A brief discussion on Head and Neck cancer and its treatment

1. A brief discussion on Head and Neck cancer and its treatment What are head and neck cancers? Head and neck cancer mainly are the range of cancers that occur in the lymph nodes or tissue in the head and neck area. This region includes the tongue, mouth, palate, salivary glands, gums, tonsils, throat, nose, voice box and sinuses. Only malignant tumours are cancer. A few tumours in the head & neck may be benign. The maximum cancers of head & neck start in cells of moist surfaces of mouth, throat or nose. These are known as squamous cell carcinomas (SCC). Some head and neck cancer occurs in the glandular cells. Many of these are addressed as adenocarcinomas. Squamous cell carcinomas and adenocarcinomas may also occur in the other parts of the body. Signs & Symptoms of Head and Neck Cancer: The Head and neck cancer usually starts with the symptoms that seem harmless enough, like an enlarged lymph node on the outside of the neck, a sore throat, neck pain or a hoarse-sounding voice. Apart from this, in the head and neck cancer, these terms may persist and may become chronic. Symptoms can include: •painful swallowing •difficult speaking •persistent earache •lump in lip, mouth or gums •mouth ulcers •bleeding from the mouth •numbness •bad breath •persist discolored patches in the mouth •a sore tongue •slurring of speech •congested sinuses •weight loss •numbness or paralysis of facial muscles

2. Types of Head & Neck cancers: The cancers of the head & neck are classified by the area of the head or neck where they start. Mouth: It is also known as oral cavity, including the tongue, lips and gums. The muscles of the base of the tongue continue into the oropharynx. Cancer of mouth is known as oral cancer. Cancer may develop in any part of the mouth such as: •gums •lips •inside lining of the cheeks and lips •oral tongue •floor of the mouth under the tongue •hard palate •small area behind the wisdom teeth Cancer that starts in the base of the tongue is known as oropharyngeal cancer. Nasal cavity & paranasal sinuses: The nasal cavity is a large and hollow space inside our nose. This space warms, moistens and filters the air during breathing. The bones around the nasal cavity have a group of small, air-filled spaces known as paranasal sinuses. These sinuses may affect the sound as well as tone of the voice. The are 4 pairs of paranasal sinuses: •maxillary sinuses •frontal sinuses •ethmoid sinuses •sphenoid sinuses Salivary glands: The salivary glands make saliva. This helps in keeping the mouth moist, helps you swallow food and mainly protects the mouth against the infections. The salivary glands has basically 3 pairs: •parotid glands •sublingual glands •submandibular glands Throat: It is also called the pharynx. Cancer of throat can affect the 3 parts of the pharynx: Nasopharynx: cancer of this upper part is called nasopharyngeal cancer oropharynx: It is a middle part of throat. The cancer of this area is known as oropharyngeal cancer. Hypopharynx: it is a lower part, around the larynx; cancer in this area is known as hypopharyngeal cancer.

3. larynx: It is also called a voice box. It is a short passageway that connects the lower part of the throat with trachea. The thyroid gland is situated right in front of the trachea under the larynx. The cancer of larynx is addressed as laryngeal cancer. The larynx includes: epiglottis: during the swallow, this small flap of tissue moves in order to cover the larynx to prevent food going into lungs and trachea. glottis: it contains the vocal cords, which vibrate during air pass helps in order to produce the sound. subglottis: located below the vocal cords. What are the risk factors? There are several risk factors of having Head and neck cancers. A couple of major risk factors are tobacco and alcohol, and the combined effect of drinking as well as smoking is significantly higher than the risk of just drinking or just smoking. Some known risk factors include: •drinking alcohol •smoking cigars, cigarettes and pipes. •chewing areca nut, gutka, pan and betel nut. •infection with HPV (human papillomavirus, especially HPV 16, or EBV. •being overweight or obese. •older age (being over 40) •being male •having a first-degree relative with some types of head and neck cancer •being from South-East Asia or southern China (because of cultural practices such as eating salty fish and chewing tobacco) •breathing in certain types of pain & chemicals, wood dust, asbestos fibres and dry-cleaning solvents or certain. •having a weakened immune system •sun exposure Consuming adequate amounts of fruit as well as vegetables can play a crucial role and help lower the risk of getting oral and oropharyngeal cancers. Discuss with your healthcare provider if you are worried about any of these risk factors. Stages of Head and Neck cancer: These are the basic stages of head and neck cancer: Stage 0 Head and Neck Cancer: It is also known as carcinoma in situ, this is the very beginning of the scale. It represents abnormal cells in the lining of affected areas that may turn into cancer.

