WHAT IS HEAD AND NECK CANCER FACT SHEET This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between yu and yur cancer care team. AN OVERVIEW TO HEAD AND NECK CANCER Head and neck cancer includes a range f different cancers that are classified based n their lcatin in the head r neck and the type f cancer cells. Head and neck cancer ften refers specifically t cancers that begin in the cells that line the mist mucsal surfaces including the muth (ral cavity), nse and sinuses, thrat (pharynx) and vice bx (larynx). These cancers are usually squamus cell carcinmas (SCCs) and accunt fr abut 95% f cases. Mucsal head and neck cancers are diagnsed in apprximately 3500 Australians every year; representing 2 3% f all cancers. Mucsal head and neck cancer is nearly twice as cmmn in men and ften diagnsed in peple ver the age f 50. Thyrid cancers are mre cmmn that mucsal head and neck cancers and ccur in 2400 Australians every year. They are mre cmmn in wmen and ften ccur at a yunger age. Skin cancers f the head and neck are s cmmn in Australia that we dn t even knw hw many ccur. It is estimated that mre than 500 000 Australians are treated every year fr skin cancer. They are mre cmmn in men and becme mre cmmn as yu get lder, mainly due t sun expsure. Less cmmnly, head and neck cancers may ccur in the salivary glands, and ther tissues in the face, neck, eyes and ears. 2016 Beynd Five 1
CAUSES OF HEAD AND NECK CANCER The mst imprtant risk factrs fr mucsal head and neck cancer are tbacc (cigarette smking, cigars, pipes, chewing tbacc r snuff) and alchl use. They are respnsible fr ver 75% f cases and are especially imprtant fr cancers f the muth, thrat and vice bx. Thse with a lng histry f tbacc use, heavy tbacc use and wh use bth tbacc and alchl are at a significantly higher risk f head and neck cancer. Infectin with the human papillmavirus (HPV) is als a risk factr fr sme types f head and neck cancer, particularly thse invlving the tnsils r tngue base (knwn as rpharyngeal cancer). Other risk factrs fr head and neck cancer include increasing age, male gender, race, inhalatin f certain chemicals and dusts, the Epstein-Barr Virus (EBV), chewing betel nut and pssibly a diet lw in fruit and vegetables. Sun expsure is the mst imprtant risk factr fr skin cancers, particularly repeated sunburn as a yung adult. Previus radiatin expsure is als an imprtant risk factr fr head and neck cancer, in particular thyrid cancers. There is usually a delay f at least 10 years frm the time f expsure t develpment f the cancer. Sme patients may nt have any identifiable cause fr their cancer. 2016 Beynd Five 2
SYMPTOMS AND DIAGNOSIS OF HEAD AND NECK CANCER Head and neck cancers may cause a variety f symptms depending n the site, type and stage f the cancer. Symptms may include a lump r sre that des nt heal, swelling, bleeding, pain r numbness, truble speaking, prblems with dentures r lse teeth, a harse vice, truble breathing, difficulty chewing r swallwing, persistent ear pain, a persistent sre thrat, a neck lump, a blcked nse r nse bleeds, a bulging r watery eye, r visin prblems. These symptms may als be caused by many ther less serius cnditins. Check with yur dctr if yu ntice any f these symptms. Cancer may be diagnsed r cnfirmed by a bipsy. This invlves remval f a tissue sample that is then examined in detail by a specialist pathlgist, under a micrscpe t lk fr cancer cells. Bipsies can ften be perfrmed in the ffice with lcal anaesthetic, but ccasinally require sedatin r general anaesthesia (yu will be asleep and will nt remember what happens during the prcedure) in the perating rm. 2016 Beynd Five 3
STAGING HEAD AND NECK CANCER The extent f the cancer (r stage) is defined by the size f the tumur, spread t adjacent structures, spread t lymph ndes in the head and neck, and spread t ther sites in the bdy such as the lungs, liver r bnes (knwn as metastases). An internatinal staging system called the TNM system is used. The T refers t the riginal r primary tumur, the N t the lymph ndes in the head and neck, and the M t metastases elsewhere in the bdy. The dctr will btain this infrmatin based n an examinatin (which may include an endscpy thrugh the nse) and imaging (which may include ultrasund, cmputed tmgraphy [CT], magnetic resnance imaging [MRI] r psitrn emissin tmgraphy [PET] scans). In sme cases, an examinatin under general anaesthesia in the perating rm may be required. TREATMENT OF HEAD AND NECK CANCER When fund early, head and neck cancers are typically curable. The treatment apprach depends n the type, lcatin and stage f the cancer as well as age and verall health. Cmmn treatment ptins include: Surgery: Invlving remval f the cancer, sme f the surrunding healthy tissue and, in sme cases, lymph ndes in the neck that are knwn t be invlved r at risk. Recnstructive surgery may als be necessary fr functinal and/r csmetic reasns. Radiatin therapy: Invlving the use f high-energy X-rays t destry cancer cells. Chemtherapy: Invlving the use f drugs t destry cancer cells. Often a cmbinatin f these treatment ptins is recmmended. The dctr may als suggest taking part in a clinical trial. 2016 Beynd Five 4
