What is head and neck cancer?
What is cancer?
Organs are formed by a collection of cells which divide themselves regularly to replace those that die.
This process of cell division in regulated by mechanisms that, when altered, cause cells and their descendents to start an uncontrolled overactive division, thus invading surrounding tissues and organs (infiltration) and even moving and growing someplace else in the organism (metastasis) forming a malignant tumour or nodule called cancer or neoplasm.
A cancer may grow:
- Locally, invading neighbour tissues cells
- Spreading through the lymphatic ganglia
- Spreading through the blood vessels
How is it diagnosed?
The specialist may observe the mucous of the mouth, nose, pharynx and larynx using a laryngeal mirror, a fiberscope or a rigid lens. In case of observing a suspicious tissue, they will perform a biopsy and extract part of it so that a pathologist may observe it through a microscope and verify what kind of tumour it is. Besides, they will have to palpate the patient's neck in search of nodules.
Eventually they will require radiologic imaging (tomography, MRI) to verify the extension of the tumour and whether the neck nodules are affected.
Then the specialist will be able to know in which development state the cancer is (staging), which will be used to plan the most adequate treatment.
Head and neck treatment, as happens with most tumours, is multidisciplinary: various specialists work together in combining therapies and offer the patient more probabilities of recovery.
What's a Head and neck cancer committee?
Head and neck tumours present a heterogeneous and complex group of neoplasms, for they have different locations, prognostics and treatments.
Tumours formed in the nose, paranasal sinuses, oral cavity, nasopharynx, oropharyx and hypopharynx and larynx, as well as those in the neck (adenopathies) and of unknown origin with carcinoma histology are head and neck tumours.
The multidisciplinary diagnosis, treatment and control of these tumours require the coordination of different specialists who have to meet and form a committee.
As a result of these meetings, where the different interventions to be performed regarding each location and stage of the illness have been discussed, a protocol, which is not definitive and may be modified, is elaborated.
How is a treatment decided?
Because of the great number of variables, the decision must be made only after a complete pre surgery study (electrocardiogram, thoracic radiography, etc.), a radiologic study of the tumour (tomography, MRI, PET) and an anatomo-pathologic study of the biopsy (is that tumour radiosensitive?, how aggressive is it?) are performed. First of all, the patient's clinic case is presented, whose health state or personal antecedents may condition or contraindicate certain therapies:
- The patient's age, physical and psychological health: whether the patient suffers from renal or hepatic alterations that would contraindicate chemotherapy, whether they could cope with a complicated surgery, whether the location of the tumour has been previously treated with radiation, whether the patient suffers from dementia, etc.
- The patient's nutritional state: malnutrition lessens the chances of recovery, hence, be this the case, an endocrinologist must be consulted. If the patient has any difficulty to swallow or it is foreseen that radiology on the neck would cause intense swallowing pain, the patient will need a stomach catheter.
- Dental state: If radiation is to be applied on the mouth, the patient's dentist must be informed since it will take 2 years before they can receive any treatment on the maxilla.
Depending on the results of this exhaustive study a certain strategy is to be followed according to the centre's protocol in order to pursue the highest degree of recovery with the least after-effects.
However, the patient must always know the different alternatives that may exist. The surgical treatment will not only depend on the size and location of the tumour, but on the experience, knowledge and aptness of the surgeonas well.
It consists in using drugs to destroy tumoral cells. Such drugs can be administrated orally, intramuscularly or intravenously. This therapy can be used in 3 different ways:
- As an induction treatment to reduce the size of the tumour and thus making it accessible through surgery and/or radiotherapy.
- Chemo-radiotherapy: used alongside with radiotherapy to kindle the radiosensitivity.
- Palliatively, stopping the growth of the tumour already radiated and inextirpable or extended to other organs.
It consists on using high energy radiation to destroy the tumours. It can be used in 3 different ways:
- Alone as first treatment.
- Combined with chemotherapy
- As a complement to surgery, usually combined with chemotherapy.
Radiotherapy is not only used on the tumour, but also on the lymphatic chains of the neck to treat the illness when it has extended to the ganglions.
Traditional surgery. It removes the tumour and the surrounding portion of healthy tissue by means of different surgical techniques.
Through the natural mouth orifice the surgeon reaches the tumour and using a surgical microscope (which amplifies the image) the surgeon uses the CO2 laser to remove the tumours from the oral cavity, tongue, pharynx and larynx with less effects on healthy tissues, thus altering less the anatomy and achieving the same oncologic results of open surgery but often preventing tracheotomy, jaw sectioning, external scars and reducing the function (swallowing, talking) recovery time and the time of hospitalization, which translates to saving money.
Laser surgery can be performed again if the tumour reappears. Microsurgery requires a long formation: the surgeon first of all needs to have mastered traditional open surgery in case the tumour is not accessible through the mouth (anatomic problems, extension of the tumour to vital tissues, etc.). The surgeon must also develop their abilities in the use of the surgical microscope with highly amplified images that help to tell the healthy tissues apart from the tumoral tissues (which allows to sear the tumour adjusting with more precision the resection of the surrounding healthy tissues).
This surgery requires a learning curve(with a gradual increase of the difficulty of the case): the more experience and ability the surgeon possesses, the more complicated cases that surgeon will be able to solve.
What must the patient do once the treatment is over?
Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.
Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.
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