Nasopharynx is fifth most common cancer in Malaysian males (MNCR 2012-2016). Ear Nose Throat (ENT) cancers, also known as Head and Neck cancers where a group of cancers that affect the soft tissue organs in the head and neck region. It is inclusive of the nasopharynx, oral cavity, lips, nose and paranasal sinuses, larynx, oropharynx, hypopharynx and salivary gland cancers.
INTRODUCTION OF EAR NOSE THROAT CANCER
The most common sites of head and neck cancer are:
- Larynx
- Oral cavity
- Oropharynx
Less common sites include:
- Nasopharynx
- Nasal cavity
- Paranasal sinuses
- Hypopharynx
- Salivary glands
There are several types of head and neck cancer:
- Oral cavity cancer– starts in the mouth
- Oropharyngeal cancer – starts in the back of the mouth or the throat
- Nasal cavity cancer– starts in the opening behind the nose, a space that runs along the top of the roof of the mouth and then turns downward to join the back of the mouth and the throat
- Paranasalsinus cancer – starts in the openings around or near the nose called sinuses
- Nasopharyngeal cancer – starts in the upper part of the throat behind the nose
- Laryngeal cancer – starts in the voice box
- Hypopharyngeal cancer – starts in the lower part of the throat beside and behind the voice box
Among the risk factors include:
- Alcohol and tobacco consumption – Increase cancers of the oral cavity, oropharynx, hypopharynx and larynx.
- Infection with cancer – causing types of human papillomavirus (HPV), especially HPV type 16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue.
Other risk factors for nasopharyngeal cancer include:
- Chewing betel quid – increases oral cancer.
- Consuming preserved or salted foods – increases nasopharyngeal cancer.
- Poor oral health – increases oral cancer.
- Occupational exposure to wood dust – increases nasopharyngeal cancer.
- Radiation exposure – Increases salivary cancer.
- Epstein-Barr virus infection – Increases nasopharyngeal & salivary cancer.
- Ancestry – Increases nasopharyngeal cancer.
You can lower your risk of getting head and neck cancer in several ways include:
- Stop smoking.
- Don’t use smokeless tobacco products.
- Limit the amount of alcohol consumption.
- Consider to get a human papillomavirus (HPV) vaccination. The HPV vaccine can prevent new infections causing oropharyngeal and other cancers.
- Use condoms and dental dams consistently and correctly during oral sex, which may help lower the chances of getting human papillomavirus (HPV).
- Use lip balm that contains sunscreen and avoid indoor tanning.
- Visit the dentist regularly for early detection of head and neck cancers.
There are several signs and symptoms for Head and Neck cancer. A doctor should be consulted if a lump in the neck persists for more than two weeks, is painless, and keeps growing.
- Lumps in the neck – Lumps in the neck may occur in the nose, thyroid and lymphoid cancers, as well as other ENT cancers. The position of the lump in the neck may give a clue to its cause.
- Nosebleeds – Nosebleeds can also be a sign of cancer, in particular, nose cancer. Especially if bleeding is persistent, scanty, or associated with a headache or unusual smell, then it is important to get checked.
- A swelling, ulcer or sore area in the mouth – A swelling, ulcer or sore area in the mouth that does not go away within a week should be evaluated by a doctor. This is particularly important if accompanied by a lump in the neck.
- Hoarseness in the voice – Hoarseness in the voice can occur with cancers of the voice box. It can also be a sign of thyroid cancer. This is because nerves to the vocal cords run closely behind the thyroid gland and can be affected by cancer within the gland.
- Difficulty swallowing food – Difficulty swallowing food can be a sign of cancer of the throat and should be evaluated by a doctor. A swallowing x-ray or an oesophagoscopy may be necessary to find the cause.
- Pain or blockage in the ear – Pain or blockage in the ear can be due to disease or a tumour in the nose or throat. Nose cancers can present with a blocked ear or sometimes unexplained pain or discomfort around the ear as the only symptom.
