Information is power, especially when it comes to health. Time and effort invested in learning about your disease, your treatment options and their likely outcomes are indeed well spent.
You can follow the links mentioned below to learn more about the various aspect of mouth and throat cancer. Remember, as a patient, one of the best steps you can take to improve the chances of beating your cancer is to get informed about it. However you must aim togain information from reliable sources avoiding newspaper or magazine and Internet articles that are not based on thorough analysis of scientific evidence. This is difficult given the millions of articles out there. Therefore,for your convenience I have provided relevant and reliable answers that are based on best available scientific evidence. Most of the information I have mentioned below is based on my experience and knowledge and is based on guidelines issued by government or medical associations from USA and UK.

Head and neck cancer refers to cancer of the following areas of your body

Mouth (Oral cavity):

  • Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor (bottom) of the mouth under the tongue, the bony roof of the mouth(hard palate), and the small area of the gum behind the wisdom teeth.

Throat (Pharynx):

The pharynx (throat) is a hollow tube about 5 inches long that starts behind the nose and leads to the food pipe (oesophagus). It has three parts:

  • Nasopharynx - The top part of the throat, behind the nose.
  • Oropharynx - The middle part of the throat. This includes the soft roof at the back of mouth(the soft palate), the backend of the tongue, and the tonsils.
  • Hypopharynx - The bottom part of the throat that lies behind your voicebox and leads to the food pipe (oesophagus).

Voice Box (Larynx):

Larynx is the medical term for your voice boxthat, at its lower end, leads to the windpipe (Trachea). The larynx contains the vocal cordswhere speech sound is produced. It has muscles to close it off while swallowing in order to prevent food from entering the air passages.

In addition to these, cancer of the following regions are also included. However, they have different risk factors.

Paranasal sinuses and Nasal cavity:

The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.

Salivary glands:

The major salivary glands are in the floor of the mouth and near the jawbone. The salivary glands produce saliva.


Cancer is caused by interaction of your genes with environmental chemicals, usually due to lifestyle behaviors. You cannot change your genes but can change what chemicals you are exposing your body to.
Presently we do not exactly know what specific genes place you at a higher risk of developing head and neck cancer. However, we know that exposure to certain chemicals raise your risk tremendously.
Tobacco and Alcoholuse are the two most important risk factors for head and neck cancers.
Tobacco smoking in any form - Cigarettes, Bidis, Hookah, Chillum, reverse chutta smoking, and hookli - all raise the risk of developing cancer.
This also includes consumption of Paan, Guthka, Zarda, Mawa, Khainnietc - all of these have tobacco along with areca nut (supari) and lime. Tobacco is also present in Naswar/Naas and some people also apply dried tobacco to the gums.
Consuming tobacco for more than 20 years is considered a strong risk factor. However you must remember that the risk of cancer in context of quantity and duration of tobacco consumption will be strongly affected by your genetic disposition (that we can NOT measure). Thus for some, consuming tobacco for shorter duration may lead to cancer while for others, even a lifelong consumption of tobacco may not lead to cancer. It is all about risk - what you need to remember is that though no one can tell if you will certainly develop cancer by consuming tobacco, what we can tell you with certainty is that you will be placing yourself at risk of getting cancer if you consume tobacco, and the risk will get stronger the more you smoke every day and the longer you smoke or if you consume alcohol and or chew tobacco in addition.
The second major risk factor is consumption of alcohol, especially for oral and pharyngeal cancer. People who drink regularly in significant quantity have 2 -3 fold higher risk of developing head and neck cancer than non-drinkers.
People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone. Infact the risk of oral cancer is increased upto 11 times by consuming both tobacco and alcohol and even higher by chewing tobacco!
Tobacco and alcohol use are not risk factors for salivary gland cancers.
Infection with cancer-causing types of a specific virus, human papillomavirus (HPV), especially HPV-16, is a risk factor for some types of head and neck cancers, particularly throat cancers that involve the tonsils or the base of the tongue.
Lack of adequate Iron in diet leading to anemia, especially in females is also associated with cancer of the mouth, throat and the upper end of food pipe.

