Head and neck cancers

Head and Neck body diagram

Oral cancer

(Includes lips, gums, buccal mucosa, floor and roof of mouth, front two thirds of the tongue and oropharynx)

Facts and figures

16th most common cancer in the UK. Higher incidence in men, male to female ratio of 2:1. Age related, although varies with gender. An average of approximately 15% of cases diagnosed in males is in the 75+years age group and 71% in the 50-74 age group. However, in women an average of 29% of cases is diagnosed in the 75+years age group and 59% in the 50-74 age group.

Cancer of the tongue is the most common mouth cancer, about 1,900 cases a year diagnosed in the UK. Oropharynx tumours are uncommon and tend to affect those aged between 40 and 70 years of age. Risk factors include smoking, chewing tobacco or betel quid, high alcohol intake (particularly spirits), poor diet, poor dental hygiene, exposure to HPV and low immunity. Skin cancers are also common on the head and neck including lips as they are related to sunlight (UV exposure).

Approximately 90% of all head and neck cancers are squamous cell carcinomas commonly arising in the mucosal lining of the oral cavity. Head and neck cancers tend to spread quickly to the lymph nodes in the neck.

Symptoms of Oral Cancer

  • Non healing ulcers.
  • Persistent mouth pain or discomfort.
  • Abnormal looking patches in the mouth or throat.
  • Difficulty in swallowing (dysphagia).
  • Speech problems and /or difficulties in moving the jaw.
  • Lumps in the mouth or throat.
  • Lump or non-healing sore on the lip.
  • Swelling/lumps in the neck.
  • Weight loss.
  • Bad breath.
  • Unexplained loose teeth.
  • Unexplained bleeding or numbness in the mouth.

Diagnosis

Investigations may include:

  • Physical examination.
  • Blood tests.
  • Chest x-ray.
  • Biopsy – tissue samples taken from the affected area.
  • Endoscopy- tissues samples may be taken for biopsy.
  • Fine needle aspiration (FNA) - if there are any lumps/swelling in the neck which could indicate possible node involvement) a thin needle may be used to collect cells from the area for analysis.
  • CT scan.
  • MRI scan.

Treatment

Depends on several factors:

  • The type of tumour.
  • The position of the tumour.
  • The size and depth of the tumour.
  • The stage of the cancer.
  • General health.

Surgery

Surgery is frequently used for mouth cancers but it is influenced by the size and position of the tumour and whether the lymph nodes are known to be involved or if there is a risk of spread to them. Surgery and radiotherapy are both effective in treating early stage disease and it is possible that radiotherapy may be recommended if surgery will result in chronic side effects such as speech impairment or loss of senses such as taste or smell or disfigurement.If surgery is performed, the malignant tissue will be removed as well as a surrounding margin of healthy tissue to try and reduce the risk of recurrence.

Due to the fact that head and neck cancers tends to spread to the neck lymph nodes, biopsies would normally be performed during surgery and if found to be involved, the nodes are usually removed on either one or both sides of the neck ( neck dissection). Neck dissections may be recommended if the tumour is 4cm or more even if the node biopsy is negative for malignant cells. Radiotherapy may be recommended post-surgery (adjuvant radiotherapy) to eradicate any remaining cancer cells and reduce the risk of recurrence.

Radiotherapy

Radiotherapy may be recommended as first choice for oral cancer, especially if surgery is not possible or will result in permanent side effects or disfigurement. As previously described, radiotherapy may be post-surgery but it is now being used more frequently in combination with chemotherapy (chemoradiation) particularly if the disease has spread to the surrounding tissues. However, the side effects from chemoradiation can be quite severe and therefore patients need to be generally in good health to tolerate the treatment.

Radiotherapy can have unpleasant chronic side effects which includes a dry mouth (xerostomia- most common late side effect) due to the potential damage to the salivary glands where saliva is produced. However, trials have proved that in suitable cases where Intensity Modulated Radiotherapy (IMRT) has been used to treat head and neck cancers the incidence of xerostomia is significantly reduced.

