Head and neck cancer is a group of cancers that begin in the mouth, nose, throat, larynx, sinus, or salivary glands. Symptoms for head and neck cancer may include a lump or pain that does not heal, a sore throat that does not go away, difficulty swallowing, or a change of sound. There may also be unusual bleeding, facial swelling, or difficulty breathing.
About 75% of head and neck cancers are caused by alcohol or tobacco use. Other risk factors include betel, certain types of human papillomavirus, radiation exposure, specific workplace exposure, and Epstein-Barr virus. Head and neck cancer is most common in squamous cell carcinoma types. Diagnosis confirmed by tissue biopsy. The extent of the spread can be determined by medical imaging and blood tests.
Not using tobacco or alcohol can reduce the risk of head and neck cancer. Although screening in the general population does not seem to be useful, a high-risk group examination with a throat examination may be useful. Head and neck cancer can often be cured if diagnosed early; However, the results are usually poor if diagnosed late. Treatment may include a combination of surgery, radiation therapy, chemotherapy, and targeted therapy. After one head and neck cancer treatment, people are at higher risk of developing second cancer.
By 2015, head and neck cancer globally attacks more than 5.5 million people (mouth 2.4 million, throat 1.7 million, and larynx 1.4 million), and has caused more than 379,000 deaths (mouth 146,000, throat 127.400, laring 105,900). Together, they are the seventh most frequent cancer and the ninth most common cause of death from cancer. In the United States, about 1% of people are affected at some point in their lives, and men are affected twice as often as women. The normal age at diagnosis is between 55 and 65 years. The average 5-year survival after diagnosis in developed countries is 42-64%.
Video Head and neck cancer
Signs and symptoms
Throat cancer usually begins with symptoms that seem harmless, such as enlarged lymph nodes on the outside of the neck, sore throat or hoarseness. However, in the case of throat cancer, this condition can persist and become chronic. There may be a lump or pain in the throat or neck that does not heal or disappear. There may be swallows that are difficult or painful. Talking may be difficult. There may be persistent earache. Other possible but less common symptoms include numbness or facial muscle paralysis.
Presenting symptoms include:
Mouth
Squamous cell cancer is common in the mouth, including the inner lips, tongue, floor of the mouth, gingiva, and hard palate. Oral cancer is strongly associated with tobacco use, especially the use of chewing tobacco or "dye", as well as the use of heavy alcohols. Cancer in this region, especially the tongue, is more commonly treated with surgery than other head and neck cancers.
Surgery for oral cancer includes
- Maxillectomy (can be done with or without orbital exenteration)
- Mandibulektomi (removal of the lower jaw or lower jaw)
- Glossectomy (removal of tongue, total, hemi or partial)
- Radical neck dissection
- Mohs procedure
- Combinations for example, glectectomy and laryngectomy are performed together.
Defects are usually covered/enhanced by using other parts of the body and/or skin grafts and/or wearing prostheses.
Nasopharynx
Nasopharyngeal cancer appears in the nasopharynx, the area where the nasal cavity and the Eustachian tube are connected to the upper part of the throat. While some nasopharyngeal cancers are biologically similar to common HNSCC, poorly differentiated nasopharyngeal carcinoma is lymphoepithelioma, which differs in epidemiology, biology, clinical behavior, and treatment, and is treated as a separate disease by many experts.
Throat
Squamous cell ocophane carcinoma (OSCC) begins in the oropharynx (throat), the middle of the throat covering the soft palate, the base of the tongue, and the tonsils. Squamous cell cancer in the tonsils is more closely related to human papillomavirus infection than cancer in other regions of the head and neck. HPV-positive oropharyngeal cancers generally have better outcomes than HPV-negative disease with 54% better survival, but these benefits for HPV-related cancers only apply to oropharyngeal cancer.
People with oropharyngeal carcinoma have a higher risk of head and second primary neck cancer.
Hypopharynx
Hypopharynx includes sinus pyriform, posterior pharyngeal wall, and postcricoid area. Hipopharyngeal tumors often have an advanced stage at diagnosis, and have the worst prognosis of a pharyngeal tumor. They tend to metastasize early because of extensive lymphatic tissue around the larynx.
Larynx
Laryngeal cancer begins in the larynx or "voice box." Cancer can occur in the vocal cords (cancer "glottis"), or on the tissues above and below the actual ropes ("supraglottic" and "subglotis" respectively). Laryngeal cancer is strongly associated with smoking tobacco.
