Cancers of the head, neck and upper respiratory system
Neck, Jaw and Face Cancer Study Clinic
We recognise two distinct groups of “head and neck” cancer. The first and larger group covers cancers of the mouth cavity, pharynx and larynx. These cancers account for 90% of “head and neck” tumours and tobacco and alcohol play a part in their formation.
The remaining 10% are rarer tumours, located in the nasal cavities, sinuses or salivary glands. Finally, nasopharyngeal cancer, a very specific form of cancer located at the rear of the nasal cavity, is found mainly in Asian countries and in the Mediterranean basin. It is caused by the Epstein Barr virus, which infects patients during the first few weeks of life.
Head and neck cancers, rarer in women, account for approximately 7% of cancers observed in men. In Belgium there are 1,500-2,000 cases of this cancer per year.
Treatment is complex and depends on the type of tumour, which will dictate the choice between surgery, radiotherapy, chemotherapy and new drugs specifically aimed at the cancer. Defining the best strategy requires discussion between doctors specialising in different field and working together in a multidisciplinary team.
Almost all head and neck cancers are linked to smoking and excessive alcohol consumption.
Although moderate alcohol consumption does not carry a real risk of cancer, the risk increases considerably if significant quantities are consumed (one bottle of wine, 10-15 units of beer a day).
Heavy smoking and excessive alcohol consumption, when combined, do not just have an additional effect; instead, the risk is multiplied by a factor of 5-10.
Head and neck cancers tend to become evident at a late stage, depending on tumour location. Persistent hoarseness can indicate localised trouble in the larynx. A lesion at the back of the throat (pharynx) can produce difficulty or pain in swallowing.
Toothache, painful eating, or problems with speech, can indicate mouth cavity problems. Pharyngitis that does not respond to antibiotics must be checked carefully. Sometimes, cancer takes the form of a painless ganglion in the neck.
To sum up, symptoms of head and neck cancers are generally non-specific to start with, and can occur in diseases other than cancer. A consultation will determine their origin. Unfortunately, warning signs are often neglected, meaning that two thirds of cancers are diagnosed at an advanced stage.
Small or medium tumours are treated with surgery or radiotherapy. There is more chance of a cure, and the consequences of treatment are not drastic: the voice is generally preserved and eating rapidly becomes easier after the surgery.
The choice of surgery or radiotherapy is taken after a multidisciplinary discussion, during which the surgeon, radiotherapy specialist and specialists determining the nature of the cancer (size, level of aggression etc) decide on the most suitable approach. The patient’s wishes are also taken into account: treatment methods, duration of treatment and hospital admission requirements can vary slightly, and this can affect the patient’s working life.
Regular monitoring is essential while the risk of another tumour appearing in the same area remains. Of course, if smoking and excessive alcohol consumption continue, the risk of lung cancer and cancer of the oesophagus remains.
More advanced cancers usually require combined treatment with surgery and radiotherapy. Frequently, however, the treatment offered combines radiotherapy and chemotherapy or the administration of drugs specifically aimed at the tumour. These combinations are aimed at making the radiotherapy more effective.
The choice of options takes account of both efficacy and functional consequences. In cases of advanced laryngeal tumours, it can be preferable to opt for accelerated or intensive radiotherapy, combined with chemotherapy or drugs, rather than a complete laryngectomy. Both options are equally effective, but the first, of course, will better preserve the voice.
For mouth cavity tumours, surgery followed by reconstruction is often a better indication, as radiotherapy within the mouth cavity can cause bone complications.
RESEARCH AND INNOVATION
Treatment of head and neck cancer is advancing on all fronts. Surgeons are developing innovative techniques not only in tumour removal but also in reconstruction of damaged organs. In radiotherapy, tomotherapy now allows tumours to be irradiated with great accuracy; the cancer can thus be treated with very high doses while the neighbouring healthy tissue is avoided.
Our specialists in the multidisciplinary “head and neck” group have published recommendations on determining the volume of tumour to be irradiated. These recommendations have been confirmed and are now used at international level.
Finally, medical treatment is not standing still. New molecules act specifically on cancer cells, increasing efficacy and reducing toxicity. New medical treatments, when combined with chemotherapy or radiotherapy, look very promising. They are used in the context of studies that our centre is conducting in association with other reference centres in Europe and the United States.
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