Head and Neck
Head and Neck Cancer TOP
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
Tumours / lumps around the head and neck can arise and be due to several factors. In most cases those arising from / within the skin are non-cancerous (benign), but on occasion such growths may be / become cancerous (malignant). Early diagnosis and prompt treatment can result in the successful treatment of such conditions.
Head and Neck Cancer is the term used to describe a variety of malignant tumours which develop in the mouth (Oral Cavity), throat (Pharynx), voice box (Larynx), salivary glands and the nose and sinuses.
Approximately 80% of neck lumps in adults are cancerous (malignant), while 20% are non-cancerous (benign). The opposite is true in children, where 80% of lumps are benign and 20% are malignant. Cancerous lumps or tumours tend to be painless and enlarge progressively.
What are the symptoms of Cancerous (malignant) lumps?
Most sufferers of head and neck cancers are heavy smokers or drinkers. Following a referral to an ENT surgeon, a thorough examination of the patient will occur in the clinic. The examination often involves using a small flexible ‘telescope’ to examine the nose/throat under a local anaesthetic. Symptoms of cancerous (malignant) lumps or growths may include:
• persistent pain in the throat and difficulty swallowing food and liquids (Dysphagia)
• swellings or ulcers in the mouth, which are initially painless until they become infected
• persistent loss or change in the voice (Hoarseness), lasting more than several weeks, which is not accompanied by a viral infection e.g. laryngitis or flu
• bleeding in the mouth and throat
• constant earache especially when swallowing
• the appearance of white lesions (Leukoplakia) and red lesions (Erythroplakia) in the mouth, which last more than several weeks
• a new / change in existing black or blue spot on the face or skin (Malignant Melanoma)
N.B.
Many of the above symptoms can also be associated with other, less serious, problems in the head and neck i.e. they are not only seen in cases of head and neck malignancy.
Click here to find out about the most common types of cancer and how they are treated.
Parotid Surgery TOP
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
What is the parotid and what causes parotid lumps?
The parotid gland makes saliva; in fact you have 2 glands, one on each side, in front of your ears. Lumps occur in the parotid due to abnormal overgrowth of some part of the salivary glands (a parotid gland tumour).
The vast majority of these tumours are benign, which means that they are not cancerous and do not spread to other parts of the body. Rarely, malignant tumours can also affect the parotid. Your doctor will probably collect a needle sample from the lump in order to try to find out what sort of tumour you have.
Why remove the lump?
Although 80% of these lumps are benign in most cases we recommend that they be removed since they generally continue to grow and can become unsightly, and after many years a benign lump can turn malignant. Also the bigger the lump the more difficult it is to remove. Lastly, there is always some concern regarding the exact cause of the lump until it has been removed.
What is a Parotidectomy operation?
A parotidectomy is the surgical removal of part or all of the parotid gland. The operation is performed under general anaesthesia, which means that you will be asleep throughout. An incision will be made which runs from in front of your ear and down into your neck. This incision heals very well indeed, and in time the scar is likely to be minimal. At the end of the operation the surgeon will place a drain (plastic tube) through the skin in order to prevent any blood clot collecting under the skin. Most patients will require 4-5 days in hospital after the operation before the drain can be removed and they can go home. You will need two weeks off work.
Possible complications
• Facial weakness:There is a very important nerve, the facial nerve, which passes right through the parotid gland. This makes the muscles of the face move and if it is damaged during the surgery can lead to a weakness of the face (facial palsy). In most cases the nerve works normally after the surgery, however occasionally (about 15-20% of cases), where the tumour has been very close to the nerve, a temporary weakness of the face can occur that can last for a few weeks. In 1% of cases there is a permanent weakness of the face following this sort of surgery for benign tumours.
• Numbness of the face and ear: The skin of the side of the face will be numb for some weeks after the operation, and often you can expect your ear lobe to be numb permanently.