Other less common risk factors for cancers of the head and neck include the following :

  • Occupational exposure - Wood dust is a risk factor for nasopharyngeal cancer. Asbestos and synthetic fibers have been associated with cancer of the larynx, but the increase in risk remains controversial. People working in certain jobs in the construction, metal, textile, ceramic, logging, and food industries may have an increased risk of cancer of the larynx.
  • Use of mouthwash that has high alcohol content is a possible, but not proven, risk factor for cancers of the oral cavity.
  • Poor oral hygiene, missing teeth or teeth that consistently hurt and cause ulcers on your tongue may be a weak risk factors for cancers of the oral cavity.
  • Industrial exposure to wood or nickel dust or formaldehyde is a risk factor for cancers of the paranasal sinuses and nasal cavity.
  • Radiation exposure to the head and neck, for noncancerous conditions or cancer, is a risk factor for cancer of the salivary glands.
  • Consumption of certain preserved or salted foods during childhood is a risk factor for nasopharyngeal cancer.
  • Epstein-Barr virus infection is a risk factor for nasopharyngeal cancer and cancer of the salivary glands.
  • Chinese ancestry is a risk factor for nasopharyngeal cancer.

Symptom refers to out of normal sensations of conditions that you may be aware of. Seek medical opinion if you experience one or more of the following symptoms –

  • Non-healing ulcer anywhere in mouth or throat for more than three weeks or unexplained loose tooththat is not associated with gum disease.
  • Persistent discomfort in the throat for more than four weeks, particularly if only on one side and if associated with sharp pain that seems to go up to the ear.
  • Pain on swallowing persisting for three weeks that does not resolve with antibiotics.
  • Difficulty in swallowing, which persists for more than three weeks, particularly if you have lost weight.
  • Noisy breathing or difficulty in breathing, called Stridor in medical terms (seek URGENT medical assessment).
  • Hoarse voice for more than 3-4 weeks, especially if you have noticed blood in your saliva or in your sputum on coughing.
  • Head or neck swelling that persists for more than three weeks, especially if it continues to get bigger. Pain may or may not be there.
  • Mucus discharge from ONE nostril that persists for more than three weeks, particularly if associated with blood and or disturbance in vision.
  • Paralysis or weakness of the face (without any diagnosis of Stroke) or severe facial pain or numbness.

These symptoms may be present due to infection or inflammation without cancer. However in adults, especially if you have any of the risk factors mentioned above, it is best to get a thorough medical check up by a head and neck cancer specialist.
Before you get cancer, the body tissue go through a series of changes that fall between normal and cancer, called as dysplasia. These are precancerous condition. This includes persistent white patches (leukoplakia), red patches (erythroplakia) and/or sub-mucosal fibrosis (white scarring of oral cavity that restricts the ability to open mouth completely). If your disease is caught at these stages, in majority of cases, by completely stopping the high-risk behavior mentioned above, you could eliminate the risk of these lesions progressing on to cancer.
Even if the disease has progressed on to become a cancer, remember, we have the best chance of curing cancer if we find it at an early stage. So do not ignore the presence of any of these symptoms and seek specialist opinion as soon as practicable.

Unfortunately, due to widespread common practice of consuming Paan, Guthka, Tobacco and alcohol, India has the highest incidence of head and neck cancer in the world. Let us look at some figures for our country from an article published in 2013.

Head and neck cancer accounts for 30% out of all cancers in males and 11 % -16%in females. (For comparison,overall this figure is 3% in USA and 4% in UK).

The number of new cases diagnosedevery year with head and neck cancer is over 200,000 in India. (For comparison these figures are 52,000 in USA and 8100 in England and Wales).

Our country has almost one third (31%) of all throat cancers in the world and one fifth (18%) of all voice box cancers in the world.

Most head and neck cancer in our country is in the mouth, the majority of which are located between the cheek and the gum, where the paan or guthka/zarda is kept for long periods.

