Head and Neck Cancer treatment Services at RGCI & RC provide Comprehensive Cancer Care from Prevention to Palliation. A team of Head & Neck Surgical Oncologists, Radiation Oncologists, Medical Oncologists, Reconstructive Surgeons and other Medical Specialties work together to treat each Head & Neck Cancer patient. They discuss majority of the cases in Multi Specialty Clinic to decide the best course of action. We discuss all options of treatment and investigations with patient and relations and follow NCCN guidelines. Head & neck cancer treatment is promptly followed by a personalized rehabilitation plan to help promote recovery and ensure an enhanced quality of life.
Most head and neck cancers begin in the cells that line the mucosal surfaces in the head and neck area, e.g., mouth, nose, and throat. Mucosal surfaces are moist linings of hollow organs and cavities of the body. Normal mucosal cells look like scales (squamous) under the microscope, so head & neck cancers are often referred to as squamous cell carcinomas. Some head & neck cancers begin in glandular cells and are called adenocarcinomas.
Cancers of the head and neck are categorized according to the area in which they originate:
Conventionally, Cancers of the eye, thyroid as well as those of the scalp, skin, muscles, and bones of the head and neck are grouped with usual cancers of the head and neck due to anatomical proximity. Brain surgery is separate super-specialty at RGCI & RC as Neuro Oncology Deptt.
To find the cause of symptoms, a surgical oncologist evaluates a person’s medical history, performs a physical examination, and orders diagnostic tests. The examination and tests conducted may vary depending on the symptoms. Examination of a sample of tissue under the microscope is always necessary to confirm a diagnosis of cancer.
We insist on clinical examination and believe that “Hand Scan is better than a CAT Scan”
If the diagnosis of cancer is confirmed, the surgical oncologist will want to know the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve an examination under anesthesia (in the operating room), x-rays and other imaging procedures. Knowing the stage of the disease helps the surgical oncologist plan treatment.
Each and every Head & Neck cancer patient is evaluated by a special team of Surgical Oncologists (Head & Neck unit), Medical Oncologists, Radiation Oncologists, Onco-pathologists and Imaging Specialists. Depending on the age, general condition, type of pathology and stage of the disease, a custom made treatment plan is charted out for each and every patient as per International Treatment Guidelines. (NCCN – National Comprehensive Cancer Network)
Modalities of Treatment Available for Head and Neck Cancer:
The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person’s age and general health. The patient and the surgical oncologist should consider treatment options carefully. They discuss each type of treatment and how it might change the way the patient looks, talks, eats, or breathes.
The surgeon may remove the cancer and some of the healthy tissue around it. Lymph nodes in the neck may also be removed (lymph node dissection); if the Surgical Oncologist suspects that the cancer has spread. Surgery may be followed by radiation treatment.
Head & neck surgery often changes the patient’s ability to chew, swallow, or talk. The patient may look different after surgery, and the face and neck may be swollen. The swelling usually goes away within a few weeks. After surgery of neck and throat, patient may feel numb because nerves have been cut. If lymph nodes in the neck were removed, the shoulder and neck may be weak and stiff. Patients should report any side effects to their Surgical Oncologist, and discuss what approach to take.
Head & neck cancer in early cases may be treated with radical dose of radiation, but patient may require radiation pre operation or post operation, with or without chemotherapy. Different types of radiation may be planned for patients for example – 3DCRT, IMRT or IGRT.
In addition to its desired effect on cancer cells, radiation therapy often causes unwanted effects. Patients who receive radiation to the head and neck may experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Other problems that may occur during treatment are loss of taste, which may decrease appetite and affect nutrition, and earaches (caused by hardening of the ear wax). Patients may also notice some swelling or drooping of the skin under the chin and changes in the texture of the skin. The jaw may feel stiff and patients may not be able to open their mouth as wide as before treatment. Patients should report any side effects to their Oncologist and ask how to manage these effects.
Chemotherapy may be given along with radiation or alone in selected situations. The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect rapidly growing cells, including blood cells that fight infection, cells that line the mouth and the digestive tract, and cells in hair follicles. As a result, patients may have side effects such as lower resistance to infection, sores in the mouth and on the lips, loss of appetite, nausea, vomiting and diarrhea. They may also feel unusually tired and experience skin rash and itching, joint pain, loss of balance, and swelling of the feet or lower legs. Patients should talk with their medical oncologist about the side effects they are experiencing, and how to handle them.
Targeted therapies are different than chemo therapies. They are like smart bombs vs cluster bombs of chemotherapy. These are oral form of drugs which selectively kill cancer cells. They have limited applications in head and neck cancer.