head & neck Oncology

General information

Head and Neck Surgery focuses on the treatment of Head and Neck masses. A number of masses may arise in this area and are variably called growths, ulcers, lumps or bumps. These masses may be benign (non cancerous) or malignant (cancerous). The malignant masses are called Head and Neck Cancers. This includes cancers of the mouth (oral cavity), throat (pharyx), voice box (larynx), swallowing passages (hypopharynx), neck, nose, sinuses, thyroid and parotid glands.
Head and Neck Cancers are among the commonest cancers in India. An estimated 300,000 new patients every year are diagnosed with this 50% of the worlds oral cancer occur in India.

 

Warning signs of Head and Neck Cancer

• Lump in the head and neck region
• Change in voice
• Growth or ulcer in the mouth
• Blood in the spit or cough
• Swallowing problems
• Persistent ear pain

Any of these signs that persist for more than two weeks warrant an evaluation by a physician

Making a diagnosis and staging

Clinical examination may allow a surgeon to determine the cause of a mass based on its location, size and other characteristics. More often, additional tests may be needed, such as:

• - FNAC : A needle in inserted into the lump and small amount of material is aspirated into a syringe. This is examined by a pathologists to give a diagnosis
  
  
• - Biopsy : A small piece of tissue (usually equal to a grain of lentil) is taken and submitted to the pathologists to provide a diagnosis.
  
  
• - CT/MRI/US : Imaging tests are used to establish the extent or spread of a mass.
  
  
• - PET-CT scan : An advanced imaging test that uses two dyes to provide more information about a tumor. It allows not only anatomical detailing of a tumor but also assessment of its functional status. Functional status can help differentiate benign, cancerous and scar tissue from one another. Its high sensitivity allows small tumor deposits to be detected which may be missed on conventional imaging studies.

Treatment of Head and Neck Cancer

Treatment of Head and Neck Cancer involves dealing with many complex issues. Not only does it have to maximize the chances of successful cure but also preserve or restore important functions like speech, swallowing, chewing, smell and facial cosmesis. To meet these diverse needs our comprehensive team involves specialists in head and neck surgery, medical oncology, radiation oncology, reconstructive surgery, maxillo-facial prosthetics, speech therapy, physiotherapy, endocrinology and holistic medicine. This comprehensive team approach ensures that all facets of patients care and all treatment options are taken care off.

A weekly multidisciplinary clinic (tumor board) discusses complicated cases, considers treatment options and aims to reach a consensus regarding individualizing a patients treatment.  The idea of a tumor board is to provide a comprehensive professional opinion from many experts in one go rather than a patient having to see multiple doctors to get it.

Surgical Options

Surgery for head and neck cancer often involves removal of functionally or cosmetically important tissue. The department performs various state of the art procedures to reduce the morbidity of the treatment. This allows patients to resume their normal lifestyle and work after surgery. These include procedures like :

• Voice conserving surgeries for cancer of the voice box including laser resections
• Voice restorative procedures after total larygectomy
• Microvascular reconstruction of oral cavity after surgery including replacement of tongue, cheek and jaw bone
• Thyroid and parathyroid surgery by minimally invasive approaches
• Salivary gland surgery under facial nerve monitoring
• Reconstruction after cancer surgery

Non surgical options

Following surgery patients may need treatment with radiation or chemotherapy. Or else, depending on the location and type of tumor these treatments may be used in place of surgery.

Skull Base Surgery

Using advance technologies our department works along with neurosurgeons to treat skull base tumors (tumor arising along the bottom of the skull). This included tumors like juvenile nasopharyngeal angiofibroma, schwannomas, extracranial meningiomas, glomus jugulare and sarcomas that arise in this region. These relatively rare tumors mostly grow towards the inside of the skull but occasionally on the outside. Treating these tumors is challenging as this area contains many blood vessels, nerve and other important structures. The treatment plan for these tumors is jointly planned along with neurosurgeons and depending on the size, location and nature of the tumor a minimally invasive approach may be taken.