Image guided radiotherapy (IGRT) also enables the radiotherapy to be precisely delivered to the intended area which reduces potential radiation dose to healthy tissues and allows the radiography team to monitor any changes in the patients shape. This is important as head and neck patients often lose weight during treatment which can affect the aligning of the radiotherapy treatment.

In some cases, it may be necessary to make a new headshell and replan the patient’s radiotherapy treatment It is important to achieve precise alignment for accuracy in delivering radiotherapy, therefore in most cases it is necessary for a ‘headshell’ to be produced. This is achieved by using a specialised thermoplastic material which can be heated in warm water and then is laid over the patient’s face to form an accurately fitting customised shell which can then be used for the planning CT scan and for all the radiotherapy treatments. It is a painless procedure which is clearly explained by the radiographers prior to the procedure.

Radiotherapy is sometimes used in advanced disease to relieve symptoms such as difficulty in breathing or swallowing by shrinking the tumour if it is obstructing structures in the region.

Chemotherapy

Chemotherapy may be advised in combination with radiotherapy or if the disease has spread to other parts of the body or if it has recurred after surgery and/or radiotherapy. Trials are researching into the use of chemotherapy before surgery or radiotherapy with the intention of shrinking the tumour but this is not commonly used at present. The two most commonly used drugs are Cisplatin and 5 fluorouracil (5FU).

Biological therapy

Cetuximab is a biological therapy referred to as a monoclonal antibody which acts by blocking areas on the surface of the cancer cells to restrict their growth. It has been proven that combining cetuximab with radiotherapy has increased survival rates for patients with advanced head and neck cancers compared to receiving solely radiotherapy; subsequently it may be used in patients not fit for chemoradiation. It is also used in combination with chemotherapy for squamous cell carcinomas that have recurred or progressed.

Pharyngeal cancer

The pharynx comprises of three sections, oropharynx, nasopharynx and laryngopharynx. Oropharynx (includes soft palate, back wall of the throat, tonsils and back 1/3 of the tongue) -see oral cancer

Nasoharynx

Facts and figures

Nasopharynx cancer is very rare; only around 240 new cases are diagnosed in the UK each year. Higher incidence in men, male to female ratio is approximately 3:1. Much higher incidence in patients of South Asian/Chinese background. Age related, in Caucasians the highest incidence is in the 50-60 years age group and in those of Chinese background it is in the 30-40 years age group.

Risk factors include smoking, formaldehyde and wood dust exposure, chronic ear, nose and throat conditions and genetics (particularly if a first degree relative has been diagnosed with nasopharyngeal cancer) and may include a poor diet, particularly lacking in fruit and vegetables, high intake of cured and salted fish and carrying the Epstein Barr virus (EBV). These are usually squamous cell carcinomas and are often diagnosed late as symptoms can be similar to cold/flu like symptoms. Symptoms may include:

  • Headaches.
  • Blocked nose, nosebleeds, blood stained nasal discharge.
  • Double vision.
  • Difficulty in swallowing (dysphagia).
  • Hearing loss (usually unilateral).
  • Tinnitus.
  • Fluid collection in the ear.
  • Numbness in the lower part of the face.
  • Swelling/lumps in the neck.

Diagnosis

Investigation may include:

  • Physical examination.
  • Blood tests.
  • Chest x-ray.
  • Biopsy – tissue samples taken from the affected area.
  • Nasendoscopy- tissues samples may be taken for biopsy.
  • Panendoscopy- tissues samples may be taken for biopsy
  • Fine needle aspiration (FNA) - if there are any lumps/swelling in the neck which could indicate possible node involvement) a thin needle may be used to collect cells from the area for analysis.
  • CT scan.
  • MRI scan.

Treatment

Depends on several factors:

  • The type of tumour.
  • The size and position of the tumour.
  • The stage of the cancer.
  • General health.

Surgery

Surgery is rarely used for nasopharyngeal tumours as this area is difficult to access and is surrounded by important blood vessels and nerves. Consequently, radiotherapy tends to be the main treatment, although neck dissections may be recommended if the disease is found to have recurred in the nodes post radiotherapy.

