Head and Neck Cancer Introduction Page
oral cavity
oropharynx (soft palate, tonsil, base of tongue)
larynx (voice box)
hypopharynx (pyriform sinus, posterior phanryngeal
wall, post-cricoid region)
nasal cavity/paranasal sinuses
nasopharynx
salivary glands
paragangliomas (glomus tumors)
thyroid
Oral Cavity
•Background
•Signs and Symptoms
•Clinical Evaluation
•Treatment
•Follow-Up
Illustration courtesy of Lippincott Williams & Wilkins
© 2004
The oral cavity includes the lips, gums, front part (anterior) of the tongue, floor of mouth, hard palate and inner surface of the cheeks.
Patients who use tobacco (especially cigarettes and chewing tobacco) or who drink alcohol excessively have a higher rate of developing oral cancers. The combination of both tobacco and alcohol use markedly increases the possibility of having oral cancer. Poor oral hygiene may also be a factor. Although oral cancers usually occur in people over the age of 40, people younger than 40 may also be effected.
Many oral cavity cancers are detected by a primary care physician or dentist before symptoms develop. When the signs and symptoms of oral cavity cancer do develop, they may vary according to the site and size of the tumor. The signs and symptoms include a painful, non-healing or enlarging sore; bloody saliva; oral discomfort associated with opening the mouth, moving the tongue, or swallowing; a white or red area that persists; dentures that no longer fit properly; and enlarging neck glands.
Clinical Evaluation
The physician evaluating you for a possible oral cavity tumor will obtain
a history of your condition (including any medical problems) and perform
a thorough head and neck examination. A biopsy of the tumor will be performed
to establish the diagnosis. A CT scan (which uses X-rays to create a two-dimensional
image of the area), or an MRI scan (which uses a magnetic field and pulses
of radio wave energy to visualize the detailed anatomy), will be performed
to evaluate the primary tumor extent and to determine if there are lymph
nodes involved with tumor. A CT scan of the chest may also be performed
to evaluate possible tumor spread. A PET scan, which creates computerized
images of the metabolic changes that occur in tissue, is sometimes used
to identify areas of tumor involvement throughout the body.
These scans complement each other by providing specific information about the tumor, which will eventually determine the best course of treatment. Sometimes a fine needle aspiration biopsy will be performed on a mass or lymph node to define the extent of tumor. A fine needle aspiration biopsy involves inserting a small needle into the mass and withdrawing cells. The pathologist examines these cells under a microscope to see if they are cancerous.
Treatment
Oral cavity cancer is generally treated by surgery. The amount of surgery
depends on the extent of the tumor. All patients are urged to discontinue
any alcohol or tobacco use. Although obtaining a cure is the most important
goal, a surgeon always considers the method of resection that will result
in the best postoperative function and cosmetic results. Larger oral cavity
tumors may have spread to detectable or non-detectable involved lymph
nodes in the neck. If this is the case, surgery may have to be performed
to remove these nodes in combination with the primary site of cancer.
Radiation therapy
may be used after surgery, depending on the results of microscopically
examining the tissue removed at surgery.
In certain circumstances, radiation therapy may be used instead of surgery as the primary treatment. Advanced tumors may require initial treatment with radiation and/or chemotherapy. Surgery may or may not be used, depending on the extent of the tumor. At Continuum Cancer Centers, an experimental protocol is being used in some advanced tongue cancer patients. It consists of radiation therapy and high dose chemotherapy injected into the blood supply to the tumor in those patients where initial surgery might result in major sacrifice of the tongue tissue.
Click Here for more information about radiation oncology treatments for head and neck cancer.
After treatment is completed, the patient enters the follow-up phase.
Usually, all of the treating physicians are involved in follow-up evaluations.
For the first year, patients are usually seen every one to two months.
During the second year, they are often seen every two to three months.
After the second year, patients are usually seen every three to six months.
Of course, the follow-up schedule is individualized for each patient.
Imaging procedures like CT scans, PET scans, or fused PET/CT scans, are
done according to a routine that is individualized for each patient. Not
all patients require these studies. A chest X-ray is usually done on an
annual basis. Regular dental evaluation is done, because good dental care
is essential to the head and neck health.