EARLY DETECTION: 5 COMMON HEAD & NECK CANCERS
There are many different types of head and neck cancers, so it is helpful to begin with an understanding of the most common ones and how to detect them.

Head and neck cancers involve the neck lymph nodes, the thyroid gland, the back of the nose and throat, and the salivary glands.

Lymphoma
The head and neck have a significant amount of lymphatic tissues. Lymphoma is cancer of the lymph tissue and usually presents with no specific symptoms except for one or a few lumps, usually at least 2cm or larger in diameter, and usually on the side of the neck. Malignant lumps are generally painless, which explains the delayed presentation.

Lymphoma lumps also present themselves in the axilla or groin. The diagnosis is via a biopsy after all the other areas have been carefully examined to exclude a primary tumour.

Thyroid cancer
Usually close to or at the midline, thyroid gland lumps are distinctive in that they move up with swallowing. Some thyroid cancers, such as papillary and medullary thyroid cancer, are genetically determined. Today's advanced screening methods mean that thyroid cancers are detected earlier, with a generally good prognosis. The cornerstone of treatment is surgery with radioiodine therapy.

Nose cancer
There is a genetic predilection for nose cancer in the Cantonese, although other Chinese communities are not exempt. Unfortunately, it presents late because it shows no symptoms until it is large enough to obstruct breathing, invade the ear or appear as a neck lymph node due to spread.

The Epstein and Barr (EB) virus has been found to be present in patients with nose cancer, so the EB viral marker is used for early detection and as part of post-treatment follow-up. The mainstay of treatment for nose cancer is radiation therapy, with chemotherapy recommended at the later stages and surgery employed in some severe cases. Overall, the prognosis is directly "related to the stage at diagnosis, with early diagnosis affecting the outcome significantly.

Squamous cell carcinoma
The mouth, tongue, throat, voice box and the entry to the food pipe (the pyriform sinus) have a squamous cell lining. This lining can change because of smoking, alcohol consumption, betel nut chewing and frequent trauma from tooth edges.

The change can result in squamous cell carcinoma, which tends to present with ulcers that don't heal, bleeding or pain. Swallowing issues and a change in voice indicate late presentation and evaluation must be sought. Such cancers are treated with a combination of surgery, radiation and chemotherapy, depending on the site and stage of the disease.

Salivary gland cancers
The three salivary gland sites are the parotid, located at the angle of the jaw; the submandibular, under the side of the jaw; and the minor salivary glands, located in the mouth. These slower-growing cancers present no early signs but are long-standing swellings. There are hardly any symptoms until they affect the nerves, resulting in pain or weakness of facial muscles. Treatment involves surgery followed by radiation therapy, and the prognosis is satisfactory.

The head and neck region affects all our major functions of expression, breathing, senses, and our eating, speaking and other functions. Since there is no better answer than early screening and detection, neck masses, mouth ulcers, bleeding, swallowing discomfort and voice change should not be ignored.

A/PROF LUKE K S TAN
Ear Nose & Throat Surgeon

MBBS FRCS (England) MMEDS ci FAMS (ORL)
Head & Neck Surgery (Texas, USA)
Luke Tan ENT - Head & Neck Cancer and
Thyroid Surgery Centre
3 Mount Elizabeth #14-17 Mount Elizabeth Medical Centre. Tel: 6474 6116
www.thyroidsurgery.com.sg