Head, Neck & Eye Cancers

ORAL CAVITY CANCER

Overview

The oral cavity includes the lips, the inside lining and the cheeks (buccal mucosa), the teeth, the gums, the front two thirds of the tongue, the floor of the mouth below the tongue, the bony roof of the mouth (hard palate), and the area behind the wisdom teeth (retromolar trigone).

Oropharyngeal cancer develops in the part of the throat just behind the mouth, called the oropharynx. The oropharynx begins where the oral cavity ends. It also includes the base of the tongue (the back third of the tongue), the soft palate, the tonsils and the tonsillar pillars, and the back wall of the throat (the posterior pharyngeal wall).

The oral cavity and oropharynx are useful in breathing, talking, eating, chewing and swalling. Minor salivary glands located throughout the oral cavity and oropharynx make saliva that keeps the mouth moist and helps digest food.

The oral cavity and oropharynx contain several types of tissue and each of these tissues contain several types of cells. Different cancers can develop from each kind of cell.

More than 90% of cancers of the oral cavity and oropharynx are squamous cell carcinomas, also called squamous cell cancers. Squamous cells are flat scale like cells that normally form the lining of the oral cavity and oropharynx. Squamous cell cancer begins as a collection of abnormal squamous cells. The earliest form of squamous cell cancer is called carcinoma in situ, meaning that the cancer cells are present only in the lining layer of cells called the epithelium. Invasive squamous cell cancer means that the cancer cells have spread beyond this layer into deeper layers of the oral cavity or oropharynx.

Symptoms 

(i) A sore in the mouth that does not heal.

(ii) Persistent pain.

(iii) Persistent lump or thickening in the cheek.

(iv) Persistent white or red patch on the gums, tongue, tonsil, or lining of the mouth.

(v) Difficulty chewing or swallowing.

(vi) Difficulty moving the jaw or tongue.

(vii) Numbness of the tongue or in other areas of the mouth.

(viii) Swelling of the jaw.

(ix) Loosening of the teeth without any apparent reason, voice change.

(x) Lump or mass in the neck, weight loss, bad breath. 

 Risk factors 

(a) Tobacco – Almost 90% of people with oral cavity and orophayngeal cancer use tobacco, and the risk of developing these cancers increases with the amount used.

(b) Alcohol – Drinking alcohol strongly increases a smoker’s risk of developing oral cavity and oropharyngeal cancer. It is found predominantly in alcohol users.

(c) Ultraviolet light – Majority of patients with lip cancer have outdoor occupation associated with prolonged exposure to sunlight.

(d) Irritation – Long time irritation to the lining of the mouth is a risk factor for oral cancer. The major source for this in India being tobacco.

(e) Human Papilomavirus – Papilomavirus are a suspected source of oral cancers, like in cervix, vagina, vulva and penis.

(f) Immune system suppression – People undergoing immunosuppressive drugs to treat certain immune system diseases, or to prevent rejection of transplanted organs, are at an increased risk of oral cancer. 

 Diagnosis  

(I) Complete medical history.

(II) Complete Head & Neck examination including nasopharyngoscopy, Pharyngoscopy, and laryngoscopy.

(III) Ex-foliative cytology.

(IV) Incisional biopsy.

(V) Fine needle biopsy.

(VI) Imaging tests including chest X-ray, CT scan, MRI. 

Stages 

(i) Stage 0 – The cancer is in situ. It has not yet penetrated to a deeper layer of oral or orophayngeal tissue and has not spread to lymph-nodes or distant sites.

(ii) Stage 1 – The tumor is 2cms or smaller and has not spread to lymph nodes or distant sites.

(iii) Stage 2 – The tumor is larger than 2 cms., but smaller tha 4 cms., and has not spread to lymph nodes or distant sites.

(iv) Stage 3 – The tumor is larger than stage 2 and has spread to one lymph node.

(v) Stage 4 – The tumor can be larger than 6 cms and has spread to lymph nodes and to distant sites.

                                   HYPO PHARYNX CANCER

Overview

Hypo pharynx is the end part of the throat or the pharynx. This is a 5 inch long hollow tube extending from behind the nose and going down to become part of the esophagus. Air and food pass through pharynx from the way on to the trachea or the esophagus respectively.

In the cancer that originates from the hypo pharynx, the cancer cells are mostly squamous cells, which are flat and scaly cells. A small portion of cancer could also be lymphomas, i.e., non-Hodgkin’s lymphoma.

Hypo pharyngeal cancer usually spreads through the lymphatic system. And the cancerous cells are carried along by the lymph’s, which are colorless fluid containing cells that help fight infections and disease.