Radiotherapy

Radiotherapy is known to cure most early stage nasopharyngeal tumours. Radiotherapy may also be given in combination with chemotherapy (chemoradiation) if the cancer cells have spread into the surrounding tissues or lymph nodes. However, the side effects from chemoradiation are quite severe so patients need to be generally in good health to tolerate the treatment.

Radiotherapy can have unpleasant chronic side effects which includes a dry mouth (xerostomia- most common late side effect) due to the potential damage to the salivary glands where saliva is produced. However, trials have proved that in suitable cases where Intensity Modulated Radiotherapy (IMRT) has been used to treat head and neck cancers the incidence of xerostomia is significantly reduced.

Image guided radiotherapy (IGRT) also enables the radiotherapy to be precisely delivered to the intended area which reduces potential radiation dose to healthy tissues and allows the radiography team to monitor any changes in the patients shape. This is important as head and neck patients often lose weight during treatment which can affect the aligning of the radiotherapy treatment. In some cases, it may be necessary to make a new headshell and replan the patient’s radiotherapy treatment.

It is important to achieve precise alignment for accuracy in delivering radiotherapy, therefore in most cases it is necessary for a ‘headshell’ to be produced. This is achieved by using a specialised thermoplastic material which can be heated in warm water and then is laid over the patient’s face to form an accurately fitting customised shell which can then be used for the planning CT scan and for all the radiotherapy treatments. It is a painless procedure which is clearly explained by the radiographers prior to the procedure.

Chemotherapy

Chemotherapy may be advised in combination with radiotherapy or if there is disease in the surrounding tissues or lymph nodes. It may also be used on its own if the disease has spread to other parts of the body.

Laryngopharynx (Hypopharynx)

Facts and figures

Much higher incidence in men, majority of tumours occurring in patients aged 55-70 years age. Risk factors include smoking, heavy alcohol consumption and nutritional deficiencies. Symptoms may include:

  • Hoarseness.
  • Pain/difficulty in swallowing (dysphagia).
  • Sore throat.
  • Cough/ Occasionally blood stained sputum.
  • Swelling/lumps in the neck.
  • There are few early symptoms so therefore tends to be diagnosed late, some patients present with breathing difficulties.

Diagnosis

Investigations may include:

  • Physical examination.
  • Blood tests.
  • Chest x-ray.
  • Laryngoscopy – tissue samples may be taken from the affected area.
  • Fine needle aspiration (FNA) - if there are any lumps/swelling in the neck which could indicate possible node involvement) a thin needle may be used to collect cells from the area for analysis.
  • CT scan.
  • PET-CT scan.
  • MRI scan.
  • Ultra sound scan.

Treatment

Depends on several factors:

  • The size and position of the tumour.
  • The stage of the cancer.
  • General health.

Surgery

Surgery has been used in early stage operable cases; however, this has involved removal of the larynx (laryngectomy) and part of the pharynx (pharyngectomy) and neck dissection followed by reconstruction and post-operative radiotherapy in most cases. However, this is in decline in order to preserve speech and swallowing function as non-surgical options are achieving equally effective tumour control. These include Intensity Modulated Radiotherapy, advances in supportive care and targeted therapy. Laser surgery is proving effective for early stage as long as surgical margins are clear.

Radiotherapy

Radiotherapy may be used as the primary treatment, particularly if the tumour is inoperable or the patient is not fit for surgery and larynx/pharynx preservation can be achieved without prejudicing curative intent.

Intensity Modulated Radiotherapy (IMRT) has proved to increase the effectiveness of treatment by enabling the disease to be targeted very accurately hence reducing dose to healthy tissue and reducing side effects. Image guided radiotherapy (IGRT) also enables the radiotherapy to be precisely delivered to the intended area which reduces potential radiation dose to healthy tissues and allows the radiography team to monitor any changes in the patients shape. This is important as head and neck patients often lose weight during treatment which can affect the aligning of the radiotherapy treatment. In some cases, it may be necessary to make a new headshell and replan the patient’s radiotherapy treatment. It is important to achieve precise alignment for accuracy in delivering radiotherapy, therefore in most cases it is necessary for a ‘headshell’ to be produced.