Types
There are several types of head and neck cancer:
- Oral cavity cancer– starts in the mouth
- Oropharyngeal cancer – starts in the back of the mouth or the throat
- Nasal cavity cancer– starts in the opening behind the nose, a space that runs along the top of the roof of the mouth and then turns downward to join the back of the mouth and the throat
- Paranasalsinus cancer – starts in the openings around or near the nose called sinuses
- Nasopharyngeal cancer – starts in the upper part of the throat behind the nose
- Laryngeal cancer – starts in the voice box
- Hypopharyngeal cancer – starts in the lower part of the throat beside and behind the voice box
Factors
Among the risk factors include:
- Alcohol and tobacco consumption – Increase cancers of the oral cavity, oropharynx, hypopharynx and larynx.
- Infection with cancer – causing types of human papillomavirus (HPV), especially HPV type 16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue.
Other risk factors for nasopharyngeal cancer include:
- Chewing betel quid – increases oral cancer.
- Consuming preserved or salted foods – increases nasopharyngeal cancer.
- Poor oral health – increases oral cancer.
- Occupational exposure to wood dust – increases nasopharyngeal cancer.
- Radiation exposure – Increases salivary cancer.
- Epstein-Barr virus infection – Increases nasopharyngeal & salivary cancer.
- Ancestry – Increases nasopharyngeal cancer.
You can lower your risk of getting head and neck cancer in several ways include:
- Stop smoking.
- Don’t use smokeless tobacco products.
- Limit the amount of alcohol consumption.
- Consider to get a human papillomavirus (HPV) vaccination. The HPV vaccine can prevent new infections causing oropharyngeal and other cancers.
- Use condoms and dental dams consistently and correctly during oral sex, which may help lower the chances of getting human papillomavirus (HPV).
- Use lip balm that contains sunscreen and avoid indoor tanning.
- Visit the dentist regularly for early detection of head and neck cancers.
Symptoms
There are several signs and symptoms for Head and Neck cancer. A doctor should be consulted if a lump in the neck persists for more than two weeks, is painless, and keeps growing.
- Lumps in the neck – Lumps in the neck may occur in the nose, thyroid and lymphoid cancers, as well as other ENT cancers. The position of the lump in the neck may give a clue to its cause.
- Nosebleeds – Nosebleeds can also be a sign of cancer, in particular, nose cancer. Especially if bleeding is persistent, scanty, or associated with a headache or unusual smell, then it is important to get checked.
- A swelling, ulcer or sore area in the mouth – A swelling, ulcer or sore area in the mouth that does not go away within a week should be evaluated by a doctor. This is particularly important if accompanied by a lump in the neck.
- Hoarseness in the voice – Hoarseness in the voice can occur with cancers of the voice box. It can also be a sign of thyroid cancer. This is because nerves to the vocal cords run closely behind the thyroid gland and can be affected by cancer within the gland.
- Difficulty swallowing food – Difficulty swallowing food can be a sign of cancer of the throat and should be evaluated by a doctor. A swallowing x-ray or an oesophagoscopy may be necessary to find the cause.
- Pain or blockage in the ear – Pain or blockage in the ear can be due to disease or a tumour in the nose or throat. Nose cancers can present with a blocked ear or sometimes unexplained pain or discomfort around the ear as the only symptom.
Diagnosis
If an individual has any of the above symptoms, a full ENT examination is recommended.
Biopsy
is the removal of cells or sample of tissues that can be looked under a microscope by a pathologist. If any abnormalities found, cells taken from the patches will be checked for signs of cancer.
Exfoliative cytology
is a method used to collect cells from the lip or oral cavity. The cells are viewed under a microscope to find out if there are presence of abnormalities.
Nasal endoscopy
Is usually necessary if nose cancer is suspected or needs to be excluded. Nasal endoscopy involves passing a thin flexible camera into the nose to examine the nose and throat. The examination only takes a few minutes and is usually painless. Nasal endoscopy can examine the throat down to the level of the voice box; if an examination is required further into the food passage, then oesophagoscopy may be recommended.
CT scan
Is a method that produce a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to assist the clarity of the organs or tissues image.
Magnetic resonance imaging (MRI) scan
Is a method that uses a magnet, radio waves, and a computer to produce a series of detailed pictures of areas inside the body. It can also be called as nuclear magnetic resonance imaging (NMRI).