As you can see, the practice of high-risk behavior is having a catastrophic effect on the health of our people. To make matters worse, most of these cancers; almost 80% are diagnosed at an advanced stage and therefore have worse chances of cure and surviving the disease.

The single most effective step you can take to reduce the risk of getting head and neck cancer is to stop consumption of Paan, Guthka (and similar products) and tobacco; in any form and limit your consumption of alcohol. You can follow this link to look at recommendation by NHS in UK (There is no equivalent recommendation made by any Indian agency)

http://www.patient.co.uk/health/Recommended-Safe-Limits-of-Alcohol.htm

People who are at risk of head and neck cancers―particularly those who use paan, guthka and or tobacco―should talk with their doctor about available medications that can help them stop these addictions. They should also discuss with their doctor how often to have checkups.

Avoiding oral HPV infection by safe sexual practice may reduce the risk of HPV-associated head and neck cancers. RecentlyHPV vaccinesGardasil® and Cervarix® has become available and its administration to younger people may help protect against the risk of developing head and neck cancer caused by HPV.

There is some evidence to support healthy diet rich in vegetable, fruits, Iron, Zinc, Copper, Ascorbic acid and Beta carotene as these can decrease the risk of developing precancerous lesions and thus cancer. Patients with Iron deficiency anemia should get Iron supplements to improve their general health and to reduce the risk of cancer.

Common sense measures such as use of good quality facemasks may be beneficial for workers that are exposed to the cancer causing chemicals mentioned above.

This starts by seeing you in my clinic where I will discuss your medical history and then examine you. This in most cases requires visualization with a special thin scope that is passed either through one of your nostril or your mouth in the clinic. In case I find anything suspicious, I may request a CT/MRI or other appropriate scan and X-Rays. Subsequently in most cases where I find something out of normal, I examine the whole head and neck region while you are asleep under a general anesthesia to get better information about the extent of disease and to take small bits of tissue (called as biopsy) from the area of concern. If the disease is easily accessible and in your mouth, I can take biopsies in the clinic after using medicines to numb that area. Examination of these sample of tissue under a microscope is necessary to confirm a diagnosis of cancer.

If the diagnosis is cancer, we will combine information gained through the scans and clinical examination (both awake in clinic and while you were under anesthesia) to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease is important to help us plan treatment and to give you some idea about your chance of cure.

Across the world, head and neck cancer are first staged for three attributes T, N and M, commonly called TNM stage.

  • Tumor (T) refers to the size of the cancer where it started and to which, if any, tissues in the adjacent areas the cancer has spread. For each area, the cancer is staged from T1 to T4.
  • Node (N) describes the involvement of lymph nodes in your neck. Lymph nodes are small, bean-shaped clusters of immune system cells that are key to fighting infections and the ones in your neck are usually one of the first sites in the body to which cancer spreads. Patients are graded from N1 to N3.

“For patients with curable cancer, spread to nodes in the neck is a major event as, generally speaking, this reduces the chances of cure by almost half.”

  • Metastasis (M) indicates whether the cancer has spread (metastasized) to other areas of the body outside head and neck. With head and neck cancer, the most common site of metastases is the lung, followed by the liver and bones. Head and Neck cancer are said to be M0 if there is no spread or M1 if the cancer has spread elsewhere.

“For most patients with cancer that has metastasized, cure is not possible. However, rarely, some patients can benefit from aggressive treatment if the spread is limited. In this group of patients, we plan treatment on a case-to-case basis.”

Subsequently the TNM stages are combined to place patients ranging from Stage I to IV. As you can imagine, the chances of cure get progressively worse as the stage of cancer increases. That’s the main reason to seek early specialist opinion, so that we can catch the cancer at an as early stage.

  • Stage I - A stage I head and neck cancer tumor means the primary tumor is 2 cm across or smaller, and no cancer cells are present in nearby structures, lymph nodes, or distant sites (Example: T1, N0, M0).
  • Stage II - A stage II head and neck tumor measures 2–4 cm across or has little cancer extension to nearby structures. However it has not spread to lymph nodes, or distant sites (Example: T2, N0, M0).
  • Stage III - A stage III head and neck tumor means one of the following:

    The head and neck tumor is larger than 4 cm across or has little cancer extension to nearby structures. However no cancer cells are present in nearby lymph nodes, or distant sites (Example: T3, N0, M0).