• Blood clot: A blood clot can collect beneath the skin (a haematoma). This occurs in about 5% of patients and it is sometimes necessary to return to the operating theatre and remove the clot and replace the drain.
• Salivary collection: In 2-5% of patients the cut surface of the parotid gland leaks a little saliva, in which case this can also collect under the skin. If this happens it is necessary to remove the saliva, usually just with a needle, like a blood test, although it may need to be repeated several times.
• Freys syndrome: Some patients find that after this surgery their cheek can become red, flushed and sweaty whilst eating. This is because the nerve supply to the gland can regrow to supply the sweat glands of the overlying skin, instead parotid. This can usually be treated easily by the application of a roll-on antiperspirant.
Submandibular gland surgery TOP
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
What is the submandibular gland?
The submandibular glands are a pair of salivary glands under the jaw bone. Each gland produces saliva which goes through a long duct to its opening under the tongue at the front of the mouth. The production of saliva increases when we eat. The saliva secreted by the submandibular gland is a bit thicker than that produced by other salivary glands. Because of its thickness this saliva can sometimes form little stones.
What problems can you have with the submandibular gland?
The commonest problem is blockage of the salivary duct. This can be caused by the presence of stones or simply a narrowing of the salivary duct. Blockage of the salivary duct can cause a painful swelling of the gland when you eat. Sometimes the swelling may settle on its own. When the blockage is severe, it can lead to persistent inflammation of the gland. Occasionally, a painless lump may develop within the submandibular gland. Those lumps are often benign but need thorough checking, as up to half of them may be or become cancerous. Even benign lumps can get gradually bigger.
What investigation are you likely to have?
An X-ray or CT scan of the submandibular gland to see if there are stones inside the gland or the duct.
Sialogram The doctor fills the duct at the front of the mouth with some contrast liquid and then takes x-rays. This will show up stones or narrowing inside the duct.
Ultrasound: This test uses sound waves to detect any lumps inside the gland.
Fine needle aspiration: This can help to find out the nature of the lump. The doctor uses a fine needle to draw some cells out from the lump. The cells are sent to the laboratory for analysis.
Why operate on the submandibular gland?
If stones inside the duct do not come out, the gland may swell up when you eat. These stones can be removed. This procedure is done through the mouth either under a local or general anaesthetic. Your consultant will discuss the options with you.
If stones are stuck inside the submandibular gland, the gland can become permanently inflamed and swollen. If it gives you undue discomfort over a longer time, your specialist may advise to have the gland removed.
If a lump has developed in the submandibular gland, your surgeon may recommend removing the gland. As a fairly high number of submandibular lumps can be cancerous the whole gland should be removed. By removing the gland we can find out whether it is benign or cancerous.
The operation to remove the gland
The operation is performed under general anaesthetic, which means that you will be asleep throughout. An incision will be made in the neck below the jaw where the submandibular gland lies. The operation will take about an hour. At the end of the operation the surgeon will place a drain (plastic tube) through the skin in order to prevent any blood clot collecting under the skin.
Most patients will require 24-48 hours in hospital after the operation before the drain can be removed and they can go home. You will need 10 days off work.
Possible complications
Blood clot
A blood clot can collect beneath the skin (this is called a haematoma). This occurs in up to 5% of patients and it is sometimes necessary to return to the operating theatre and remove the clot and replace the drain.
Wound infection
This is uncommon in the neck but can happen if the submandibular gland was badly infected. Wound infection will require antibiotic treatment. Pus collected under the skin may need to be drained.
Facial weakness
There is an important nerve that passes under the chin close to the submandibular gland. It makes the lower lip move. If it is damaged during the surgery it can lead to a weakness of the lower lip. In most cases this nerve works normally after the surgery, however in some cases weakness of the lower lip can occur, particularly when the gland is badly inflamed or if the nerve is stuck to a lump. This weakness is usually temporary and can last for 6-12 weeks. Occasionally there is a permanent weakness of the lower lip following this surgery.