Symptoms

(I) A sore in the throat that will nor soothe.

(II) Difficulty and pain while chewing and swallowing.

(III) A change in the voice or pain in the ear.

Risk factors

(i) Tobacco use

(ii) Tobacco chewing as is common in many south asean countries.

(iii) Chronic usage of alcohol.

Diagnosis

(i) Direct laryngoscopy.

(ii) Biopsy

(iii) Barium swallow to detect spread in the oesophagus and digestive organs.

Stages

(a) Stage 1 – The disease is only in one part of the hypo pharynx and has not spread to the lymph nodes in the area.

(b) Stage 2 – It has spread to more than one part of the hypo pharynx or has spread to tissues adjacent to the hypo pharynx but has not grown into the larynx. Has not spread to the lymph nodes.

(c) Stage 3 – The disease has spread to nearby organs and the lymphatic system.

(d) Stage 4 – The cancer has spread to the distant organs of the body. 

LARYNGEAL CANCER

Overview

The larynx is a two inch long organ in the neck. The larynx in used by humans to talk, breathe or swallow. It is made of cartridge. The main cartiledge which forms the front of the larynx is also called as adam’s apple.

Just behind the trachea and the larynx in the neck lies the food pipe or the oesophagus, which carries the food from the mouth to the stomach. The opening of the oesophagus and the larynx are adjascent to each other in the throat.

When we swallow food, a small flap called the epiglottis moves down to cover the larynx in order to prevent the food from going down the wrong passage and into the lungs.

The other important anatomical areas of the larynx are,

(i) The glottis, which is where the vocal cords are.

(ii) The supraglottis, which is the area above the vocal cords.

(iii) The subglottis, which is the area which connects the larynx to the trachea.

Cancer of the larynx, can develop in any other region of the larynx, the glottis, the supraglottis, or the subglottis. The cancer can also go outside the larynx into lymph nodes or lymph glands in the neck.

Through lymphnodes laryngeal cancer can spread to other parts of the throat and neck, the lungs, and to the back of the tongue, and other distant parts of the body such as the bones and the brain. 

Symptoms

(i) Majority of cancers originate from the vocal cords. These are painless tumors, which almost always cause a change in the voice or hoarsness.

(ii) The tumors which are located in the supraglottis cause a feeling of a lump or a sore throat or earache.

(iii) Tumors below the vocal cords are very rare, but they make it hard to breathe and produce noisy difficult breathing.

(iv) A cough which refuses to goaway, or the feeling of a lump in the throat are early warning signs of cancer of the larynx.

(v) As the tumors keep progressing, it causes weight loss, pain, bad breath, and frequent choking upon food.

(vi) In some cases tumor can grow so big that it may become impossible for the patient to swallow. 

Risk factors

(i) Gender & age – It is most often seen in people aged above 55 years and it is seen more commonly in men than in women.

(ii) Smoking and chewing tobacco is a very potent risk for developing laryngeal cancer.

(iii) Alcohol – Alcohol combined with tobacco is a high risk factor for causing laryngeal cancer.

(iv) Asbestos – Asbestos workers also run a great risk of getting cancer of the larynx. 

Diagnosis

(i) Indirect laryngoscopy – Which comprises of a small, long handled mirror being used to check the larynx and the vocal cords indirectly to look for abnormal areas. The test is painless.

(ii) Direct laryngoscopy – It is a more specific investigation in which a self-lit or indirectly lit metallic tube is inserted into the patient’s nose or mouth. This tube is also called a laryngoscope. As the tube descends down the throat, the doctor can look at areas that cannot be seen with the simple mirror used in indirect laryngoscopy.

(iii) Biopsy – If the doctor doctor notices any abnormalities he perfoms biopsy, which is the removal of a small piece of representative tissue. This tissue piece is then examined to find the presence of cancer cells.

Usually cancer cells of larynx are squamous cell carcinomas. Squamous cells are cells lining the epiglottis, the vocal cords, and other parts of the larynx and they are flat, scale like cells. 

Stages

(a) Stage 1 – There is no of spread to lymph nodes the tumor is smaller than 2cms.

(b) Stage 2 – The tunmor involves more than 1 subsites of the larynx, or is 2 to 3 cms. in size.

(c) Stage 3 – The cancer has spread to lymph nodes but size not larger than 3 cms., on the same side of the neck as primary tumor.

(d) Stage 4a – There is spread to 1 lymph node, size is about 3 to 6 cms., on the same side of the neck as primary tumor.

             4b – There is spread to lymph nodes on both sides of the neck, the tumor may be larger than 6 cms.