This is achieved by using a specialised thermoplastic material which can be heated in warm water and then is laid over the patient’s face to form an accurately fitting customised shell which can then be used for the planning CT scan and for all the radiotherapy treatments. It is a painless procedure which is clearly explained by the radiographers prior to the procedure.

Chemotherapy

Chemotherapy in combination with radical radiotherapy (chemoradiation) appears to be proving successful, although this is still under evaluation. Also, cisplatin and 5 fluorouracil (5FU) are commonly used in those presenting with advanced disease to improve loco regional control and shrink tumours prior to surgery or radiotherapy.

Biological therapy

Cetuximab is a biological therapy referred to as a monoclonal antibody which acts by blocking areas on the surface of the cancer cells to restrict their growth. It is being used in combination with radiotherapy for early stage hypopharyngeal patients and combined with chemotherapy drugs such as cisplatin for more advanced cases.

Laryngeal cancer

Facts and figures

Accounts for approximately 1% of all new male cancer cases and 0.3% of new female cancer cases each year in the UK. Much higher incidence in men, male to female ratio of approximately 45:10. Age related, 25% of cases arising in the 75+years age group and 74% in those 60+ years.

Risk factors include smoking, heavy alcohol consumption (especially spirits), diet of high processed foods and lack of fruit and vegetables. Also, increased risk in those with gastro-oesophageal reflux disease, laryngeal dysplasia, organ transplant recipients, HPV and helicobacterpylori infections, HIV, first degree relative diagnosed with larynx cancer or occupational exposure to asbestos or rubber production chemicals.

Symptoms may include:

  • Hoarseness/ changes in voice.
  • Pain/difficulty in swallowing (dysphagia).
  • Persistent sore throat.
  • Persistent coughing.
  • Ear pain.
  • Breathing difficulties.
  • Weight loss.
  • Swelling/lumps in the neck.

Diagnosis

Investigations may include:

  • Physical examination.
  • Blood tests.
  • Chest x-ray.
  • Endoscopy – tissue samples may be taken from the affected area.
  • Fine needle aspiration (FNA) - if there are any lumps/swelling in the neck which could indicate possible node involvement) a thin needle may be used to collect cells from the area for analysis.
  • CT scan.
  • PET-CT scan.
  • MRI scan.
  • Ultra sound scan.

Treatment

Depends on several factors:

  • The position of the tumour/ mobility of the vocal cords.
  • The stage of the cancer.
  • General health.

Surgery

Surgery may be used in early stage disease to remove a small tumour or part of the larynx (partial laryngectomy) and in very early stage it may be treated by laser surgery. If the tumour is above the vocal cords, the surgeon will try to avoid damaging them during the operation.

Post-operative radiotherapy may be advised if there is a risk of recurrence. During surgery neck some lymph nodes are likely to be removed for analysis and then the nodes may be removed on one or both sides (neck dissection).

If a partial laryngectomy is performed, the surgeon will aim to leave at least part of one vocal cord if possible to preserve some speech function. However, if the whole larynx is removed and possibly part of the pharynx, then it may be necessary to attach the trachea to a hole in the neck to enable the patient to breathe. This is a stoma (tracheostomy) which is permanent if a total laryngectomy is performed. Speech function will be lost and patients will be helped to learn new ways of ‘speaking’ and communicating.

Radiotherapy

Radiotherapy is often the first choice of treatment for cancer of the larynx, resulting in good outcomes for those with early stage laryngeal cancer. Also may be treatment of choice if the tumour is inoperable or the patient is not fit for surgery and has the advantage of larynx/pharynx preservation and therefore speech preservation.