Numbness of the face and ear
The skin around the wound may be numb after the operation. If that happens, the numbness will usually improve over the next three months.
Numbness of tongue
The nerve which gives sensation and taste to one half of the tongue runs close to the duct of the gland. It very rarely gets injured. However, if this nerve is damaged your tongue may feel numb immediately after the operation. This will usually go, and permanent numbness of the tongue is rare.
Injury to the nerve that ‘moves’ the tongue
Another nerve runs close to the submandibular gland that supplies the muscles of the tongue on that side (and hence helps with movement of the tongue). It would be very unusual for this nerve to be damaged in this surgery. If it were to occur, it is unlikely to produce any noticeable disability.
Will my mouth be dry?
You are very unlikely to notice a dryness of the mouth.
Neck Dissection TOP
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
How do cancers spread?
Most cancers which start in the head and neck region have the ability to spread to other parts of the body; these are called metastases (“mets”) or “secondaries”. Cancers can spread in a number of different ways, most often by the lymph system to lymph nodes, and sometimes by the blood to other distant organs like the liver. In the head and neck region, localised lymphatic spread is quite common, but spread by blood to distant parts of the body is uncommon. Lymph nodes or “glands” are like sieves, which catch bacteria, viruses or cancer cells in the body. Each node drains a particular area of the body. The nodes in the neck drain the skin of the head and neck and all the swallowing and breathing tubes. Once one cancer cell has been “caught” by a lymph node it can grow and multiply there, and in time can spread to the next node down the chain and so on.
What is a neck dissection?
There are two basic sorts of neck dissection:
1:A radical neck dissection is a surgical operation, which aims to remove all the lymph nodes in the neck between the jaw and the collarbones. This operation may be carried out if there is evidence that there are one or more nodes affected with cancer in the neck. The nodes are often small and stuck to structures in the neck, so we usually remove other tissues as well to ensure that we get a complete clearance of the cancer nodes. We only remove structures which you can safely do without, and those which do not leave serious long lasting affects.
2:A partial neck dissection is performed when there are strong suspicions that there may be microscopic amounts of cancer cells in nodes in the neck. In this case we tend to only remove those groups of nodes which are most likely to be affected in your type of cancer. In both sorts of operation we send all the tissues away to the laboratory to search for cancer cells and to see how extensive the spread has been.
What can I expect from the operation?
Most patients will be admitted 1 or 2 days before their operation. In many cases the neck dissection is only part of the surgery and some other procedure will also have been planned which is aimed at removing the primary or original tumour. The operation is performed under general anaesthesia, which means that you will be asleep throughout. There will usually be two long cuts made in the neck. At the end of the operation you will have 1 or 2 drain tubes coming out through the skin and stitches or skin clips to the skin. Most patients do not have much pain after the operation. We usually remove one of the large muscles from the neck so that patients find that the neck looks a little flatter on the side of the operation and their neck can be stiff after the operation.
Numb skin: The skin of the neck will be numb after the surgery, this will improve to some extent, but you should not expect it to return to normal.
Stiff neck: Some patients find that their neck is stiffer after the operation.
Blood Clot: Sometimes the drain tubes which are put in at surgery block, in which case blood can collect under the skin and form a clot (haematoma). If this occurs it is usually necessary to return to the operating room to remove the clot and replace the drains.
Chyle leak:Chyle is the tissue fluid, which runs in lymph channels. Occasionally one of these channels called the thoracic duct leaks after the operation. If this occurs, lymph fluid or chyle can collect under the skin, in which case we need to keep you in hospital longer and sometimes need to take you back to the theatre to seal the leak.
Injury to the Accessory nerve: This is the nerve to one of the muscles of the shoulder. We try hard to preserve this nerve but sometimes it needs to be removed, because it is too close to the tumour to leave behind. In this case you will find that your shoulder is a little stiff and that it can be difficult to lift your arm above the shoulder. Lifting heavy weights, like shopping bags, may also be difficult.