    The head and neck tumor is any size or has little cancer extension to nearby structures but has not gone to distant sites. However, cancer cells are present in one lymph node, which is located on the same side of the head or neck as the primary tumor and is smaller than 3 cm across (Example: T1–3, N1, M0).

  • Stage IV –

    • Stage IV A : One of the following applies –
    T4a, N0 or N1, M0: the head and neck cancer tumor is any size and is growing into nearby structures. Cancer cells may not be present in the lymph nodes, or they may have spread to one lymph node, which is located on the same side of the head or neck as the primary tumor and is smaller than 3 cm across. Cancer has not spread to distant sites.
    or
    T1–4a, N2, M0: the tumor is any size and may or may not have invaded nearby structures, it has not spread to distant sites, and one of the following is true:

    • cancer cells are present in one lymph node, located on the same side of the head or neck as the primary tumor and measuring 3–6 cm across (N2a)
    • cancer cells are present in one lymph node on the opposite side of the head or neck and measuring less than 6 cm across (N2b)
    • cancer cells are present in 2 or more lymph nodes, all smaller than 6 cm across and located on either side of the head or neck (N2c)

    • Stage IV B : One of the following applies –

    T4b, any N, M0: the tumor has invaded deeper areas and/or tissues. It may or may not have spread to lymph nodes and has not spread to distant sites.

    or

    Any T, N3, M0: the tumor is any size and may or may not have grown into other structures. It has spread to one or more lymph nodes larger than 6 cm across, but has not spread to distant sites.

    • Stage IV C :

    Any T, Any N, M1: The head and neck cancer tumor is any size and may or may not have spread to lymph nodes. Cancer cells have spread to distant sites.

The treatment plan for your cancer depends on the following :

1. The exact location of your cancer

2. The stage of you cancer

3. Your age and general health

4. Your level of function with cancer

5. Can you reliably come for assessment after treatment (usually for 5 years)

Generally speaking head and neck cancer is treated with surgery (operation), radiotherapy or chemotherapy.

“Remember, if you cancer is at an advanced stage, you may require a combination of all three modalities!’’

Surgery

Radiation therapy

Chemotherapy

1. Surgery :

The aim of surgery in head and neck cancer treatment is to remove all the visible cancer. For head and neck cancer, surgery can be for two different parts of cancer

1. Surgery for the primary cancer – This means operation to remove the cancer from the head and neck region where it started and from adjacent areas where it may have spread. You can follow the link to learn more about cancer surgery for the different regions of the head and neck.
MOUTH (ORAL)CANCER
VOICE BOX (LARYNX) CANCER
OROPHARYNX (THROAT) CANCER
HYPOPHARYNX (THROAT) CANCER
NOSE AND PARANASAL SINUS CANCER

2. Surgery for the neck nodes – At time of diagnosis some cancers may have spread to the lymph nodes in the neck. This may be apparent when Iexamine your neck and/or when we review your scans. Therefore in these cases, surgery to remove these nodes in the neck is required. This is referred to as neck dissection.

Certain regions of head and neck, e.g. tongue, throatetc have a very high risk of spread to lymph nodes in the neck. In these cases, neck dissection is carried out even if the lymph nodes look normal on scans. This is because studies have shown a higher chance of cure if the lymph nodes are removed in someone who has cancer in these higher risk areas of the head and neck, even if they appear to be normal. Remember, all the scans, CT/MRI or PET scan cannot pick up cancer in lymph nodes if the cancer spread is too small!

Even if surgery removes all the cancer that can be seen at the time of the operation, some patients may be advised radiation therapy (with or without chemotherapy) after surgery to kill any cancer cells that are left. This is because even after extensive surgery in advanced stage disease, some cancer cells may be left behind in the remaining structures of your original site of cancer or in the neck tissue. Studies have shown better cure rates for advanced T stage and N stage head and neck cancer when additional treatment is given after the surgery.