During treatment fr head and neck cancer there may be a range f health prfessinals specialising in different areas that are respnsible fr yur care. This is called a multidisciplinary team and may include a head and neck surgen, recnstructive surgen, radiatin nclgist, medical nclgist, cancer nurses, speech therapists, dietitians, dentists and scial wrkers. When planning treatment the cancer care team may discuss the ptins available and help weigh up the advantages and disadvantages f each apprach and/r cnsider the pssible side effects which may affect appearance, wellbeing, speech, eating and breathing. SEEKING A SECOND OPINION A multidisciplinary head and neck clinic is usually recmmended fr patients with head and neck cancer. This affrds a cnsensus pinin frm several specialists in head and neck cancer. Hwever, after cnsulting with a specialist r cancer care team, yu may want a secnd pinin abut yur diagnsis and treatment plan. Sme peple wrry that the dctr will be ffended if they ask fr a secnd pinin, hwever specialists ften welcme a secnd pinin. This can be an imprtant part f the decisin making prcess fr yu, and reassure yu that yu have explred all yur ptins and allw yu t feel mre cnfident abut the decisins yu make. UNDERSTANDING THE PROGNOSIS OF HEAD AND NECK CANCER Prgnsis means the expected utcme f a disease and chance f cure. It is imprtant t discuss head and neck cancer prgnsis with the dctr. Althugh the type, lcatin and stage f cancer may allw an estimate f the prgnsis, there are many ther factrs that influence this and every individual is different. Because f this n dctr can give yu a cmpletely accurate predictin abut the curse f yur illness. Typically, if a head and neck cancer is ging t recur it des s within the first few years after treatment but this is nt always the case. The cancer care team usually cntinues clse fllw-up fr at least 5 years, at which time many cancers are cnsidered t be cured. 2016 Beynd Five 5
QUESTIONS TO ASK YOUR DOCTOR Being diagnsed with cancer can be verwhelming and cnfusing. There are a lt f infrmatin and treatment decisins t make at a distressing time fr bth the individual and their family. T help yu understand everything and get the infrmatin yu need t make decisins abut yur health, cnsider asking the fllwing questins t yur cancer care team: Exactly what type f cancer d I have? Where is it lcated? Why did I get this cancer? Is it related t smking r the HPV virus? What stage is the cancer? What are my treatment ptins? Which treatment d yu recmmend fr me and why? Have yu discussed my case at a multidisciplinary team (MDT) meeting and if s, what were the recmmendatins? Wh will be part f my cancer care team, and what des each persn d? D I need t see ther specialists befre treatment (such as a radiatin nclgist, medical nclgist, recnstructive surgen, dentist, dietician r speech pathlgist)? What are the pssible side effects f treatment in the shrt- and lng-term? Hw can they be prevented r managed? What will happen if I dn't have any treatment? Hw much will the treatment and/r peratin cst? Will Medicare r my health insurance cver it? What fllw-up tests will I need? Hw ften will they be? Am I suitable fr any clinical trials? Wh can I call if I have any prblems r questins? Where can I find emtinal supprt fr me and my family? Are there any patient supprt grups that yu wuld recmmend? If I wanted t get a secnd pinin, can yu prvide all my medical details? D yu mind if I get a secnd pinin? 2016 Beynd Five 6
Yu may want t write additinal questins here t ask yur dctr r cancer care team Beynd Five disclaimer: Yu acknwledge and accept that the infrmatin in this factsheet is fr general infrmatin purpses nly. It is nt intended, nr shuld it be relied n, as medical r legal advice, r as a substitute fr cnsultatin with a physician r ther licensed healthcare prvider. Yu agree that if yu have individual healthcare-related questins yu shuld cntact yur dctr prmptly and shuld nt disregard prfessinal medical advice, r delay seeking it, because f infrmatin cntained here. Yu als agree that Beynd Five is nt liable fr any injury r damage t persns r prperty (hwsever caused, including by negligence) arising ut f r related t any use f Beynd Five s patient educatin materials, r fr any errrs r missins. Last Updated: 21 Octber 2016 2016 Beynd Five 7