Injury to the Hypoglossal nerve: Very rarely this nerve, which makes your tongue move, also has to be removed due to involvement with the tumour. In this case you will find it difficult to clear food from that side of the mouth and it can interfere with your swallowing.
Injury to the Marginal Mandibular Nerve: This nerve is also at risk during the operation, but we also try hard to preserve it. If it is damaged you will find that the corner of your mouth will be a little weak. This is most obvious when smiling.
Will I need any other sort of treatment?
This will depend very much on what treatment you have had already, where your tumour is and what type of tumour it is. Sometimes we add radiotherapy to surgery to try to get a better cure rate.
How long will I need off work?
This will depend on the type of treatment you have had and you should discuss this with your ENT surgeon; but as a general rule at least three weeks will be required off work.
Common Types of Head and Neck Cancer TOP
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
Salivary Gland Cancer
Tumours can involve the major salivary glands, particularly the Parotid glands, which are situated just in front of the ear on the side of the face. Such tumours are uncommon (the majority of parotid tumours are benign) and rarely effect children. They are often discovered by accident, as this type of tumour shows no visible symptoms. However signs of malignancy include a lump or growth on the gland, paralysis of the face and changes in skin colour.
Treatment
Benign lumps are usually removed, as over time they do increase in size and may become more difficult to remove. Malignant tumours are removed and, in some cases, a course of post-operative radiotherapy may be recommended. Radiotherapy is the use of high energy radiation, usually in the form of X-rays, to kill cancerous cells.
Laryngeal Cancer
Malignant tumour or lumps on the voice box (Larynx) frequently occur in middle aged people, who have a history of smoking and drinking alcohol. Lesions develop on the vocal cords (Glottis) and the upper part of the larynx, which is located above the vocal cords (Supraglottis). Cancerous cells grow from flat cells that are located on the surface of the throat / larynx (Squamous Cell Carcinoma). This is the most common type of malignant growth in the head and neck.
Treatment
Radiotherapy is used to kill small malignant tumours in the voice box (Larynx) in many cases although some surgeons are advising the use of the laser to remove small tumours, there is still some debate regarding this form of treatment. If radiotherapy is unsuccessful or the cancer is recurrent, then surgery is recommended to remove some or all for the voice box (Partial or Total Laryngectomy). Many patients undergoing laryngectomy will retain voice , either through developing oesophageal speech or the use of a small ‘valve’ that is placed at the time of surgery.
Cancer of the Mouth (Oral Cavity)
Malignant growths from the thin flat cells that line the structures in the mouth (Squamous Cell Carcinoma) are the cause of all oral cancers. Oral cancer is widespread amongst smokers, people with high alcohol consumption and in patients with chronic dental infection.
Treatment
Surgical removal or radiotherapy, or sometimes a combination of these in more advanced tumours may be the initial treatment. If radiotherapy is the initial treatment and is unsuccessful, then surgery may be used to deal with the problem.
Cancer of the Thyroid Glands
The thyroid gland is located in the front of the neck just below, and either side of, the voice box (larynx). This gland produces hormones that help regulate our metabolism. These tumours usually present as an isolated lump in the neck. Thyroid cancer is more common in women.
Treatment
Surgery would normally be the primary treatment of this condition although radiotherapy may have a part to play in some cases. Drugs which affect the activity of the thyroid gland are also sometimes used in their treatment.
Cancer of the Nose and Paranasal Sinuses
Cancers of the nose and sinus are extremely rare. Symptoms arising from these tumours include nasal obstruction, bleeding from the nose, pain, and occasionally eye symptoms such as double vision , watering eye etc.
Treatment
Surgery is used to remove tumours in the nose (Nasal Cavity). Post-operative radiotherapy may be recommended if the tumours are more extensive. A combination of Radiotherapy and Chemotherapy is used to treat malignant tumours in the area at the back of the nose (Postnasal Space).
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