Radiotherapy can be targeted very accurately to reduce dose to healthy tissue. Image guided radiotherapy (IGRT) also enables the radiotherapy to be precisely delivered to the intended area which reduces potential radiation dose to healthy tissues and allows the radiography team to monitor any changes in the patients shape. This is important as head and neck patients often lose weight during treatment which can affect the aligning of the radiotherapy treatment. In some cases, it may be necessary to make a new headshell and replan the patient’s radiotherapy treatment. It is important to achieve precise alignment for accuracy in delivering radiotherapy, therefore in most cases it is necessary for a ‘headshell’ to be produced.

This is achieved by using a specialised thermoplastic material which can be heated in warm water and then is laid over the patient’s face to form an accurately fitting customised shell which can then be used for the planning CT scan and for all the radiotherapy treatments. It is a painless procedure which is clearly explained by the radiographers prior to the procedure.

Radiotherapy may be given in combination with chemotherapy (chemoradiation), but the side effects can be quire severe, so patients need to be generally in good health to tolerate the treatment. Radiotherapy is sometimes used in advanced disease to relieve symptoms such as difficulty in breathing or swallowing by shrinking the tumour.

Chemotherapy

Chemotherapy may be used to shrink the tumour before surgery or radiotherapy or it may also be used in combination with radical radiotherapy (chemoradiation). Also, it may be advised if the tumour recurs after surgery or radiotherapy or in very advanced cases where it is likely to be palliative treatment aiming to control symptoms.

Biological therapy

Cetuximab is a biological therapy referred to as a monoclonal antibody which acts by blocking areas on the surface of the cancer cells to restrict their growth. It is being used in combination with radiotherapy for locally advanced squamous cell carcinomas or an option for patients deemed unfit for chemoradiation. Also, trials are being conducted, researching the use of biological therapy with chemotherapy for tumours that have recurred or spread to other parts of the body.

Salivary gland cancer

There are three main pairs of salivary glands: parotid, sublingual and submandibular and over 600 minor salivary glands. Most salivary gland tumours are benign, 3 out of 4 tumours that arise in the parotid glands are benign.

Facts and figures

Salivary gland cancer is very rare, about 690 new cases are diagnosed each year in the UK, but this is increasing. There is a very slightly higher incidence in men; male to female ratio is approximately 1.02:1. Age related, most common in the 50-70 years age group.

Risk factors include smoking, radiotherapy for a previous head and neck cancer, exposure to radioactive sources, first degree relative having been diagnosed with salivary gland cancer and possibly HPV exposure. 80% of these tumours arise in the parotid glands and are usually mucoepidermoid tumours, another 10% arise in the submandibular glands and the other 10% occur in the sublingual and minor salivary glands. Other tumour types include acinic carcinoma, adenoid cystic and adenocarcinoma with a small number of mixed type. Symptoms may include:

  • A lump or swelling near the jaw – this is the most common symptom at presentation.
  • Lump/swelling in the mouth or neck.
  • Drooping of one side of the face (facial palsy).
  • Pain/discomfort in the area.
  • Difficulty in swallowing (dysphagia).
  • Difficulty with fully opening the mouth.

Diagnosis

Investigations may include:

  • Physical examination.
  • Blood tests.
  • X-ray of jaw and teeth.
  • Fine needle aspiration (FNA)- a thin needle is used to collect cells from the lump/swelling for analysis.
  • MRI scan.
  • Ultra sound scan.

Treatment

Depends on several factors:

  • The type of salivary gland cancer.
  • The position of the tumour.
  • The stage of the cancer.
  • Impact of treatment on speech, chewing and swallowing.
  • General health.

Surgery

Surgery is the most common treatment for salivary gland cancer as it is effective in early stage disease. It will depend on the size and possibly the depth of the tumour and whether the lymph nodes are known or thought to be involved. During surgery some neck nodes nearest to the tumour may be removed but if disease is found in the neck nodes then all of the nodes on one or both sides of the neck may be removed to reduce the risk of recurrence (neck dissection). Post-operative radiotherapy may be advised to reduce possible recurrence.

Radiotherapy

Radiotherapy may be effective and can sometimes be the main treatment particularly if surgery is inappropriate due to the patient’s general health or position of the tumour inhibits complete excision. Also, surgery carries a high risk of facial disfigurement and therefore some patients will refuse surgery and request radiotherapy as an alternative.