Mouth cancer :

Surgery is the best treatment for all stages of lip and oral cavity cancer. Surgery for oral cancer is in the form of wide local excision i.e. removal of the cancer and some of the healthy tissue around. If cancer has spread into jaw bone, surgery may include removal of the involved bone (mandible).

Reconstructive surgery to restores the appearance and function of removed part of oral cavity is usually required as your mouth is so important for a natural look and plays a critical role in both swallowing and speaking. Dental implants, a skin graft, or local or free flap surgery may be needed to repair parts of the mouth, throat, or neck after removal of large tumors. I have extensive experience in both local and free flap plastic surgery to reconstruct the defect resulting from surgery. You can follow this link to learn more about reconstruction that that I can do for you.
Read More : Head neck face reconstruction.

Voice Box cancer :

Surgery is a common treatment for all stages of voice box cancer. I use the following surgical procedures to remove your cancer:

  • Cordectomy : Surgery to remove the vocal cords only. I do this with CO2 LASER.
  • Hemilaryngectomy or Partial laryngectomy: Surgery to remove half or part of the voice box. This saves the voice.
  • Total laryngectomy : Surgery to remove the whole larynx. During this operation, a hole is made in the front of the neck leading to the windpipe that allows the patient to breathe. This is called a stoma. In these cases, a tiny plastic tube is inserted between the stoma in the front and the food pipe behind and the patient can learn to use this to speak. The voice in these cases is different but can be understood.

For limited cancer of voice box, I use CO2 LASER for more precise operation. A LASER beam (a narrow beam of intense light) works as a knife to make bloodless precise cuts in tissuewhile I look under the microscope. If facilities are available, we can also use ROBOTIC technique. I have trained in both CO2 LASER and ROBOTIC surgery. You can follow this link to learn more about ROBOTIC and LASER surgery that I can offer for more precise surgery that has best rates of cancer cure with minimal side effect.

Oropharynx :

Traditionally Surgery is a less common treatment of all stages of oropharyngeal cancer. This is because, with traditional surgery, it is difficult to reach the back of tongue without dividing your jaw bone or normal structures in the front of your mouth. Radiation therapy (with chemotherapy) is more commonly used for most stages as the chances of cancer cure are similar to that with surgery while side-effects are less, especially if your cancer is positive for HPV.

However, more recently ROBOTIC surgery has been employed for surgery of the back of tongue. ROBOTIC surgery has made it possible to access these difficult areas without making a cut in your jawbone or normal structures in the front of oral cavity. This has led to remarkable reduction in side effects with excellent cure rates. This is rarely offered in India due to lack of trained surgeons and availability of robots in hospitals. I have excellent training and expertise in robotic surgery from my time in USA and you can follow this link to learn more about it.
Read More : Robotic surgery.

Hypopharynx :

Surgery is a common treatment for all stages of hypopharyngeal cancer. The following surgical procedures may be used:

  • Laryngopharyngectomy: Surgery to remove the larynx (voice box) and part of the pharynx (throat). Afterwards reconstruction by local or free flaps is required to reconstruct a new pharynx so that the patient can resume swallowing. You can follow this link to learn more about reconstruction option that I can offer.
  • Partial laryngopharyngectomy: Surgery to remove part of the larynx and part of the pharynx. A partial laryngopharyngectomy prevents loss of the voice.

Read More : Head neck face reconstruction.

Nose and Para nasal sinus cavity cancer :

Surgery is the most common treatment offered for cancer of the nose or para nasal sinuses. The extent of surgery depends upon the extent the cancer has spread. The following surgical procedures may be used

  • Rhinectomy – This refers to resection of the nose and the inside lining in cases where the cancer has spread or is too close to the skin of your nose.
  • Partial Maxillectomy – This refers to surgery where the maxillary sinus and the bone is resected partially as the cancer is still limited.
  • Radical Maxillectomy – This refers to complete resection of the maxillary sinus and the bone. If the cancer has spread to the structures surrounding your eye, this may have to be combined with removal of the involved eye and structures around it (called as orbital exenteration)

For early stage cancer, I perform surgery with special nasal endoscopes, without any visible cut or scar in your face. This provides best chance of beating cancer with the least functional and cosmetic side effects.

