Overview of Cancers 1

Overview of Head and Neck Cancers

Dawn Dawson, Advanced Nurse Specialist Head and Neck Cancer

This is split into three pages – Introduction, signs & causes (this page), Surgery (Next Page) and other treatments & after treatment (Third Page)

What are Normal Cells?
• Develop to a specific set of instructions in their DNA which tells them what they are (Eg skin, mucosal, muscle, or nerve cells) and their function (differentiation)
• Grow by cell division (mitosis)
• Their instructions also tell them to switch off and stop dividing when they have fulfilled body’s need for new or replacement tissue.

What is Cancer?
• Is a complex group of disease characterised by uncontrolled growth and spread of immature cells
• Due to complex genetic and cellular mechanisms, cancer cells have lost their switch off mechanism
• They continue to grow beyond the body’s need
• Invade and damage adjacent tissues and organs
• Lose their ability to develop a specific identity and to function as mature cells

Head and Neck Cancers
• A complex group of cancers
• Sixth most common form of cancer worldwide
• Approx 10 head and neck cancers reported per 100,000 of UK population annually
• More common in the North of England than in the South
• Approx 7,000 new cases diagnosed in England and Wales each year
• Can occur at : lip, tongue, floor of mouth, gum, other oral cavity sites, salivary glands, oropharynx, nasopharynx, hypopharynx, larynx, nose and sinuses, ear, eye and thyroid
• Most common site is the larynx (voice box)
• Cells most commonly involved – squamous epithelial cells, which line upper respiratory tract and gastrointestinal tract
• Tumours arising from epithelium are called squamous cell carcinomas – most common in head and neck 90%
• Adenocarinomas in glandular tissue
• Others – acinic cell, adenoid cystic, sarcoma, malignant melanoma, sebaceous, verrucous, spindle cell, basoloid, mucoepidermoid and pleomorphic adenomas
• Thyroid cancers – papillary, follicular, medullary and anaplastic

Cancers from other sites can metastasize (spread) to Head and Neck :- Lymphomas, Renal, Breast, Sarcoma, Malignant Melonoma , Prostate

Pre cancerous Conditions
• Dysplastic – cells undergo several changes before they become malignant
• Degrees of dysplasia – mild, moderate, severe
• Most common in larynx
• Leukoplakia in the oral cavity
• Patient education and regular follow up utmost importance.

Tumour Staging
Cure rates are very dependant upon the precise site of the tumour, its size and extent of any spread to surrounding structures Tumour staging is used to make treatment decisions :-
• T refers to primary. Ranges T1 – T4 based on surface diameter and anatomical invasion
• N refers to nodal stage. Range 1-3 Cancer cells break off from original tumour and travel in blood or lymphatic system to other parts of the body and continue to divide, invading local structures
• M refers to distant mets – relatively rare to see a head and neck cancer cause distant mets

Signs and Symptoms
• Similar to minor ailments (blocked nose, sore throat, hoarse voice, ear ache, mouth ulcers, swollen lymph glands) Difficult for GP to refer early
• Symptoms persisting for more than two weeks should be investigated

Fast track referral guidelines :-
• An ulcer in the mouth that doesn’t heal within a few weeks
• Trouble speaking or breathing, such has hoarse voice
• Difficulty in swallowing, or pain when chewing or swallowing
• A constant sore throat and earache affecting one side
• A swelling or lump in the mouth or neck

Less common:
• A numb feeling in the mouth or on the lips
• An unexplained loose tooth
• A persistent blocked nose or nose bleeds
• A ringing in the ears or difficulty hearing
• A pain in the face or upper jaw

Causes
• Salivary and thyroid different
• Smoking
• Alcohol use (risk doubled if both)
• Chewing betal nut
• Sun exposure
• Environmental carcinogens include: marijuana, occupational exposure such as nickel refining, textile fibres and woodworking
• Diet and nutrition (nasopharyngeal) has been associated with consumption of salted food
• Medullary carcinoma of thyroid only are thought to have genetic cause
• Viral (epstein virus) in nasopharyngeal
• HPV in tonsil – seen increase in oral cancers in young adults

Individuals at Risk
• Male, average age 65
• Disadvantaged socioeconomic groups
• Occupational exposure to dust, fumes or chemicals
• Use of tobacco and alcohol
• Low level of awareness of symptoms (no screening available)
• Presentation with advanced tumour

Diagnostic Procedures
• Clinical examination including neck examination
• FNE (fibre optic naso-endoscope)
• EUA +Bx (examination under anaesthetic and biopsy)
• Radiology – CT, MRI, USS, PET,MRA
• FNAC neck node (fine needle aspiration cytology)
• Rapid access neck lump clinic

More Pages – Surgery (Next Page), Other Treatments (Third Page)