Surgery may include laser excision of small vocal cord lesions, partial laryngectomy (partial removal of the larynx) or total laryngectomy (removal of the entire larynx). If the entire larynx has been removed, the person is left with a permanent tracheostomy. Sound rehabilitation in such patients can be achieved through 3 important ways - esophageal speech, tracheoesophageal or electrolyngary puncture. One may need the help of intensive talk and talk therapy and/or electronic devices.
Trachea
Tracheal cancer is a rare cancer that can be similar to head and neck cancer, and is sometimes classified as such.
Most salivary gland tumors are different from common carcinoma of the head and neck on the cause, histopathology, clinical presentation, and therapy. Other unusual tumors that occur in the head and neck include teratoma, adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma. More rarely are melanomas and lymphomas from the upper aerodigestive tract.
Maps Head and neck cancer
Cause
Alcohol and tobacco
Approximately 75% of cases are caused by alcohol and tobacco use.
Tobacco smoke is one of the major risk factors for head and neck cancer and one of the most carcinogenic compounds in tobacco smoke is acrylonitrile. (See Smoking tobacco). Acrylonitrile appears to indirectly cause DNA damage by increasing oxidative stress, leading to elevated levels of 8-oxo-2'-deoxyguanosine (8-oxo-dG) and formamidopyrimidine in DNA (see figure). Both 8-oxo-dG and formamidopyrimidine are mutagenic. NEIL1 glycosylase DNA prevents mutagenesis by 8-oxo-dG and removes formamidopyrimidine from DNA.
Smokers smokers, however, have an increased lifetime risk for head and neck cancers that increase 5 to 25 times more than the general population. The risk of former smokers for squamous cell cancer on the head and neck is approaching risk in the general population twenty years after quitting smoking. The high prevalence of tobacco and alcohol use worldwide and the high association of these cancers with these substances make them the ideal target for improving cancer prevention.
Smokeless tobacco is a cause of oral and pharyngeal cancer (oropharyngeal cancer). Cigar smoking is an important risk factor for oral cancer as well.
Other environmental carcinogens suspected of potential causes of head and neck cancer include occupational exposure such as nickel refining, textile fiber exposure, and woodworking. The use of marijuana, especially when young, is associated with an increase in cases of squamous cell carcinoma while other studies have shown that use has not been shown to be associated with oral squamous cell carcinoma, or is associated with a decrease in squamous cell carcinoma.
Diet
Excessive consumption of processed meat and red meat was associated with increased rates of head and neck cancer in one study, while consumption of raw and cooked vegetables appeared to be protective.
Vitamin E was not found to prevent the development of leukoplakia, a white plaque that is a precursor to mucosal surface carcinoma, in adult smokers. Another study examined the combination of Vitamin E and beta carotene in smokers with oropharyngeal early cancer, and found a poorer prognosis in vitamin users.
Pin
Chewing betel nut is associated with an increased risk of squamous cell cancer in the head and neck.
Infection
Human papillomavirus
Some head and neck cancers are caused by Human papillomavirus (HPV). Especially HPV16, is a contributing factor for some squamous cell carcinomas of the head and neck (HNSCC). Approximately 15 to 25% of HNSCC contain genomic DNA from HPV, and associations vary by tumor site, especially HPV-positive oropharyngeal cancers, with the highest distribution in the tonsils, where HPV DNA is found in (45 to 67%). ) of cases, less commonly in the hypopharynx (13% -25%), and most rarely in the oral cavity (12% -18%) and larynx (3% -7%).
Some experts estimate that while up to 50% of cancers can be infected with HPV, only 50% of this is likely to be caused by HPV (compared to ordinary tobacco and alcohol). The role of HPV in the remaining 25-30% is unclear. Oral sex is not risk free and produces a significant proportion of HPV head and neck cancers.
A positive HPV16 status was associated with an increased prognosis compared to the HPV-negative OSCC.
HPV can induce tumors with several mechanisms:
- E6 and E7 oncogenic proteins.
- Gene suppressor tumor disorders.
- High-level DNA amplification, for example, oncogenes.
- Produce an alternative nonfunctional transcript.
- the interchromosomal rearrangement.
- Genome genome metrics and different gene expression patterns, generated even when the virus is not integrated into the host genome.