Head and neck radiotherapy can have unpleasant chronic side effects which includes a dry mouth (xerostomia- most common late side effect) due to damage to the salivary glands which stops saliva production. However, trials have proved that in suitable cases where Intensity Modulated Radiotherapy (IMRT) has been used to treat head and neck cancers the incidence of xerostomia is significantly reduced as the treatment can be very accurately targeted to the area requiring treatment and sparing healthy surrounding tissue. In patients with salivary gland tumours, the affected salivary gland will need to be treated and therefore it is important to minimise dose to the other salivary glands.

Image guided radiotherapy (IGRT) also enables the radiotherapy to be precisely delivered to the intended area which reduces potential radiation dose to healthy tissues and allows the radiography team to monitor any changes in the patients shape. This is important as head and neck patients often lose weight during treatment which can affect the aligning of the radiotherapy treatment. In some cases, it may be necessary to make a new headshell and replan the patient’s radiotherapy treatment.

It is important to achieve precise alignment for accuracy in delivering radiotherapy, therefore in most cases it is necessary for a ‘headshell’ to be produced. This is achieved by using a specialised thermoplastic material which can be heated in warm water and then is laid over the patient’s face to form an accurately fitting customised shell which can then be used for the planning CT scan and for all the radiotherapy treatments. It is a painless procedure which is clearly explained by the radiographers prior to the procedure.

Chemotherapy

Chemotherapy is rarely used as it is not as effective as surgery or radiotherapy. However, it may be used if the disease has spread to other parts of the body or recurred after surgery or radiotherapy.

Nasal cavity and paranasal sinus cancer

The paranasal sinuses comprise of the frontal, ethmoidal, sphenoid and maxillary sinuses.

Facts and figures

Cancer of the nasal cavity and sinuses are very rare, only around 440 new cases are diagnosed each year in the UK, 40-50% arise in the nasal cavity, 30-40% arise in the maxillary sinuses and 10-15% arise in the ethmoid sinuses, tumours in the frontal or sphenoid sinuses are extremely rare. Much higher incidence in men. Age related, 80% of cases occurring in those aged 55+years.

Risk factors include smoking and exposure to HPV. Occupational exposure to wood dust, leather dust, formaldehyde, cloth fibres, chromium, nickel and mineral oils are also thought to increase the risk. Mostly squamous cell carcinomas, anaplastic and adenocarcinomas (approximately 60% squamous cell, 17% anaplastic and 10% adenocarcinomas others are a mix of rare tumour types). Symptoms may include:

Nose related:

  • Persistent blocked nose particularly on one side.
  • Nosebleeds.
  • Decreased sense of smell.
  • Pain/discomfort around the nose.
  • Discharge from the nose or draining into the throat.

Eye related:

    • Swelling around eye/both eyes.
    • Sight impairment/double vision.
    • Pain above or below the eye/both eyes.
    • Eye/both eyes watering.

Others:

    • Headaches.
    • Persistent pain or numbness in parts of the face.
    • Lumps on the face, nose or roof of the mouth.
    • Difficulty opening the mouth/unexplained loose teeth.
    • Ear pain or discomfort.
    • Swelling/lumps in the neck.

Diagnosis

Investigations may include:

  • Physical examination.
  • Blood tests.
  • CT scan.
  • PET-CT scan.
  • MRI scan.
  • Nasoendoscopy.
  • Panendoscopy- tissue samples may be taken for biopsy.
  • Fine needle aspiration (FNA) - a thin needle is used to collect cells from lumps/swellings for analysis.

Treatment

Depends on several factors:

  • The type of tumour
  • The size and position of the tumour
  • The stage of the cancer
  • General health

Surgery

Surgery alone is sometimes the choice of treatment for some of these tumours although some of them respond better to radiotherapy. Therefore, surgery is used as a common treatment and for some very early stage disease it may be possible to treat them with laser surgery. During surgery some neck nodes may be removed and if disease is found in the neck nodes then all of the nodes on one or both sides of the neck may be removed to reduce the risk of recurrence (neck dissection).