In more advanced stage cancer requiring extensive resection, reconstruction with appropriate flap is necessary for maintaining the best possible appearance. You can follow this link to learn more about facial reconstruction and the options I can provide.

Read More : Head neck face reconstruction.

2. Radiation therapy :

Radiation therapy uses high-energy x-raysto kill cancer cells. Radiation therapy kills cancer cells by damaging their DNA either directly or by creating charged particles (free radicals) within the cells that can in turn damage the DNA.

Cancer cells whose DNA is damaged beyond repair stop dividing and die. When the damaged cells die, they are broken down and eliminated by the body’s natural processes. However, radiation therapy can also damage normal cells, leading to side effects. The amount of radiation that normal tissue can safely receive is known for all parts of the body. Radiation specialists use this information to help them decide where to aim radiation during treatment. A radiation oncologist develops a patient’s treatment plan through a process called treatment planning, which begins with simulation. Patients getting radiation to the head may need a mask. The mask helps keep the head from moving so that the patient is in the exact same position for each treatment.During simulation, detailed imaging CT scans show the location of a patient’s tumor and the normal areas around it. Patients who receive most types of external-beam radiation therapy usually have to travel to the hospital or an outpatient facility up to 5 days a week for several weeks (usually 5-6 weeks). One dose (a single fraction) of the total planned dose of radiation is given each day that usually takes 20-30 minutes.

There are two main reasons for once-daily treatment:

• To minimize the damage to normal tissue.

• To increase the likelihood that cancer cells are exposed to radiation at the points in the cell cycle when they are most vulnerable to DNA damage.

You may receive radiation therapy before or after surgery. Some patients may receive radiation therapy alone, without surgery or other treatments. Some patients may receive radiation therapy and chemotherapy at the same time. The timing of radiation therapy depends on the type and stage of cancer being treated and the goal of treatment

“Another important thing to remember is that radiotherapy, as a general rule, can not be given more than once because the side effects and complications from their effect on normal tissues gets too high.”

3. Chemotherapy :

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects.

“Unfortunately chemotherapy alone does not cure head and neck cancer and therefore when used, it is given with radiotherapy where studies have shown that it increases the effect of radiation and helps it kill more cancer cells.” In these situation usually you need three cycles of chemotherapy spread during the planned radiotherapy schedule.

Chemotherapy for head and neck cancer is given directly in your blood (IV) through catheters or ports, sometimes with the help of a pump.

Catheters.

A catheter is a soft, thin tube. A surgeon places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until all your chemotherapy treatments are done. Catheters can also be used for drugs other than chemotherapy and to draw blood. Be sure to watch for signs of infection around your catheter.

Ports.

A port is a small, round disc made of plastic or metal that is placed under your skin. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for more than 1 day. Be sure to watch for signs of infection around your port.

Pumps.

Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port. Pumps can be internal or external. External pumps remain outside your body. Most people can carry these pumps with them. Internal pumps are placed under your skin during surgery.

Surgery side effects

There are general risks associated with surgery and general anesthesia. Anesthesia has its risk irrespective of any surgery and this includes heart failure, Stroke, other organ failure or death. Similarly all operations, irrespective of the type and site, carry general risks of pain, bleeding, scar and infection. However these risks are incredibly rare with modern medicine. Naturally, if you have pre-existing heart condition or general medical disease such as diabetes that are not well controlled, your risk will be higher then normal.