Cancer induction can be attributed to the most important viral, E6 and E7 oncoprotein expression, or other mechanisms many of which are run by integration such as altered transcript generation, tumor suppressor disorders, high levels of DNA amplification, interchanging of interchromosomial, or altered DNA methylation patterns , the latter can be found even when the virus is identified in the episode. E6 sequesters p53 to promote p53 degradation while pRb inhibits E7. p53 prevents cell growth when DNA is damaged by activating apoptosis and p21, the kinase inhibiting the formation of cyclin D/Cdk4 avoids phosphorylation of pRb and thus preventing the release of E2F is the transcription factor necessary for gene activation involved in cell proliferation. pRb remains bonded to E2F while the action is phosphorylated which prevents the activation of proliferation. Therefore, E6 and E7 act synergistically in triggering the development of cell cycle and therefore uncontrolled proliferation by deactivating p53 and Rb tumor suppressors.
Virus integration tends to occur within or near oncogenes or tumor suppressor genes and for this reason viral integration can contribute greatly to the development of tumor characteristics.
Epson.E2.80.93Barr_virus "> Epstein-Barr Virus
Epstein-Barr virus (EBV) infection is associated with nasopharyngeal cancer. Nasopharyngeal cancer occurs endemically in some countries in the Mediterranean and Asia, where the antibody titer of EBV can be measured to screen high-risk populations. Nasopharyngeal cancer is also associated with consumption of salted fish, which may contain high levels of nitrite.
Gastroesophageal reflux disease
The presence of acid reflux disease (GERD - gastroesphogeal reflux disease) or laryngeal reflux disease can also be a major factor. Stomach acids that flow through the esophagus can damage the lining and increase susceptibility to throat cancer.
Hematopoietic stem cell transplant
Patients after hematopoietic stem cell transplantation (HSCT) are at a higher risk for oral squamous cell carcinoma. Post-HSCT oral cancer may have more aggressive behavior with a worse prognosis, when compared with oral cancer in non-HSCT patients. This effect should be due to continuous lifetime immune suppression and chronic graft-versus-host disease.
Other possible causes
There are various factors that can put a person at high risk for throat cancer. These factors include smoking or chewing tobacco or other things, such as gutkha, or paan, heavy alcohol consumption, poor diet that results in vitamin deficiency (worse if this is caused by a high intake of alcohol), weakened immune system , asbestos exposure, prolonged exposure to wood dust or paint smoke, exposure to petroleum chemical chemicals, and aged over 55 years. Other risk factors include the appearance of white patches or freckles in the mouth, known as leukoplakia; in about 1/3 of these cases develop into cancer. Other high risk: breathe or breathe silica from cutting concrete, stone or cinder-block, especially in enclosed areas such as warehouses, garages or basements.
Diagnosis
Someone usually complains to the doctor about one or more of the above symptoms. People will usually undergo a needle biopsy of this lesion, and histopathological information is available, a multidisciplinary discussion of the optimal treatment strategy will be performed between radiation oncologists, surgical oncologists, and medical oncologists.
Histopathology
Throat cancer is classified according to their histology or cell structure, and is often referred to by its location in the oral cavity and neck. This is because where cancer appears in the throat affects prognosis - some throat cancers are more aggressive than others depending on their location. The stage at which cancer is diagnosed is also an important factor in the prognosis of throat cancer. Treatment guidelines recommend routine testing for the presence of HPV for all oropharyngeal squamous cell carcinoma tumors.
Squamous cell carcinoma
Squamous cell carcinoma is squamous cell cancer - a type of epithelial cells found in the skin and mucous membranes. It accounts for more than 90% of all head and neck cancers, including over 90% of throat cancers. Squamous cell carcinoma is most likely to occur in men over the age of 40 years with a history of heavy alcohol use coupled with smoking.
Cyfra 21-1 tumor markers may be useful in diagnosing carcinoma of the squamous cell head/neck (SCCHN).
Adrenalcinoma
Adenocarcinoma is an epithelial tissue cancer that has glandular characteristics. Some head and neck cancers are adenocarcinomas (either from intestinal or non-intestinal cell types).
Prevention
Avoiding recognized risk factors (as described above) is the most effective form of prevention. Routine dental examination can identify pre-cancerous lesions in the oral cavity.
When diagnosed with early cancer, the mouth, head and neck can be treated more easily and the likelihood of survival increases remarkably. By 2017 it is not known whether existing HPV vaccines can help prevent head and neck cancer.
Management
Improvements in local diagnosis and management, as well as targeted therapies, have led to improved quality of life and survival for people with head and neck cancers.
