What is head and neck cancer?

Head and neck cancers are malignant tumours which develop in the face, mouth, jaws, salivary glands, sinuses, throat etc. One of the most common cancers within this group is oral cancer, which can affect the tongue, cheeks, palate, gums, and lips in the oral cavity.

Patients with oral cancer can present with mouth ulcers which are not healing even after 2-3 weeks, persistent lump or swelling in the mouth or neck, unexplained numbness of the lips, chin or tongue, unusual bleeding in the mouth, and white and red patches in the mouth.

Patients with other types of head and neck cancer can present with breathing or swallowing difficulty and pain, blocked sinuses that do not respond to antibiotic treatment, recurrent bleeding from the nose, ear pain, ringing or blockage, change in voice or swelling of the face and neck.

Squamous cell carcinoma is the most common type of mouth cancer, and they develop from the mucosal surfaces within the head and neck region. The known risk factors for oral cancer include tobacco, alcohol and betel quid usage, radiation exposure and viral infections such as Human Papilloma virus and Epstein-Barr virus.

Oral and maxillofacial surgeons can perform a detailed physical examination to check the oral cavity for any signs of cancer and perform a biopsy for diagnosis if required. Some oral and maxillofacial surgeons who are further trained in head and neck surgery will be able to provide surgical treatment for this group of patients.

Why should I seek treatment?

Early identification and treatment of head and neck cancers are vital to improve outcomes and increase survival rates for these patients. When the tumours are small and localized, the tumours can often be completely removed and treated to achieve a cure.

If left untreated, head and neck cancers can grow rapidly, spread to nearby regions and other parts of the body. Any symptoms which are present may continue to worsen. Tumours may be painful or sore, and if they grow to a large size, the patients may also suffer from difficulty in chewing, swallowing, and breathing. Delayed treatment will likely also increase the complexity of treatment.

What are the treatment options?

A biopsy is usually required to remove a piece of tissue to establish a diagnosis for head and neck cancer. Radiographs and scans may be performed to evaluate the extent and spread of cancer.

The treatment options available depend on several factors such as the type, location, size and spread of the tumours. Treatment options for head and neck cancers include surgery, radiotherapy, chemotherapy, immunotherapy, and targeted therapy. These treatments may be used in isolation or, more frequently, in combination.

Surgery for oral cancer is commonly performed for the affected sites in the mouth together with the removal of a margin of surrounding healthy tissues. Surgery for removal of the lymph nodes in the neck may also be required to remove cancerous cells which may have spread. The patient may need to undergo reconstructive surgery and dental rehabilitation to rebuild the bones, tissues and teeth which were removed. A fibula flap from the leg is usually used to replace parts of the jaw bones which were resected.

Discuss with your surgeon to decide which treatment is best for you.

What to expect after treatment?

Head and neck cancer patients need to undergo a period of therapy and rehabilitation to regain functions such as talking, chewing, and swallowing. The patients will be supported by allied health professionals such as speech therapists, physiotherapists, dieticians, and occupational therapists to assist in their recovery.

Patients will need to be reviewed closely after treatment to detect any cancer recurrence. During these visits, physical exams, blood tests, radiographs, and scans may be performed. The patients may also experience side effects depending on the type of treatment received, and they should discuss with their doctors how to manage these side effects.