Surgery for head and neck cancers can often changeyour ability to chew, swallow, or talk. Dependent on the area of operation, you may look different after surgery, and the face and neck may be swollen. The swelling usually goes away within a few weeks.After a laryngectomy (surgery to remove the voice box) you will need to learn to produce voice through a speech valve. After surgery in the neck, parts of the neck and throat may feel numb because nerves have been cut. If lymph nodes in the neck were removed, the shoulder and neck may become weak and stiff.

You can follow the link to learn about specific risks associated with some of the surgery.
Read more : know about your operation.

Radiotherapy side effects

Radiation therapy can cause both early (acute) and late (chronic) side effects. Acute side effects occur during treatment, and chronic side effects occur months or even years after treatment ends. The side effects that develop depend on the exact area of the head and neck being treated, the dose given per day, the total dose given, your general health and medical condition, and if you also received chemotherapy at the same time.

Acute radiation side effects are caused by damage to rapidly dividing normal cells in the area receiving radiation. These effects damage to the salivary glands and red inflamed skin which can shed its outer lining and thus get more prone to infection. Almost all will experience painful ulcerations in the mouth and inflammation of the throat that makes it difficult and painful to swallow. Because of this, you may need feeding through a tube that is passed through one of the nostrils. In addition you are likely to find food bland without taste as radiotherapy affects taste buds. Most acute effects disappear after treatment ends, though some like salivary gland damage) can be permanent.

Fatigue is a common side effect of radiation therapy regardless of which part of the body is treated.

The common late side effects after radiotherapy to head and neck are

• Fibrosis - the replacement of normal tissue with scar tissue, leading to restricted movement of the affected area. This can lead to difficulty in swallowing and opening your mouth. This can also cause restricted movement of the neck and shoulder which may feel stiff.

• Dry mouth due to fibrosis of salivary glands

• Thyroid hormone deficiency

• Pituitary hormone deficiency

Radiotherapy for voice box cancer can lead to huskiness and altered voice that may be permanent.

It is important to tell your dentist about radiotherapy as this can lead to early decay of teeth and removal of infected teeth after radiotherapy can cause infection and subsequent fracture of jawbone.

To learn more about radiotherapy side effects, you can follow these links :

http://www.cancer.gov/cancertopics/coping/physicaleffects/radiation-side-effects

http://www.cancerresearchuk.org/cancer-help/about-cancer/treatment/radiotherapy/side-effects/head/

Chemotherapy side-effects :

You can follow this link to learn more about side effects due to chemotherapy :

http://www.cancerresearchuk.org/cancer-help/about-cancer/treatment/chemotherapy/chemotherapy-side-effects

http://www.cancer.gov/cancertopics/coping/physicaleffects/chemo-side-effects

Like every other cancer, in some patients we are unable to provide any treatment that can cure head and neck cancer. The reasons could be amongst those mentioned below

  • Due to advanced stage of your cancer :
  • • Your cancer may be so advanced at the time of diagnosis that we cannot remove it by surgery completely. This can be whether it is the first time you have been found to have cancer or after the cancer has recurred following treatment.

    • The cancer may have spread so much in the lymph nodes and other structures in the neck that surgery can not remove the cancer completely. Usually this happens when the cancer completely covers the blood vessel (carotid) taking blood to the brain or is extending into the muscles and / or bone of your neck bones (vertebrae).

    Usually, in these situations, other treatment such as radiation therapy (with or without chemotherapy) may be offered, though chances of success after treatment will be relatively less.

    • In most patients when the cancer has spread to other part of your body outside the head and neck region.

  • Due to your age and general health :
  • • If you are very old or have very poor health due to other medical conditions such as heart / lung / liver problem, the risks of having anesthesia and surgery, radiotherapy and or chemotherapy may be too high. In these circumstances, we may not be able to offer you any treatment that is aimed at cure of cancer. However, this decision is not taken without extensive discussion of risks and complication with you and your near family.

In such cases where cure is not possible, we can still offer treatment that is called ‘palliative care’. This refers to treating problems and symptoms such as pain, inflammation, difficulty in swallowing or weight loss. The treatment can include medicines, radiation therapy, and chemotherapy or limited surgery. This is valuable to maintain your quality of life and aid your day-to-day function for as long as possible. Naturally, the aim of palliative care is to ease discomfort and problems due to your cancer rather than getting rid of the cancer completely.