4. Stage I Head & Neck Cancer: Stage I indicates the cancer is in its very early stage. The tumor's size is not greater than 2CM. Stage II Head & Neck Cancer: Stage II cancer describes a tumor that is larger than 2CM but not more than 4 CM. Stage II cancer has not spread to the lymph nodes. Stage III Head & Neck Cancer: Stage III head and neck cancer describes cancer that either is larger than 4 CM or has spread to the lymph node on the same side of the neck as the tumor and the lymph node smaller than 3CM. Stage IV Head & Neck Cancer: This is known as the most advanced stage of head and neck cancer. The tumor may be any size, but it has spread to nearby tissue, lymph nodes, other parts of the head and neck and to distant parts of the body outside of the head and neck, such as the lungs. How does the healthcare provider know I have head and neck cancer? These are the cancers which may not be detected until they cause serious trouble that make any person walk out to the doctor. Sometimes changes appear during a routine visit to the GP or dentist. You may be sent to see an ENT doctor, an otolaryngologist, or a head and neck surgeon. Your healthcare provider asks you questions about your health and performs a physical exam. If signs are indicating head or neck cancer, you will be recommended for more tests. The following tests you may be recommended: •Complete head and neck exam •Panendoscopy •Biopsy •CT scan •MRI scan •Barium swallow •Chest x-rays •PET scan •Blood tests Treatment: Advanced diagnosis and local management, and targeted therapy, have led in order to improve the quality of life and survival for patients with head & neck cancer. After the establishment of histologic diagnosis and tumor extent determined, choosing the right treatment for a specific cancer depends

5. upon the several factors including concomitant health problems, tumor site, tumor size, the previous history of patients. Surgery: Surgery is frequently used in the most sorts of head and neck cancer. It is usually done in order to remove the cancerous cells entirely. Surgery is also commonly used in order to remove some or all of cervical lymph nodes to prevent further spread of the disease. In surgery, CO2 laser surgery and Transoral laser microsurgery most often recommended. Radiation therapy: This is the most common form of treatment. There are different forms of radiation therapy, including intensity modulated radiation therapy, 3D conformal radiation therapy and particle beam therapy, which are commonly recommended for treating cancers of the head and neck. Several side effects of radiation treatment are as follows: •Skin changes where the radiation is given •Feeling very tired (fatigue) •Hoarse voice •Taste changes •Mouth and throat sores •Dry mouth •Trouble swallowing or eating Chemotherapy: Docetaxel-based chemotherapy has shown impacting response in the locally advanced head & neck cancer. The docetaxel injection is a taxane that holds US FDA approval for the head and neck cancer, together with the cisplatin and fluorouracil for treating inoperable, locally advanced squamous cell carcinoma of the head & neck. Carboplatin: This is used as a chemotherapy drug that contains platinum. The carboplatin 450 mg is used in order to slow or stop the cancer cell growth. Bleomycin Sulphate: It is specifically an antineoplastic chemo drug, which is classified as an antitumor antibiotic. The bleomycin injection is used as a chemo drug. Several side effects of chemo are as follows: •very tired •hair fall •sick to your stomach Photodynamic therapy: Photodynamic therapy may have promising results in order to treat mucosal dysplasia and small head and neck tumors. Amphinex showing good results in initial clinical trials for treating advanced head and neck cancer. Targeted therapy: Targeted therapy, is a type of treatment that uses drugs or other substances, such as monoclonal antibodies, in order to identify

6. and attack specific cancerous cells without even harming healthy cells. A few targeted therapies for the squamous cell cancers of the head and neck are as follows: •cetuximab •bevacizumab •erlotinib Immunotherapy: Immunotherapy helps by activating the immune system in order to fight cancer. One sort of immunotherapy, immune checkpoint, binds to and blocks the inhibitory signals on the immune cells in order to release their anti-cancer activities. A few FDA approved immunotherapy drugs are as follows: •pembrolizumab •nivolumab •pembrolizumab Source: https://ikrispharmanet.wixsite.com/blog/post/head-and-neck-cancer