Head and Neck Cancer from Detection to Treatment
What Is Head and Neck Cancer?
Head and neck cancer refers to cancers that start in the mouth, throat, nose, sinuses, larynx | voice box, and salivary glands.
Most are squamous cell carcinomas, starting in the lining of these areas.
They are often linked to lifestyle factors like smoking, alcohol, and HPV infection.
Head and neck cancer refers to cancers that start in the mouth, throat, nose, sinuses, larynx | voice box, and salivary glands.
Most are squamous cell carcinomas, starting in the lining of these areas.
They are often linked to lifestyle factors like smoking, alcohol, and HPV infection.
1. Initial Evaluation and Scanning
Medical History and Physical Exam
Doctor reviews symptoms
• Lump in neck
• Sore throat
• Hoarseness
• Difficulty swallowing
• Unexplained weight loss
Physical exam focuses on the
• Head
• Neck
• Mouth
• Throat
• Nose and
• Lymph nodes
Use of mirror and fiber-optic endoscope to look inside the throat and nasal passages.
Medical History and Physical Exam
Doctor reviews symptoms
• Lump in neck
• Sore throat
• Hoarseness
• Difficulty swallowing
• Unexplained weight loss
Physical exam focuses on the
• Head
• Neck
• Mouth
• Throat
• Nose and
• Lymph nodes
Use of mirror and fiber-optic endoscope to look inside the throat and nasal passages.
2. Imaging and Scanning Tests
CT Scan - Computed Tomography
Detects size, shape, and position of tumors.
Checks if the cancer has spread to lymph nodes or nearby tissues.
MRI - Magnetic Resonance Imaging
Provides detailed images of soft tissues, especially useful for tongue, throat, or brain involvement.
PET-CT Scan - Positron Emission Tomography
Detects metastasis spread by showing how cells consume glucose.
Often done after CT or MRI to assess staging.
Ultrasound
Helps evaluate lymph nodes and guide needle biopsies.
X-rays / Dental Scans
Used if cancer is near the jaw or oral cavity.
CT Scan - Computed Tomography
Detects size, shape, and position of tumors.
Checks if the cancer has spread to lymph nodes or nearby tissues.
MRI - Magnetic Resonance Imaging
Provides detailed images of soft tissues, especially useful for tongue, throat, or brain involvement.
PET-CT Scan - Positron Emission Tomography
Detects metastasis spread by showing how cells consume glucose.
Often done after CT or MRI to assess staging.
Ultrasound
Helps evaluate lymph nodes and guide needle biopsies.
X-rays / Dental Scans
Used if cancer is near the jaw or oral cavity.
3. Diagnostic Tests
Biopsy | Gold Standard
Fine Needle Aspiration
Uses a thin needle to extract cells from a lump
Incisional Biopsy
A small tissue piece is removed from the tumor site.
Excisional Biopsy
Entire lump is surgically removed
Pathologists examine the tissue under a microscope to confirm cancer and identify type.
HPV and EBV Testing
Human Papillomavirus
Often linked to oropharyngeal cancers.
Epstein–Barr Virus
Linked to nasopharyngeal carcinoma.
Blood Tests
To check overall health and organ function
Biopsy | Gold Standard
Fine Needle Aspiration
Uses a thin needle to extract cells from a lump
Incisional Biopsy
A small tissue piece is removed from the tumor site.
Excisional Biopsy
Entire lump is surgically removed
Pathologists examine the tissue under a microscope to confirm cancer and identify type.
HPV and EBV Testing
Human Papillomavirus
Often linked to oropharyngeal cancers.
Epstein–Barr Virus
Linked to nasopharyngeal carcinoma.
Blood Tests
To check overall health and organ function
4. Cancer Staging
➛ TNM Classification
Tumor:
Size and extent of the main tumor.
Node:
Spread to nearby lymph nodes.
Metastasis:
Spread to other organs.
Stages range from Stage I | localized to Stage IV | advanced/metastatic).
➛ TNM Classification
Tumor:
Size and extent of the main tumor.
Node:
Spread to nearby lymph nodes.
Metastasis:
Spread to other organs.
