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Head & Neck Cancer Treatment in Delhi NCR India

About Head Neck Cancer

Head cancer is site-specific, which includes oral cavity, pharynx, larynx, paranasal sinuses and nasal cavity, and salivary glands.

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Head Neck Cancer comprises of Oral (Mouth) Cancer, Oropharangeal (Throat) cancer, Laryngeal (Voice Box), Maxilla and Para Nasal Sinus Tumors, Skull Base lesions, Orbital Cancers, Thyroid and Salivary gland tumors along tumors in the neck in form of lymph nodal metastases and other neck tumors in form of paragangliomas, congenital neck cysts, lymphomas etc.

The most common form of Head Neck Cancer is the one occurring at the mucosal lining of Oral Cavity (Mouth), Posterior tongue and Tonsil (Oropharynx), Laryngeal apparatus (Voice Box) and Upper part of esophagus (food pipe) in the form of Squamous Cell Carcinoma. Tobacco abuse is the most common reason for its development. In our part of world, where the habit of tobacco chewing is very prevalent has led to India having the world’s largest population of Oral Cancer patients. If Alcohol is added to the tobacco the risk or the chances of cancer development are further increased.

The survival statistics in Head Neck Cancer depend on the stage of tumor, treatment modality and its adequacy. The survival, which is more than 80% in stage I, falls to 50% in stage III. Performing a timely biopsy and imaging (CT scan, PET CT etc.) are the essentials of timely diagnosis of HNC.

Stages

In early stages the cancer is localized to the primary site without involvement of adjacent tissues and no spread to regional neck nodes. In advanced stages the disease involves adjacent tissues, e.g. a cancer in the cheek will have involved the lower or upper jawbone or the outside skin; and/or the disease spreads to neck lymph nodes. In metastatic stage, the disease spreads to the lungs, liver and/or bones, etc. distant tissues if the body

Treatment

A. In early stages disease can be controlled with only surgery as single modality of treatment.

The methodology of surgery can vary according to the site.

  • Oral cavity: open approach may be splitting the lip, angle of mouth or intraoral
  • Oropahraynx(Posterior part of tongue, Tonsil, Lateral Pharangeal wall) : Trans oral Robotic or endoscopic approach / Radiation
  • Larynx (Vocal Cord): Laser in form of Microlarangeal surgery / Radiation

B. In advanced stages the treatment becomes multimodality:
  • Oral Cavity: Surgery followed by Radiation (RT) or Chemoradiation (CCRT),
  • Oropharynx, Some sites of Larynx like (supraglottis), Hypopharynx

    • a. If history of smoking or tobacco abuse present: Induction (Neoadjuvant) chemotherapy followed by reassessment after 2/3 cycles

    b. If No history of smoking & with suspected signs and/or symptoms of HPV virus exposure: CCRT (chemoradiation)

  • Larynx: Radiation or Chemoradiation followed by salvage surgery if needed
  • In the stage when the disease has metastasized to other sites the treatment is mainly palliative in form of low dose chemotherapy known as metronomic therapy; immunotherapy and/or targeted therapy.