In some cases post-operative radiotherapy may be advised to reduce possible recurrence. Surgery for these tumours is complex and can result in significant facial disfigurement particularly if it is quite advanced at diagnosis.

Radiotherapy

Radiotherapy is the main treatment for some of these tumours and is effective in early stage cancers. Due to the complexities of surgery and the high risk of facial disfigurement, some patients are not fit for surgery or may request radiotherapy as an alternative to surgery. Radiotherapy may be given in combination with chemotherapy (chemoradiation), but the side effects can be quite severe, so patients need to be generally in good health to tolerate the treatment.

Radiotherapy can have unpleasant chronic side effects which includes a dry mouth (xerostomia- most common late side effect) due to the potential damage to the salivary glands where saliva is produced. However, trials have proved that in suitable cases where Intensity Modulated Radiotherapy (IMRT) has been used to treat head and neck cancers the incidence of xerostomia is significantly reduced. Image Guided Radiotherapy (IGRT) also enables the radiotherapy to be precisely delivered to the intended area which reduces potential radiation dose to healthy tissues and allows the radiography team to monitor any changes in the patients shape. This is important as head and neck patients often lose weight during treatment which can affect the aligning of the radiotherapy treatment.

In some cases, it may be necessary to make a new headshell and replan the patient’s radiotherapy treatment. It is important to achieve precise alignment for accuracy in delivering radiotherapy, therefore in most cases it is necessary for a ‘headshell’ to be produced. This is achieved by using a specialised thermoplastic material which can be heated in warm water and then is laid over the patient’s face to form an accurately fitting customised shell which can then be used for the planning CT scan and for all the radiotherapy treatments.

It is a painless procedure which is clearly explained by the radiographers prior to the procedure. Radiotherapy can be prescribed to relieve symptoms in advanced nasal cavity and paranasal sinus cancers. It may help to relieve difficulty in swallowing or breathing by shrinking the tumour but also as some nasal cavity and paranasal sinus cancers are close to the brain, they can grow and put pressure on the brain and radiotherapy treatment may be used in this situation to help relieve the pressure.

Chemotherapy

Chemotherapy may be used in combination with radiotherapy for some types of nasal and paranasal sinus tumours. Also, it can be used if the disease has spread to other parts of the body or recurred after surgery or radiotherapy and occasionally it is used to reduce the size of a tumour prior to surgery if there is no spread to other organs.

Thyroid cancer

Facts and figures

Thyroid cancer is quite rare; about 2,700 new cases are diagnosed each year in the UK. Higher incidence in women; male to female ratio is approximately 1:2.5. Age related, the highest incidence in women is in the 40-60 years age group and the highest incidence in men is in the 60-80 years age group. Risk factors include benign thyroid disease, radiation exposure, first degree relative diagnosed with thyroid cancer, low iodine levels in diet, obesity, diabetes, bowel condition FAP (familial adenomatous polyposis) and acromegaly. Most common type is papillary (80-85%); other types are follicular, medullary and anaplastic.

Symptoms may include:

  • A lump usually at the base of the neck/ lumps or swelling elsewhere in the neck.
  • Persistent hoarse voice.
  • Persistent sore throat.
  • Difficulty in swallowing (dysphagia).

Diagnosis

Investigations may include:

  • Physical examination.
  • Blood tests (will include thyroid function test to check thyroid hormone levels).
  • Ultrasound scan.
  • Needle biopsy- a small amount of tissue will be taken for analysis.

Treatment

Depends on several factors:

  • The type of tumour.
  • The stage of the cancer.
  • General health.
  • Age and fitness.

Surgery

Surgery is usually the first treatment for papillary, medullary and follicular thyroid cancer; this may be partial or complete removal of the thyroid (thyroidectomy) depending on the size of the tumour. During surgery some neck nodes nearest to the tumour may be removed but if disease is found in the neck nodes then all of the nodes on one or both sides of the neck may be removed to reduce the risk of recurrence (neck dissection).