Once the histologic diagnosis has been established and tumor levels are determined, the selection of appropriate treatment for certain cancers depends on a complex array of variables, including the location of the tumor, the relative morbidity of various treatment options, concurrent health problems, social factors and logistics, previous primary tumors, and preference that person. Care planning generally requires a multidisciplinary approach involving specialist surgeons and medical and radiation oncologists.
Surgical resection and radiation therapy is a mainstay of care for most head and neck cancers and remains the standard of care in most cases. For small primary cancers without regional metastases (stage I or II), extensive surgical excision or curative radiation therapy alone are used. Larger primary tumors, or those with regional metastasis (stage III or IV), planned combinations of pre- or postoperative radiation and complete surgical excision are commonly used. More recently, as survival and historical control levels are recognized to be less than satisfactory, there is an emphasis on the use of various induced or simultaneous chemotherapy regimens.
Surgery
Surgery as a treatment is often used in most types of head and neck cancers. Usually the goal is to remove cancer cells completely. This can be very complicated if the cancer is near the larynx and may cause people to not speak. Surgery is also commonly used to rescue some or all of the cervical lymph nodes to prevent further spread of the disease.
CO 2 laser surgery is another form of treatment. Transoral micro surgery allows the surgeon to remove the tumor from the voice box without an external incision. It also allows access to tumors that can not be reached by robotic surgery. During surgery, surgeons and pathologists work together to assess the adequacy of excision ("margin status"), minimizing the amount of normal tissue removed or damaged. This technique helps provide as many people as possible talk and swallowing function after surgery.
Radiation therapy
Radiation therapy is the most common form of treatment. There are various forms of radiation therapy, including conformal 3D radiation therapy, intensity modulated radiation therapy, particle file therapy and brachytherapy, which is commonly used in the treatment of head and neck cancers. Most people with head and neck cancers treated in the United States and Europe are treated with radiation-modulated intensity therapy using high-energy photons. At higher doses, head and neck radiation is associated with thyroid dysfunction and pituitary axis dysfunction.
Chemotherapy
Chemotherapy in throat cancer is generally not used to cure such a cancer. Instead, it is used to provide an environment unfriendly to metastasis so that they will not form in other parts of the body. A typical chemotherapy agent is a combination of paclitaxel and carboplatin. Cetuximab is also used in the treatment of throat cancer.
Docetaxel-based chemotherapy has shown an excellent response to local head and neck cancers. Docetaxel is the only taxane approved by the US FDA for head and neck cancer, in combination with cisplatin and fluorouracil for the treatment of indivisible and inoperable induced carcinoma of squamous cell carcinoma in the head and neck.
Although not specifically chemotherapy, amifostine is often given intravenously by chemotherapy clinics prior to IMRT radiotherapy sessions. Amifostine protects the gums and salivary glands from the effects of radiation.
Photodynamic therapy
Photodynamic therapy may have promise in treating mucosal dysplasia and small head and neck tumors. Amphinex provides good results in early clinical trials for the treatment of advanced head and neck cancers.
Targeted therapies
Targeted therapy, according to the National Cancer Institute, is "a type of treatment that uses drugs or other substances, such as monoclonal antibodies, to identify and attack certain cancer cells without damaging normal cells." Some targeted therapies used in squamous cell cancers of the head and neck include cetuximab, bevacizumab and erlotinib.
The best quality data is available for cetuximab since the 2006 publication of a randomized clinical trial comparing radiation treatment plus cetuximab rather than radiation treatment alone. The study found that concurrent cetuximab and radiotherapy improved the survival and control of locoregional disease compared with radiotherapy alone, without substantial improvement in side effects, as expected with concurrent chemoradiotherapy, which is the current standard gold treatment for advanced head and neck cancers. While this study is very important, interpretation is difficult because cetuximab-radiotherapy is not directly compared with chemoradiotherapy. Ongoing research results to clarify the role of cetuximab in this disease are awaited with interest.
Another study evaluated the effect of cetuximab addition on conventional chemotherapy (cisplatin) versus cisplatin alone. The study found no improvement in survival or disease-free survival with the addition of cetuximab to conventional chemotherapy.
However, another study completed in March 2007 found that there was an increase in survival.
A 2010 review concluded that the combination of cetuximab and platin/5-fluorouracil should be considered as a standard first-line regimen today.
Gendicine is a gene therapy that uses adenovirus to deliver the tumor suppressor gene of p53 to the cell. It was approved in China in 2003 for the treatment of squamous cell carcinoma of the head and neck.
The profile of HPV and HPV mutations- head and neck cancer has been reported, increasingly suggesting that they are essentially different diseases.
