Head & Neck Cancer

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Clinical Description

These involve the following malignancies:

  • Oral cavity cancers: Buccal, gingival, retro-molar trigone, hard palate, oral tongue and floor of mouth
  • Oropharynx: Tonsil, soft palate, Base of Tongue
  • Nasopharynx
  • Hypopharynx
  • Larynx
  • Salivary gland: Parotid, submandibular, submental

Clinical Features

SIGNS AND SYMPTOMS

  • Depends on specific location of the cancer.
  • Non healing ulcers in the mouth, which easily bleed
  • Associated difficulties in mastication and progressive dysphagia
  • Neck mass/lymphadenopathy
  • Otalgia
  • Nasal blockage and bleeding
  • Trismus
  • Persistent cough
  • Stridor
  • Hoarseness of voice in advanced cases.

INVESTIGATIONS

  • Done in conjunction with ENT surgeons and pathologists.
  • Clinic: Complete upper airway assessment using Indirect Laryngoscopy +/- Flexible Nasal Endoscopy
  • Radiological imaging forms part of work up e.g. Panorex, CT Scan Base of skull to upper chest
  • Biopsy: primary mass or suspicious lymph nodes

Treatment

NON-PHARMACOLOGICAL

  • Depends on the extent of disease.
  • Local therapies: Early-stage disease (T1/T2) can use single modality i.e. surgery or radiotherapy
  • Advanced cases T3/T4: chemo- radiation is preferred to surgery for cosmesis and organ preservation. If recurrence, then surgery is treatment of choice.

PHARMACOLOGICAL

Drugs of choice: Cisplatin, Paclitaxel, Docetaxel, Gemcitabine, 5FU, Methotrexate, Cetuximab, Doxorubicin 

  • Follow up with routine clinical examinations and CT scans at scheduled visits.