ENT cancers, also known as Head and Neck cancers are a group of cancers that affect the soft tissue organs in the head and neck region. It includes cancers of the nasopharynx, oral cavity, lips, nose and paranasal sinuses, larynx, oropharynx, hypopharynx, thyroid and salivary glands.
Head and Neck cancers are among the most common types of cancers in Malaysia. In 2006, 2,884 cases of head and neck cancers were reported in Peninsular Malaysia, making it the number one cancer group apart from female breast cancer (3,525), followed by colorectal cancer (2,866) and lung cancer (2,048).
The most frequent head and neck cancers were Nasopharyngeal, Thyroid, Oral, Laryngeal, Salivary Gland cancer, Pharyngeal, and Sinonasal cancer.
Head and neck cancer studies in Malaysia show that males are 1.2 times more affected than females with men more commonly afflicted with nasopharyngeal, laryngeal and pharyngeal cancers.
Nose cancer is more common in men, thyroid cancer is more common in women, and lymphoid cancers occur in both sexes. There is about a 1 in 100 chance of developing one of these cancers by the age of 75.
There are several signs and symptoms for Head and Neck cancer. A doctor should be consulted if a lump in the neck persists for more than two weeks, is painless, and keeps growing.
Lumps in the neck may occur in the nose, thyroid and lymphoid cancers, as well as other ENT cancers. The position of the lump in the neck may give a clue to its cause.
Nosebleeds can also be a sign of cancer, in particular, nose cancer. Especially if bleeding is persistent, scanty, or associated with a headache or unusual smell, it is important to get checked.
A swelling, ulcer or sore area in the mouth that does not go away within a week should be evaluated by a doctor. This is particularly important if accompanied by a lump in the neck.
Hoarseness in the voice can occur with cancers of the voice box. It can also be a sign of thyroid cancer. This is because nerves to the vocal cords run closely behind the thyroid gland and can be affected by cancer within the gland.
Difficulty swallowing food can be a sign of cancer of the throat and should be evaluated by a doctor. A swallowing x-ray or an esophagoscopy may be necessary to find the cause.
Pain or blockage in the ear can be due to disease or a tumour in the nose or throat. Nose cancers can present with a blocked ear or sometimes unexplained pain or discomfort around the ear as the only symptom.
Diagnosis and Treatment
If an individual has any of the above symptoms, a full ENT examination is recommended. Nasal endoscopy is usually necessary if nose cancer is suspected or needs to be excluded. Nasal endoscopy involves passing a thin flexible camera into the nose to examine the nose and throat. The examination only takes a few minutes and is usually painless. Nasal endoscopy can examine the throat down to the level of the voice box; if the examination is required further into the food passage, then esophagoscopy may be recommended.
For suspected cancer inside the nose or throat, a tissue specimen must be sent to the laboratory to establish the diagnosis. For nose cancer, this may be performed in the clinic using local anaesthesia, and the endoscope to guide the biopsy. With cancers deep in the throat, for example at the voice box, general anaesthesia and special instruments are usually needed to access the area.
ENT cancers can be treated successfully, and the earlier cancer is diagnosed, the easier it is to treat and cure. Side effects from early treatment are also likely to be less. It is important to seek medical advice early if warning signs are present.
Surgery, radiotherapy and chemotherapy are the main treatments for head and neck cancers. The exact treatment option varies according to the cancer type and extent.
While early treatment would usually give positive results, frequent examinations are needed to monitor for any recurrence. In treating a recurrence of the disease, Cyberknife treatment is particularly appealing due to dose conformality that the treatment offers, which is critical in the setting of re-irradiation.
Alcohol and tobacco use (including smokeless tobacco, sometimes called “chewing tobacco” or “snuff”) are the two most important risk factors for head and neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx, and larynx.
At least 75% of head and neck cancers are caused by tobacco and alcohol use. Individuals who use both tobacco and alcohol are at greater risk of developing these cancers than those who use either tobacco or alcohol alone. Tobacco and alcohol use, however, are not risk factors for salivary gland cancers.
Infection with cancer-causing types of human papillomavirus (HPV), especially HPV type 16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue.
Other risk factors for cancers of the head and neck include chewing betel quid or paan; consuming preserved or salted foods; poor oral health; occupational exposure to wood dust, asbestos and synthetic fibres; radiation exposure; Epstein-Barr virus infection; ancestry, particularly Chinese ancestry, is a risk factor for nasopharyngeal cancer.
Dr. Raymond, Beacon Hospital Malaysia