           4c – There is spread to lymph nodes and the tumor is larger than 6 cms, with evidence of distant metastasis. 

NASOPHARYNX CANCER

Overview

The nasopharynx is the area in the back of the nose towards the base of the skull. The nasopharynx is a box like organ about 1.5 inches in size. It lies just above the soft palate, behind the entrance into the nasal passages. It tends to spread very rapidly. The nasopharynx contains several types of cells. Different cancers can develop in each type of cell.

Three types of cancerous tumors are recognized in the nsopharynx.

(a) Keratinizing squamous cell carcinoma.

(b) Non—keratinizing squamous cell carcinoma.

(c) Undifferentiated carcinoma.

Lymphomas can also be found in the nasopharynx. They are cancers of immune system cells called lymphocytes.

Symptoms

Some patients with nasopharynx cancer have no symptoms at all. Most of the patients have a lump or tumor mass in the neck area when the cancer is diagnosed. Other symptoms may present as follows.

(i) Loss of hearing.

(ii) Nasal blockage or stuffiness.

(iii) Painful nose-bleeds.

(iv) Difficulty opening the mouth.

(v) Blurred or double vision. 

Risk factors

 (i) Diet – Nasopharynx cancer is commonly seen in people having high salt content fish and meat diet.

(ii) Virus infections – Infection with EBV virus can cause mononucleosis, leading to cancer of the nasopharynx.

(iii) Tobacco and alcohol – People habituated to chewing tobacco, or smoking with alcohol intake are at a very high risk of developing nasopharynx cancer.

(iv) Genetic factors – It is found that people with certain tissue types are at a higher risk of developing nasopharynx cancer. 

Diagnosis

(a) X-Ray

(b) C-T Scan

(c) MRI

(d) Blood Tests

(e) Fine needle Biopsy 

Stages

(A) Stage 0 – Cancer is in-situ, has not penetrated to deeper levels of tissues, and has not spread to lymph nodes or distant sites.

(B) Stage I – Tumor is only in the nasopharynx and has not spread to lymph nodes or other organs.

(C) Stage II – The tumor has spread to soft tissues of the nasal cavity and the oropharynx and has not spread to lymph nodes or distant sites.

(D) Stage III – The tumor has spread to soft tissues of the nasal cavity and the oropharynx and to lymph nodes, not larger than 6 cm, on both sides of the neck but not to distant sites.

(E) Stage IV – The tumor is larger than 6 cm, has spread to lymph nodes and distant sites. 

SALIVARY GLANDS TUMOR

Overview

These are glands that produce saliva, saliva  is a fluid which keeps the mouth moist. It also moistens and softens food during the act of chewing and has a minimal digestive action on food components as well.

The salivary glands are chiefly arranged in three groups

(i) The parotid glands are the largest, placed just in front of the ear.

(ii) The submandibular glads are placed just beneath the jaws, protruding partially into the top of the neck.

(iii) The sublingual glands are arranged on both sides of the floor of the mouth.

(iv) There are several monor salivary glands as well, scattered randomly in the mouth and other parts of the upper gastrointestinal tract.

Most of the salivary gland tumors are non-cancerous, however few tumors can be cancerous. Cancers arising from salivay glands are of several types. 

Symptoms

 (i) A mass or lump in the face, neck, or mouth

(ii) Pain in one place in the face, neck, or mouth

(iii) A newly noticed difference between the size and/or shape of the left and right sides of the face or neck

(iv) Numbness in part of the face, noticeable  weakness of the muscles on one side of the face. 

Risk factors

(i) Radiation exposure – Industrial exposure to certain radioactive elements increases risk levels of salivary glands tumor.

(ii) Diet – Diets rich in animal fats, but low in fruits and vegetables may leads to salivary glades tumors.

(iii) Tobacco & Alcohol – Chewing and smoking of tobacco combined with alcohol greatly increases the risk of salivary glands tumors.

(iv) Hereditary factor – Certain inherited genetic factors are responsible for causing salivary gland tumors. 

 Diagnosis

(i) X – Ray

(ii) C-T Scan

(iii) MRI

(iv) Biopsy

(v) Fine needle aspiration 

Stages

(a) Stage 1 – The cancer is not more than 4 cm in diameter and has not spread into the surrounding tissue or to the lymph nodes in the region.

(b) Stage 2 – The cancer is more than 4 cm and has spread into the surrouding tissues including the skin, soft tissues, bone or nerve near the glands, but there is no spread to the neighbouring lymph nodes.

(c) Stage 3 – There is spread to nearby lymph node.

