 - 2.5 million cases of the cancers in India at any given
time out of that about 40% of cases arises from head & neck region. |
Is this cancer preventable?
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Approximately 90% of oral cavity cancer is related to environmental irritants
like alcohol & tobacco and avoiding consumption of these irritants may prevent
cancer formation. In oral cavity white patch (leucoplakia), red patch
(erythroplakia) or red or purple erosive lines (lichen planus) is precancerous
condition which has high potential to turn out malignant.
However oral cancer may develop even without any precancerous condition and it
is not necessary that all premalignant lesions lead to cancer. Treatment or
regular check-up of this early lesion may help to prevent or early detection of
the cancer. |
What are
the Symptoms of Head & Neck cancer ?
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- Oral ulcer not relieved by medicine.
- Oral/gum/dental growth progressively increasing
in size.
- Swelling in neck region progressively increasing
in size.
- Change in voice.
- Difficulty or pain during swallowing.
- Difficulty in breathing.
- Burning sensation during swallowing.
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How
the Head & Neck Cancer Diagnosed ?
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Following Methods help to diagnose head and neck cancer:-
- Physical Examination.
- Laboratory Tests.
- Endoscopy (Nasopharyngoscopy/Direct
Laryngoscopy/Oesophagoscopy/Bronchoscopy)
- X-ray, CT scan, MRI scan.
- Histopathological :- F.N.A.C., Biopsy.
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Is
the Head & Neck Cancer treatable?
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It
is a myth that once cancer is diagnosed it is only way to horrible death but
same is not true. If cancer is diagnosed in early stage it will be cured up to
95% of cases and at this stage only one modality of treatment is required even
the patients who presented in stage III OR IV are also cured by multimodality
approach up to 65-75% cases.
Only very advanced cases require palliative or symptomatic management. In India
early diagnosis is a big challenge due to ignorance of patients toward the
symptoms and most of the cases even after being diagnosed as cancer do not take
proper treatment probably due to fear of hospital, more faith in quakes,
inadequate knowledge of the disease and poverty which turn the early stage
cancer in very advance stage where we can offer only palliative management. Only
awareness, faith in multimodality treatment and avoid ignorance make head & neck
cancer completely curable. |
What is multimodality treatment?
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There are three modalities (Surgery, Radiotherapy, Chemotherapy) to fight the
cancer. In multimodality approach the case is discussed in tumour board, in
which surgeon, radiotherapist and chemotherapist discuses the clinical,
pathological and radiological aspect of the disease and dispense best
combination of the treatment, best suited to the patient. Treatment plans
depends on exact location, stage, histology, person's age and general health. |
When and Why surgery
is necessary in Head & Neck Cancer?
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Usually cancer situated in anterior part of oral cavity is best treated with
surgery and cancer situated in posterior part of oral cavity is best treated
with radiotherapy. Basic principle behind this is that if tumour involving the
bone (mandible), just near to the bone or involving the thyroid cartilage is not
completely responding to the radiotherapy and chances of osteoradionecrosis is
also there. Patient who has disease spread to the neck nodes (>3cm) is also
candidate for surgery. Since cancer of oral cavity has high potential to spread
into neck nodes neck dissection is usually necessary to clear complete disease.
In short we can say tumour involving tongue,buccal mucosa, lower upper gum and
advance hypopharyneal and laryngeal cancer require surgery as first line of
management where as tumour involving tonsil, base of tongue, nasopharynx,
oropharynx, and early hypopharyneal and laryngeal cancer require radiotherapy as
a definitive treatment. |
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