Stages range from Stage I | localized to Stage IV | advanced/metastatic).
5. Multidisciplinary Treatment Planning
A team of specialists meets to decide the best treatment plan.
ENT surgeon
Oncologist
Radiologist
Pathologist
Dentist
Nutritionist
Speech therapist
A team of specialists meets to decide the best treatment plan.
ENT surgeon
Oncologist
Radiologist
Pathologist
Dentist
Nutritionist
Speech therapist
6. Treatment Options
➛ Surgery
Goal:
Remove tumor and affected lymph nodes.
Transoral robotic surgery:
Minimally invasive for throat/oropharynx tumors.
Neck dissection:
Removes affected lymph nodes.
Reconstructive surgery:
Restores appearance and function using tissue grafts.
➛ Radiation Therapy
Often used after surgery or as main treatment if surgery isn’t possible.
External Beam Radiation Therapy:
Common for localized tumors.
Intensity-Modulated Radiation Therapy:
Focused radiation to reduce damage to healthy tissue.
➛ Chemotherapy
Drugs kill cancer cells or make radiation more effective.
Used for:
Advanced cancers
After surgery - adjuvant therapy
Before surgery - neoadjuvant therapy
➛ Targeted Therapy
Drugs like Cetuximab | Erbitux | target EGFR proteins on cancer cells.
➛ Immunotherapy
Pembrolizumab or Nivolumab used for recurrent or metastatic head and neck cancers.
Helps the immune system attack cancer cells.
➛ Surgery
Goal:
Remove tumor and affected lymph nodes.
Transoral robotic surgery:
Minimally invasive for throat/oropharynx tumors.
Neck dissection:
Removes affected lymph nodes.
Reconstructive surgery:
Restores appearance and function using tissue grafts.
➛ Radiation Therapy
Often used after surgery or as main treatment if surgery isn’t possible.
External Beam Radiation Therapy:
Common for localized tumors.
Intensity-Modulated Radiation Therapy:
Focused radiation to reduce damage to healthy tissue.
➛ Chemotherapy
Drugs kill cancer cells or make radiation more effective.
Used for:
Advanced cancers
After surgery - adjuvant therapy
Before surgery - neoadjuvant therapy
➛ Targeted Therapy
Drugs like Cetuximab | Erbitux | target EGFR proteins on cancer cells.
➛ Immunotherapy
Pembrolizumab or Nivolumab used for recurrent or metastatic head and neck cancers.
Helps the immune system attack cancer cells.
7. Supportive Care During Treatment
Nutritional Support:
Feeding tubes if swallowing is difficult.
Speech Therapy:
For speech and swallowing rehabilitation.
Pain and Symptom Management:
Medications for pain, dry mouth, and mucositis.
Dental Care:
Prevent tooth decay and jawbone problems from radiation.
Nutritional Support:
Feeding tubes if swallowing is difficult.
Speech Therapy:
For speech and swallowing rehabilitation.
Pain and Symptom Management:
Medications for pain, dry mouth, and mucositis.
Dental Care:
Prevent tooth decay and jawbone problems from radiation.
8. Post-Treatment Monitoring and Follow-up
First 2 years:
Exams every 1 - 3 months.
Years 3 - 5:
Every 4 - 6 months.
After 5 years:
Yearly.
Includes:
Physical exams, Imaging, and Blood tests to detect recurrence.
Rehabilitation:
Speech and swallowing recovery continues long-term.
First 2 years:
Exams every 1 - 3 months.
Years 3 - 5:
Every 4 - 6 months.
After 5 years:
Yearly.
Includes:
Physical exams, Imaging, and Blood tests to detect recurrence.
Rehabilitation:
Speech and swallowing recovery continues long-term.
9. Long-Term Outlook
Early-stage cancers:
high cure rates.
Advanced cancers:
prognosis depends on response to combined therapies.
Lifestyle changes:
Stop smoking, limit alcohol, maintain nutrition, and follow rehabilitation programs.
Early-stage cancers:
high cure rates.
Advanced cancers:
prognosis depends on response to combined therapies.
Lifestyle changes:
Stop smoking, limit alcohol, maintain nutrition, and follow rehabilitation programs.
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