Focus on head and neck cancer

Q: What is Head and Neck Cancer?

A: Head and Neck Cancer (HNC) is a grouping of cancers involving the larynx, pharynx, oral cavity, sinonasal area, thyroid and salivary glands. HNC is not a common cancer, with 12,000 new cases diagnosed per year in the UK; which is a similar incidence to renal cancer. However, the incidence of some HNC types are rapidly increasing; especially thyroid (75% increase in last 10 years) and oropharyngeal (50% increase in last 20 years).

Q: What causes Head and Neck cancer?

A: Most cases of HNC are squamous cell carcinomas, and are caused by tobacco smoking and alcohol, and occur in more deprived populations. However, 50% of oropharyngeal cancers we treat now are related to the Human Papilloma Virus. These patients are typically non-smokers and more affluent.

Q: How is it diagnosed?

A: Patients will often present with symptoms from the primary, such as a unilateral sore throat or hoarse voice, or as a neck lump, from cervical lymph node metastasis. A tissue biopsy, or fine needle aspiration, is required from the neck or primary site to confirm a cancer diagnosis. CT and/or MRI scans are also required for staging. One-stop clinics combine many of these tests into one consultation.

Q: How is it treated?

A: All cancer patients should be discussed in a Multi-Disciplinary Team setting. Treatment modalities include surgery, radiotherapy and chemotherapy. Patients with advanced disease often require multi-modality treatment. Surgical advances allow minimal access techniques using trans-oral lasers and robotic technology. Refinements in radiotherapy delivery with Intensity Modulated Radiotherapy (IMRT) help to reduce side effects of conventional radiotherapy. Immunotherapy is a promising new therapeutic modality for metastatic and recurrent disease.

Jonathan Hughes runs a One-Stop Neck lump clinic and general ENT clinic on Saturday mornings at Spire Bushey.