PET scan
Is a method of indentifying malignant tumor cells in the body. A small amount of radioactive glucose is injected into a vein. The PET scanner rotates around the body and produce an image of where glucose is being used in the body. Malignant tumor cells appear up brighter in the images because they are more active in taking up more glucose than normal cells do.
Treatment
Several treatments for head and neck cancer are:
Surgery
may be used to remove cancer and edges of healthy tissue around it and to take out lymph nodes in the neck that haven’t gotten better with other treatments.
Immunotherapy
Immunotherapy stimulate the body’s immune system to recognize, attack and kill cancer cells. Immunotherapy may not be suggested for all patients, and responses to the treatment may vary widely. Immunotherapy may also be used in combination with other treatments such as radiotherapy or chemotherapy. Immune checkpoint inhibitors are used to track ‘checkpoints’ proteins on immune cells that need to be triggered to start an immune response.
Targeted therapy
uses drugs to identify and attack cancer cells. Targeted therapy could be used in combination with other treatments, such as chemotherapy, surgery, or radiotherapy.
Chemotherapy
Type of chemotherapy drugs:
- Alkylating agent is a type of chemo drug that is capable of damaging the DNA of a cancer cell to ensure that the cell doesn’t make more copies of them.
- Topoisomerase inhibitor is a compound that can block the human enzymes that contributes to the growth of cancer cells.
- Antitumor antibiotic is an anticancer drug that is capable of slowing down or stop the growth of cancer cells.
- Antimetabolites is a chemo drug that is capable of interfering more than one enzyme that’s necessary for the growth of DNA inside the cancer cell.
- Mitotic inhibitor is a type of chemo drug that is capable of stopping the body from producing the protein which contributes to the cancer cell growth.
- Corticosteroids is man-made steroids used to help reduce the side effects of chemotherapy.
Radiotherapy
uses external beam radiation to kill cancer or to shrink it for the ease of surgery process. External Beam Radiation Therapy (EBRT), which is usually delivered by a machine called a linear accelerator that focuses high-energy X-rays from the outside of the body to the tumour.
Halcyon Radiotherapy System
Halcyon Radiotherapy System at Beacon Hospital enables:
- Fast and precise X-ray dose delivered to each tumour with high accuracy over a minimum number of treatment sessions
- Reduces unwanted radiation dose, thus, minimising side effects
At Beacon Hospital’s Cancer Centre, treatment may comprise a number of healthcare professionals depending on the type of treatment. We adopt a multidisciplinary approach which includes a clinical oncologist, medical oncologist, radiologist, neurologist, neurosurgeon, cancer nurses, as well as other allied health professionals such as dietitian and physiotherapists.
TrueBeam 2.7 Radiosurgery/Radiotherapy System
TrueBeam 2.7 Radiosurgery/Radiotherapy System at Beacon Hospital offers:
- HyperArc™ High-Definition Radiotherapy and Radiosurgery
HyperArc™ high-definition Radiotherapy system represents a significant step forward for high quality Linac-based Radiosurgery, with an easy delivery of non-coplanar Stereotactic Radiosurgery (SRS) treatments. HyperArc™ could irradiate multiple tumours at the same time without repositioning the patient, which provides better management of patient motions while saving time for the patient and the clinical team. HyperArc™ ensures the planners achieve extremely compact dose distributions consistently and efficiently while maintaining patient safety.
- Stereotactic Radiosurgery (SRS)
Stereotactic radiosurgery (SRS) is a non-surgical radiation therapy used to treat functional abnormalities and small tumours of the brain. It can deliver precisely-targeted radiation in fewer high-dose treatments than traditional therapy, which can help preserve healthy tissue.
- Stereotactic Body Radiotherapy (SBRT/SRT)
Stereotactic Radiotherapy (SBRT/SRT) gives radiotherapy from many different angles around the body. The beams meet at the tumour, this means the tumour receives a high dose of radiation and the tissues around it receive a much lower dose. This lowers the risk of side effects. Stereotactic Radiotherapy (SBRT/SRT) is mainly used to treat smaller size tumour in lung, liver, lymph nodes, spinal cord and brain.