Post-operative radioactive iodine or external radiotherapy may be advised to reduce possible recurrence. Curative surgery is rare for anaplastic tumours as they have usually spread into the surrounding tissues at the time of diagnosis.

Radiotherapy

Radiotherapy is frequently used in the treatment of thyroid cancer. This may be radioactive iodine or external radiotherapy depending on the type and stage of disease. Radioactive iodine may be advised post-surgery for papillary or follicular tumours to reduce the risk of recurrence.

External radiotherapy is sometimes used to treat papillary, follicular or medullary tumours if surgical removal was incomplete and to treat medullary or anaplastic tumours if they recur after initial treatment. External radiotherapy is also used to treat papillary or follicular tumours if they recur and do not respond to radioactive iodine.

Intensity Modulated Radiotherapy (IMRT) has proved to increase the effectiveness of treatment by enabling the disease to be targeted very accurately hence reducing dose to healthy tissue and reducing side effects. Image guided radiotherapy (IGRT) also enables the radiotherapy to be precisely delivered to the intended area which reduces potential radiation dose to healthy tissues and allows the radiography team to monitor any changes in the patients shape. This is important as head and neck patients often lose weight during treatment which can affect the aligning of the radiotherapy treatment. In some cases, it may be necessary to make a new headshell and replan the patient’s radiotherapy treatment.

It is important to achieve precise alignment for accuracy in delivering radiotherapy, therefore in most cases it is necessary for a ‘headshell’ to be produced. This is achieved by using a specialised thermoplastic material which can be heated in warm water and then is laid over the patient’s face to form an accurately fitting customised shell which can then be used for the planning CT scan and for all the radiotherapy treatments. It is a painless procedure which is clearly explained by the radiographers prior to the procedure. Surgery or radiotherapy for anaplastic tumours is often palliative to help control symptoms.

Chemotherapy

Chemotherapy is occasionally used to treat advanced disease or recurrences.

Thymus gland cancer

Facts and figures

Thymus gland cancer is very rare; accounting for only 0.2-1.5% of all malignancies. Equal incidence in men and women; male to female ratio is approximately 1:1. Age related, although this varies depending on type of tumour. The most common is a thymoma and the highest incidence is in the 40-60 years age group, thymic tumours are much rarer and can occur at any age although it tends to be middle aged onwards. Risk factors include some autoimmune conditions and 40% of those diagnosed have myasthenia gravis but some causes are unknown.

Symptoms may include:

  • (Some patients have no symptoms relating to this and approximately 50% of these tumours are detected on a plain chest x-ray performed for other reasons).
  • Difficulty in swallowing (dysphagia).
  • Cough/chest pain.
  • Fatigue.

Diagnosis

Investigations may include:

  • Chest X-ray.
  • CT scan.
  • PET-CT scan.
  • MRI scan.
  • Mediastinoscopy.

Treatment

Depends on several factors:

  • The type of tumour.
  • The stage of the cancer.
  • General health.

Surgery

Surgery to remove the thymus gland is the main treatment. 50% of thymomas are localised within a capsule, which makes complete excision possible and will usually be sufficient treatment for these tumours. However, in other cases where there is no fibrous capsule around the tumour, excision is more difficult and if incomplete, post-operative radiotherapy would be advised. Thymic tumours are difficult to remove, so they will require surgery and radiotherapy. Thymic tumours develop quicker and spread to other parts of the body, often lungs, chest lymph nodes and sometimes bone and liver.

Radiotherapy

Radiotherapy is most likely to be used post operatively where there is incomplete excision of the tumour or to reduce the risk of recurrence. Occasionally it is used to shrink the tumour before surgery.

Chemotherapy

Chemotherapy is sometimes used if the tumour has spread, or if surgery and/or radiotherapy have not been successful. Thymus gland cancers can respond very well to chemotherapy. Often, a combination of chemotherapy drugs will be used.

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Specialist Cancer Consultant

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GenesisCare

On 8th January 2016, we changed our name to GenesisCare.