Prognosis
Although early-stage head and neck cancers (especially the larynx and oral cavity) have a high cure rate, up to 50% of people with head and neck cancer present with advanced disease. The healing rate decreases in advanced local cases, whose healing possibilities are inversely proportional to the size of the tumor and even more to the level of regional nodal involvement.
The consensus panel in America (AJCC) and Europe (UICC) has established a staging system for squamous cell cancers of the head and neck. The staging system seeks to standardize clinical trial criteria for research studies, and attempts to define prognostic disease categories. Head and neck squamous cell cancers are performed in accordance with the TNM classification system, where T is the size and configuration of the tumor, N is the presence or absence of lymph node metastases, and M is the presence or absence of distant metastases. Characteristics of T, N, and M are combined to produce a "stage" of cancer, from I to IVB.
Second preliminary issue
The survival provided by the new treatment modalities has been undermined by a significant percentage of people recovering from head and neck squamous cell carcinoma (HNSCC) which later develops a second primary tumor. The incidence of a second primary tumor ranged from a study of 9% to 23% at 20 years. The second primary tumor is a major threat to long-term survival after successful early-stage HNSCC therapy. The high incidence is generated from the same carcinogenic exposure that is responsible for the initial primary process, called cancer of the field.
Digestive System
Because it can damage a person's ability to swallow and eat, throat cancer affects the digestive system. Difficulty swallowing can cause a person to choke their food in the early stages of digestion and disrupt the smooth food journey into the esophagus and so on.
Treatment for throat cancer can also be harmful to the digestive system as well as other body systems. Radiation therapy can cause nausea and vomiting, which can uproot the body of vital fluids (although this can be obtained through intravenous fluids if necessary). Frequent vomiting can cause electrolyte imbalances that have serious consequences for the functioning of the heart. Often vomiting can also disrupt the balance of stomach acid that has a negative impact on the digestive system, especially the stomach and esophageal lining.
Respiratory system
In some cases of throat cancer, the airways in the mouth and behind the nose can be clogged from a lump or swelling from open sores. If a throat cancer is near the bottom of the throat, it is likely to spread to the lungs and interfere with a person's ability to breathe; this is even more likely if the person is a smoker, as they are very susceptible to lung cancer.
More
Like other cancers, metastasis affects many parts of the body, because the cancer spreads from cell to cell and organ to organ. For example, if it spreads to the bone marrow, it will prevent the body from producing enough red blood cells and affect the functioning of white blood cells and the immune system; spreading to the circulatory system will prevent oxygen transferred to all body cells; and throat cancer can cause the nervous system to become chaotic, so it can not regulate and control the body properly.
Care side effects
Depending on the treatment used, People with head and neck cancer may experience the following symptoms and treatment side effects:
Epidemiology
The number of new cases of head and neck cancer in the United States was 40,490 in 2006, accounting for about 3% of adult malignancies. 11,170 people died of their disease in 2006. Incidence worldwide exceeds half a million cases per year. In North America and Europe, tumors usually arise from the oral cavity, oropharynx, or larynx, whereas nasopharyngeal cancer is more common in Mediterranean countries and in the Far East. In Southeast China and Taiwan, head and neck cancer, especially nasopharyngeal cancer is the most common cause of death in young men.
- In 2008, there were 22,900 cases of oral cancer, 12,250 cases of laryngeal cancer, and 12,410 cases of pharyngeal cancer in the United States.
- In 2002, 7,400 Americans were projected to die of this cancer.
- More than 70% of throat cancers are present at an advanced stage.
- Men are 89% more likely than women diagnosed, and nearly twice as likely to die, this cancer.
- African Americans are disproportionately affected by head and neck cancer, with a younger age of incidence, increased mortality, and more advanced disease at presentation. The incidence of laryngeal cancer is higher in African-Americans compared with white, Asian and Hispanic populations. There is a lower survival rate for similar tumor countries in African Americans with head and neck cancer.
- Smoking and tobacco use are directly related to oropharyngeal cancer death (throat).
- Head and neck cancer increases with age, especially after 50 years. Most people are between 50 and 70 years old.
Research
Immunotherapy with immune inhibitory inhibitors is being investigated in head and neck cancers.
References
External links
- Head and Neck Cancer at MedlinePlus (National Library of Medicine)
- Head and Neck Cancer Treatment at RadiologyInfo
- Cancer Head and Neck at Cancer.net (American Society of Clinical Oncology)
Source of the article : Wikipedia
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