Increase the risk of developing suspicious smoking, drinking, and HPV in the case of lumps in the neck, resting voice, or ulcers in the mouth
Aug 05, 2024
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Head and neck cancer, which needs careful treatment to improve the quality of life of patients beyond cure, was summarized as a Q&A with Professor Eun-jae Jung of Seoul National University Hospital.
- What is head and neck cancer?
▶ Head and neck cancer is a collective term for all cancers that occur between the base of the brain and the mediastinum (empty space in the thorax), except for the brain and eyes. Oral cancer (mouth), nasal cancer and sinus cancer (nose), pharyngeal cancer, laryngeal cancer, thyroid cancer, and salivary gland cancer. According to recent national cancer registration statistics, head and neck cancer excluding thyroid cancer accounts for 2.2% of all cancer cases and about 15% including thyroid cancer.
- What are the causes and risk factors?
▶ Smoking is the most important risk factor for head and neck cancer. Smokers, in particular, have a 1.7 to 2 times higher risk of developing laryngeal cancer than non-smokers, and have a strong effect on the occurrence of head and neck cancer in other areas. It is known that drinking in parallel causes mucosal cell mutations, increasing the risk of head and neck cancer. In addition, human papillomavirus (HPV) and oropharyngeal cancer, Stein-Barr virus (EBV) and nasopharyngeal cancer are involved.
- How to diagnose?
▶ Early diagnosis is important because head and neck cancer can increase survival rates by 80-90% if detected and treated in the first or second stages. Diagnosis is based on physical examination (obstetric endoscopy, cervical palpation examination) and imaging examination. Cervical CT and ultrasound can be used to precisely examine cervical lymph node metastasis. In the case of head and neck cancer that has already progressed, an additional PET-CT test is performed before entering treatment to determine whether it is distant metastasis to liver, lungs, and bones.
If a lesion is found, a biopsy may be performed immediately in an outpatient clinic. However, areas that are difficult to remove tissues immediately, such as laryngeal cancer or hypopharyngeal cancer, located deep inside the neck, may require general anesthesia.
- What are the main symptoms?
▶ Head and neck cancer symptoms vary depending on the site of cancer and the degree of progression.
Nasal cancer and sinus cancer often cause nasal congestion, persistent nosebleeds only in one nose, and mouth cancer is similar to stomatitis but does not recover. In addition, discoloration (white or red), pain, and lumps under the ear or upper part of the neck are found.
Pharyngeal cancer causes constant pain and foreign body sensation in the neck in the early stages. After progression, symptoms that are difficult to swallow or lumps in the throat are caught. Nasopharyngeal cancer can cause a feeling of fullness or otitis media in one ear.
Laryngeal cancer can cause breathing difficulties when the voice rests, and when the tumor progresses, salivary gland cancer is swollen in the salivary gland (under the ear, under the chin, under the tongue), and a bead-like lump around the neck is touched. If the tumor progresses, it can invade the facial nerve and accompany facial paralysis.
Thyroid cancer has no specific symptoms. Problems such as some pain, a raspy voice, and difficulty swallowing can occur.
- How do you treat it?
▶Head and neck cancer has a very important impact on quality of life because it occurs in areas related to the function of eating, talking, and breathing. Therefore, the location of the primary site, the stage, the expected loss of function during surgery, and the expected reactivity to non-surgical treatment (such as anti-cancer radiation therapy) are considered, and the treatment plan is decided after multidisciplinary discussions with various medical departments.
In general, surgery or radiation alone is performed in the early stages, and combined surgery and chemotherapy are performed in the advanced stage.
- What is the treatment for head and neck cancer by part?
For head and neck cancer, treatment plans are carefully established according to the site of occurrence so that the patient's function and quality of life can be preserved as much as possible.
Surgical treatment is the basic for nasal cancer and sinus cancer, and endoscopic surgery is recently preferred to preserve nasal function. If the roof of the mouth or the facial bone needs to be removed, reconstruction techniques are performed to restore the original function and shape by transplanting autologous tissues from the arms, legs, and shoulders.
Oral cancer initially has fewer surgical sites. As the tumor progresses, the removal area widens, requiring reconstructive surgery, and it takes more time to restore the eating function.
Nasopharyngeal cancer has good reactivity to chemotherapy. Anatomically, it is close and deep to the brain and eyes, so non-surgical treatment is considered first.
In addition, oropharyngeal cancer caused by HPV virus responds very well to chemotherapy. If chemotherapy fails, rescue surgery is performed, and in order to reduce complications and preserve function, surgery is performed through the neck without splitting the jawbone.
Laryngeal cancer is treated with initial surgery or radiation alone. If progressed, chemotherapy can be selected for laryngeal preservation, and if recurrence occurs, surgery is performed. Although the larynx can be preserved during surgery, the majority perform an occipital dislocation (removal of both larynx), in which case an artificial vocal tract is inserted to enable vocalization.
Salivary gland cancer requires surgical treatment first. If the tumor invades the facial nerve extensively, serious facial paralysis can occur after surgery. Recently, surgery to minimize this and restore facial function has been developed to minimize complications.
Thyroid cancer is known to be a relatively mild cancer, but it is classified as an aggressive cancer if it invades nerves or muscles that move the airways, esophagus, and vocal cords. In this case, surgery removes the bronchial or esophagus that has been invaded with the tumor and performs appropriate reconstruction.
Professor Jung Eun-jae said "Like all cancers, it is best to prevent head and neck cancer, and if diagnosed early, the cure rate is very high. Therefore, we should practice abstaining from alcohol and smoking for prevention, and if symptoms of head and neck cancer such as lumps or pains in the neck, voice changes, mouth ulcers and bleeding, one nasal congestion, and bleeding persist, we recommend that you visit the hospital for examination."
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