(d) Stage 4 – The cancer is any size and has spread to more than one lymph nodes on the same side of the neck, or on both sides. Has spread to distant organs. 

NASAL CAVITY & PARA NASAL SINUS CANCER

Overview

The nose opens into the nasal passageway, or cavity. This cavity runs along the top of the palate, and turns downward to join the passage from the mouth to the throat.

Para nasal sinus means in the vicinity of the sinus area. They are cavities of small tunnels. The nasal cavity and par nasal sinuses help filter, warm, and humidify the air we breathe. They also provide resonanace to the voice, lighten the skull, and provide a bony frame work for the face and eyes.

The nasal cavity and par nasal sinuses are lined by a layer of mucus producing tissue called mucosa. The mucosa has multiple types of cells including.

-Squamous epithelial cells, which are lining cells and form the majority of the mucosa.

-Glandular cells, such as minor salivary glands etc. which produce mucus and other fluids.

-Nerve cells which are responsible for sensation and the sense of smell in the nose.

-Infection fighting cells which are part of the immune system, blood vessel cells, and other supporting cells

All of these cells that make up the mucos can become cancerpus.

-Squamous cell carcinoma is the most common type.

-Adenocarcinoma – Cancer of the glandular cells.

-Malignant lymphomas – Cancer arising out of lymph or immune system cells.

-Malignant melanoma – Cancer of pigment or skin color containing cells.

-Papilomas – Wart like growths that are not cancer, but have a potential to become cancerous.

-Esthesioneuroblastomas – These are derived from the olfactory nerves, the cells that govern the sense of smell. 

Symptoms

- Persistent or progressive nasal congestion and stuffiness.

- Pain above or below the eyes.

- One sided nasal obstruction

- Nasal bleeds and nasal drainage in the back of the nose and throat.

- Pus drainage from the nose

- Decresed sense of smell and numbness or pain inparts of the face.

- Groeth or tumor in the face

- Bulging of the eyes or loss of vision. 

Risk factors

(a) Occupational hazards – Occupational exposure to dust of wood, textiles, and leather inhaled, and also flour.

Other material may include glues, formaldehyde, solvents used in furniture and shoe production, nickel and chromium dust, radium.

(b) Smoking – Smoking is a risk factor for nasal cavity cancer, as well as for cancers of other organs.

(c) Family history – Genetic inheritance is a factor for causing nasal and paranasal sinus cancers. 

Diagnosis

 (1) X-Ray

(2) Computed tomography

(3) Magnetic resonance imaging

(4) Biopsy. 

Stages

(A) Stage 1 – The cancer is limited to sinus mucosa and has not spread.

(B) Stage 2 – The cancer has affected or destroyed some of the bones of the maxillary sinuses, but has not spread beyond that.

(C) Stage 3 – The cancer has grown through the back of the sinus. The cancer has reached the tissues of the cheek, the eye socket, or the ethmoid sinus in front of the maxillary sinus. The cancer may not have spread to the lymphatic system or to distant organs.

(D) Stage 4 – In this stage the cancer has spread to one or more lymph nodes, is larger than 3 cms, spread to distant organs.

  

EYE CANCER

Overview

The retina is a lining of nervous tissues located at the back of the two eyes. It is a photosensitive layer, that is, it is responsible for sensing light and forming images.

Cancer of the retina is called retinoblastoma. It can occur at any age. It can appear in any one of the eye, or both the eyes. Usually, the tumor is confined to the eye socket without spreading to the adjacent tissues.

Retinoblastoma has a tendency to be hereditary. This type of cancer often is seen in children. 

Symptoms

Usually the tumor id quite evident, with the patient having a white or discolored bulging tumor in one or both eyes, which may have no vision at all. 

Risk factors

(1) Age – Eye cancer predominantly found in children and is rarely seen in adults.

(2) Genetic factors – About half the cases of retinoblastoma are hereditary. The other half may occur due to other reasons. Hereditary retinoblastoma tends to affect both the eyes whereas the sporadic ones usually occurs only in one eye. 

Diagnosis

As per modern science diagnosis may involve CT Scan, MRI, Sonography of the abdomen, Bone scan, Biopsy etc. 

Stages

(a) Intraoccular retinoblastoma – Cancer is restricted to one or both eyes and has not spred to adjascent or distant tissues.

(b) Extraoccular retinoblastoma – Cancer has spread beyond the eyes, either in adjascent tissues or to distant organs.

(c) Recurrent retinoblastoma – This is a disease which has recurred after the initial therapy is completed. It may have occurred in the eye or in any other part of the body.