Head and neck cancers
Cancers of the mouth, throat, voice box, thyroid and salivary glands. Mouth cancer is one of the most common cancers in India, and most cases are linked to tobacco.
Which cancers are included?
- Mouth (oral cavity): tongue, cheek lining, gums, floor of the mouth and palate
- Throat (pharynx) and voice box (larynx)
- Salivary glands, including the parotid gland in front of the ear
- Thyroid gland, at the front of the neck
Warning signs
See a doctor if any of these last more than two to three weeks:
- A mouth ulcer that does not heal
- A white or red patch in the mouth
- A lump in the neck
- Difficulty or pain when swallowing
- A hoarse voice
- A swelling in front of the ear or below the jaw
- A lump in the front of the neck that moves when you swallow (thyroid)
- Difficulty opening the mouth fully, or teeth that become loose for no reason
Risk factors
The biggest risk is tobacco in any form: gutka, khaini, betel quid with tobacco, cigarettes and beedis. Areca nut and alcohol add to the risk. Stopping at any age lowers it.
How it is diagnosed
- Examination of the mouth, throat and neck, sometimes with a small camera (endoscopy)
- A biopsy of the suspicious area, or a fine needle test (FNAC) for thyroid and salivary gland lumps
- Ultrasound of the neck for thyroid lumps
- CT or MRI scans, and sometimes a PET-CT scan
Treatment
- Surgery removes the tumour with a margin of healthy tissue, usually together with a neck dissection to remove lymph nodes.
- Reconstruction using tissue from elsewhere in the body restores form and function when a large area is removed.
- Radiotherapy, sometimes with chemotherapy, is given after surgery when needed, or as the main treatment for some throat cancers.
- Thyroid cancer is treated by removing part or all of the thyroid gland (thyroidectomy), sometimes with the lymph nodes, and in some cases radioactive iodine afterwards.
Scar-sparing robotic surgery
Conventional thyroid and neck operations leave a visible scar on the front or side of the neck. For selected patients, robotic surgery moves the cuts to places that clothing or the natural folds of the body hide:
- Robotic thyroidectomy removes the thyroid gland without a cut on the front of the neck
- RIA-MIND for neck dissection, through small cuts below the collarbone
- PRIA for parotid gland tumours, through the same route
Recovery
- Speech and swallowing therapy, dental care, and stopping tobacco are all part of recovery.
- Follow-up visits are frequent in the first two years.
Common questions
Is a white patch in the mouth cancer?
A white patch (leukoplakia) or red patch (erythroplakia) is not cancer, but it can turn into cancer over time. It should be examined, and a biopsy may be needed. Stopping tobacco is essential.
Why remove lymph nodes from my neck when I cannot feel a lump?
Mouth cancers can spread to neck lymph nodes before they can be felt or seen on scans. Removing them (neck dissection) treats any hidden spread and shows whether further treatment is needed.
Will I be able to eat and speak normally?
Most people do, although it can take time. Speech and swallowing therapists help with recovery, and reconstruction with tissue from elsewhere in the body helps restore form and function after larger operations.
Is every thyroid lump cancer?
No. Most thyroid lumps (nodules) are harmless. An ultrasound and, if needed, a fine needle test (FNAC) show which ones need treatment.