The goal of treatment for head and neck cancers is to cure you of cancer. However, we are also concerned about preserving the function of the affected areas as much as we can and help you return to normal activities as soon as possible after treatment. This process is called rehabilitation and is a very important part of treatment. The goals of rehabilitation depend on the extent of the disease and the treatment that you have received.Depending on the location of the cancer and the type of treatment, your rehabilitation may require physical therapy, dietary counseling, speech therapy, and/or learning how to care for a stoma. A stoma is an opening into the windpipe through which a patient breathes after a laryngectomy, which is the surgery to remove your voice box.

Sometimes, especially with cancer of the oral cavity, you may need reconstructive and plastic surgery to rebuild bones or tissues. If reconstructive surgery is not possible, prosthesis (an artificial dental and/or facial part) may be required to restore satisfactory swallowing, speech, and appearance. You will receive special training on how to use the device. If you have trouble speaking after treatment you may need speech therapy. Often, a speech-language pathologist will visit you in the hospital to plan therapy and teach speech exercises or alternative methods of speaking. Speech therapy usually continues after you return home.Eating may be difficult after treatment for head and neck cancer. You may receive nutrients directly into a vein after surgery or need a feeding tube until they can eat on their own. A feeding tube is a flexible plastic tube that is passed into the stomach through the nose or an incision in the abdomen. A nurse or speech-language pathologist will help you learn how to swallow again after surgery.

Regular follow-up care is very important after treatment for head and neck cancer to make sure that the cancer has not returned, or that a second primary (new) cancer has not developed.

‘I advocate review for five years after completion of the treatment as the cancer can come back within this duration. The highest risk period is the first two years after completion of all treatment and therefore you will require a much closer regular examination during this period.’

I follow my patients once every month for the first year, once every two months for the second year, once every three months for the third year and at six monthly intervals till five years are complete. Some patients prefer to have annual follow up subsequently. Patients who continue to consume tobacco, paan, guthka or significant alcohol require life long follow up as their risk of developing another head and neck cancer is significantly increased.

Depending on the type of cancer medical checkup mayinclude examination of the mouth, neck, and throat. From time to time we may need to perform examination under general anesthesia with or without biopsies. You may also need additional scans and X- rays. We may also need to monitor thyroid and pituitary gland function, especially if the head or neck was treated with radiation.

It is very important that you quit high risk behavior such as consumption of tobacco, paan, guthka and alcohol once a diagnosis of head and neck cancer is made. If you continue with your addiction, your risk of having complications is massively increased irrespective of the modality of treatment, surgery, radiotherapy or chemotherapy. You will also have a much higher risk of the cancer coming back. In addition, even if you are cured of the original cancer, you will have a very high risk of developing another head and neck cancer, either in the same site or somewhere else.

Choosing the correct specialist is critical in beating head and neck cancer. There are many good cancer specialists in our country who can offer you good quality care. I believe, I am amongst the best doctor providing surgical care in this field, that you can find anywhere in the world. To ensure you get the best clinical care overall and surgical care specifically; I have worked hard to get training and experience in the best hospitals around the world. Thereafter to ensure that my skills and experience in cancer are not diluted, I have worked exclusively in managing head and neck cancer. I have trained in the latest technology and surgical techniques such as Robotic and LASER surgery so that you will get the most advanced treatment comparable to the best hospitals in USA, Europe or anywhere else in the world. Furthermore, I have made sure that the hospitals I work in and other specialist I practice with; share my patient centered vision and enthusiasm for offering the highest quality care. Working as a team with these reputed cancer specialists, I can assure you that the treatment you receive from me will be the very best and the care you will get will be honest, humane and with empathy.

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Northampton General Hospital
NHS Hospital
Northampton NN1 5BD
Tel - 01604 634700
BMI Three Shires Hospital
Private Hospital
Northampton NN1 5DR
Tel - 01604 620311

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