These are growths that primarily occur anywhere in the head (excluding the brain) and neck. Head and neck tumors may be benign or malignant (cancerous) and oftentimes the cause is unknown. Most head and neck cancers arise after prolonged exposure to risk factors such as tobacco, excessive alcohol use, a history of pre-cancerous lesions including HPV infections or exposure to environmental cancer-causing agents.
Symptoms
Benign tumors of the head and neck often cause no symptoms other than the presence of a hard or firm lump. Other symptoms are site-specific and are due to direct pressure by the slow growing tumor on adjacent structures. Cranial extension of head and neck cancers often involves areas of the respiratory tract, the digestive tract, as well as the visual tracts, thus often interfering with the vital functions of eating, seeing and breathing. However, in many occasions, early symptoms or warning signs are subtle and non-specific and many of these symptoms can be caused by other, non-cancerous conditions.
Some of the most common presenting symptoms of head and neck cancers are:
- A lump or swelling in the neck
- A sore in the mouth that does not heal or that bleeds easily
- A red or grayish patch in the mouth
- Frequent bleeding per nose, ongoing nasal congestion or chronic sinus infections
- Persistent sore throat
- Persistent hoarseness or a change of voice
- Persistent pain in the neck, throat or ears
- Blood-tinged sputum
- Difficulty chewing, swallowing or moving the jaws or tongue
- Numbness in the tongue or other areas
- Loosening of teeth or dentures that no longer fit
Diagnosis
Physical examination focusing on the head and neck area and a thorough medical history noting all the symptoms and risk factors associated with the development of different types of head and neck tumors are the first steps in the diagnosis.
Radiographic imaging tests include plain x-rays, computed tomography (CT) scans and magnetic resonance imaging (MRI). Positron emission tomography (PET) scans may also be useful in some cases. Other possible tests in malignant cases to scan for metastasis or primaries in other areas of the body include ultrasound, chest x-rays and radionuclide bone scans.
Subsequently, a biopsy (cutting a small piece of the tumor and sending it for histopathological examination) is typically taken from the suspected tumor. The biopsy is often the most important piece of information and the only definite way to differentiate benign from malignant neoplasms. If the suspicious lesion is in the mouth or nose, the biopsy can often be done in the office on an outpatient basis. However, if it is located in deeper regions, the biopsy will probably be done in the operating room under a general anesthetic – this is usually done endoscopically.
Treatment
Surgery is usually the mainstay of treatment for most head and neck tumors. Benign tumors are generally treated with surgery alone. Treatment options for malignant tumors include surgery, radiotherapy, chemotherapy, or a combination of the three. In some cases, surgery is combined with craniofacial reconstructive surgery to obtain a better cosmetic outcome. Distant and loco-regional metastases, when found, should be treated accordingly with surgery, radiotherapy or chemotherapy.
Radiation therapy may involve external beam treatment, Gamma Knife of brachytherapy. Radiation therapy is often given in conjunction with surgical treatment, but in some inoperable cases, it is combined with chemotherapy. These multi-modal approaches can often preserve the patient’s ability to speak and swallow even in patients with advanced disease.
Rehabilitation therapy is often an integral part of the treatment plan for patients with head and neck cancer and continuous evaluation of each patient’s individual needs together with physical and functional rehabilitation provides a means to improve mobility and function following treatment.
Prognosis
Benign neck masses are treated by surgical removal of the primary tumor in its entirety and typically have a good prognosis. For malignant head and neck cancers, early detection and treatment is of utmost importance. Occasionally salvage surgery or salvage radiation therapy are appropriate. Although cure of the cancer is the primary goal in treatment, preserving a patient’s appearance and ability to function, and thus quality of life, are also important goals and are considered an integral part of the treatment plan.
Our physicians at Affiliated Ear, Nose and Throat Physicians are experts in investigating and treating head and neck tumors.