The term ‘head and neck cancer’ brings together a range of cancers from the mouth to the back of the nose and throat and down to the larynx, or voice box. They are all lined by the same type of cell, the squamous cell, which accounts for most of the cancers in the region. Smoking cigarettes and drinking alcohol is the major risk factor for developing these cancers.
The extent of disease is determined by CT scans and having a look, under anaesthetic, with an endoscope. In general, the mainstay of treatment has been surgery to remove the primary cancer and the draining lymph nodes in the neck. Repairing the defect left by trying to remove all the tumour often requires grafts of flaps of tissue rotated from other areas. Removal of the larynx can mean loss of speech and a tracheostomy or breathing hole in the windpipe. With special techniques or mechanical voice synthesisers, speech can be restored.
Radiation therapy is often used as an adjuvant to surgery to improve local control. For small cancers, radiotherapy can be curative and should be considered as an alternative to surgery that may allow preservation of the larynx and vocal cords, although this may need to be balanced with radiation side effects such as a persistently dry mouth. Chemotherapy with cisplatin and 5 fluorouracil can palliate advanced disease or be used together with the other treatments.
The interesting fact about head and neck cancers is that they tend to remain local and recur locally. Although they can spread to other organs, such as the lungs, most of the problems associated with them occur locally. To improve local control, combinations of all types of treatments have been tried. Currently, there is much interest in the potential for radiotherapy and chemotherapy given together to improve the outcome.