Head and Neck Cancers: Symptoms, Screening and Diagnosis
Head & Senior Consultant – Head & Neck Oncology
Posted on : Dec 24, 2021
Head and neck cancers (HNC) are a group of cancers affecting the mouth (oral cavity), pharynx, larynx, nose, and sinuses. It also includes various subsite within the oral cavity viz, tongue, buccal, palate, lip, upper and lower jaw. The majority of oral cancers are caused by tobacco use. (Refer to the previous blog on risk factors for details). HNC is one of the most common cancers in India with estimated 250,000 new patients being diagnosed every year.
Head & Neck Cancer Symptoms:
The HNC affects vital organs associated with speech, swallowing, chewing voice, breathing etc. therefore patients with HNC usually develop symptoms early. Any of the following symptoms if persists more than 3 weeks, particularly in tobacco users warrants an evaluation by a qualified oncologist to rule out cancer.
- Persistent ulcer.
- White or red patch.
- Lump or swelling in mouth, throat, or neck.
- Inability to open mouth
- Pain during swallowing, mastication
- Loose tooth
- Difficulty in swallowing
- A foreign body or sticky sensation in the throat
- Persistent earache
- Change of voice
- Difficulty in breathing
- Hoarseness of voice
- Blood-stained saliva, sputum
- Unexplained weight loss
This is not an exhaustive list but the usual symptoms. These mimic common conditions like cold or aphthous ulcers and may respond to usual remedies. However, any complaint that persists for more than 3 weeks should alert both primary care physician and the patient. Particularly in high-risk individuals who are current or former tobacco users.
Screening: The purpose of screening is to detect cancer early so that appropriate treatment can be initiated. HNC has excellent outcomes if the lesions are detected in pre-cancerous or early stages. For example, a precancerous leukoplakia has a 100% cure rate as compared to 30-40% for a stage IV oral cancer. Thus, underscoring the importance of screening for HNC. Unfortunately, 80 % of HNC in India are diagnosed in advanced stages limiting chances of cure. Patients tend to neglect the symptom for a long during such time the disease progresses to advanced stage.
Screening for HNC is relatively simpler as mouth is easily assessable, throat and voice box examination can be performed as an officer procedure. Screening of the entire population on a regular interval is ideal for early detection, however the feasibility of such a screening is resource intense. The studies have shown that the screening is most helpful in a high risk population of tobacco users. Thereby detecting cancers early and reducing mortality and morbidity.
Oral screening can be done by high-risk individuals is called as oral self-examination. High risk individuals are taught
1. How to look?
2. What to look?
Similarly, paramedical staff, dentist and community level practitioners can be taught pick suspicious lesions which can be referred for expert opinion. Efforts are on-going to transmit images to experts using mobile phones for instant opinion. Artificial intelligence may have role in differentiating malignant verse nonmalignant lesion in future.
Diagnosis for Head & Neck Cancers :
In order to establish the diagnosis a small tissue from edge of growth/ ulcer (5mm) is send for pathological testing. This is called incisional biopsy. Pathologist will then confirm or rule out cancerous lesion. There is a myth that doing a biopsy causes the cancer to spread. The purpose of biopsy is to establish a diagnosis and does not promote cancer growth or rapid spread.
Book an appointment online to consult with a head & neck cancer specialist in India.