Head and Neck Cancer

The diagnosis of head and neck cancer generally involves several steps combining physical examination, imaging tests, and tissue sampling:

1. Physical Examination

A healthcare provider closely examines the head and neck area for lumps, sores, or abnormalities. This includes feeling the neck for swollen lymph nodes and inspecting the mouth and throat using a light and mirror. Sometimes, a flexible camera (endoscope) is inserted through the nose or mouth to visualize areas that are hard to see, such as the throat or nasal passages.

2. Imaging studies (CT, MRI, PET, US)

Imaging helps determine the size, location, and spread of the tumor. Common imaging modalities include:

• Computed Tomography (CT) scans: Provide detailed cross-sectional images to evaluate primary tumors, lymph nodes, and nearby structures; often performed with contrast agents.
• Magnetic Resonance Imaging (MRI): Offers superior soft tissue contrast, useful for assessing tumor extent, bone marrow involvement, and perineural spread.
• Positron Emission Tomography (PET) scans: Detect metabolically active cancer cells to find primary tumors and distant metastases.
• Ultrasound: Sometimes used to assess neck lymph nodes or accessible tumors.
• Additional imaging may include panoramic dental X-rays or sinus imaging where relevant

3. Biopsy with pathological evaluation

A biopsy involves removing a sample of tissue or cells for microscopic examination to confirm cancer. How the sample is obtained depends on tumor location:

• Direct removal with a scalpel or punch biopsy if the lesion is accessible.
• Fine-needle aspiration biopsy (FNAB) for lymph nodes or deeper lesions.
• Endoscopic biopsy using special instruments to collect tissue from inside the throat or nose.
• Laboratory Testing of Tissue Samples

Pathologists analyze the biopsy samples to verify malignancy and identify cancer type, grade, and molecular markers. Tests may include detection of HPV or Epstein-Barr virus to guide treatment planning.

Head and neck cancer treatment typically involves a combination of surgery, radiation therapy, and chemotherapy, with the choice depending on the cancer’s location, stage, and patient factors.

1. Surgery (with possible reconstruction) 

Surgery aims to remove the tumor and some surrounding healthy tissue to ensure complete excision. In early-stage cancers, surgery alone may be sufficient, especially for oral cavity and salivary gland cancers. Advanced cases may require surgery followed by additional treatments. Reconstructive surgery is often performed to restore function and appearance.

2. Radiation therapy (often with chemotherapy)

Radiation therapy uses high-energy rays (like X-rays or protons) to destroy cancer cells. It can be used alone for early-stage tumors or after surgery to eliminate residual cancer cells. For advanced cancers, radiation is often combined with chemotherapy (concurrent chemoradiation) to improve outcomes. Intensity-modulated radiation therapy (IMRT) allows precise targeting to spare healthy tissues and reduce side effects.

3. Chemotherapy uses drugs to kill cancer cells and is commonly given alongside radiation therapy in locally advanced cases.

It's sometimes used before other treatments (induction chemotherapy) or when surgery is not an option. Newer systemic therapies like immune checkpoint inhibitors are also being incorporated into treatment plans.

Multidisciplinary approach: Head and neck cancer treatment usually requires coordinated care involving surgeons, radiation oncologists, medical oncologists, pathologists, radiologists, and rehabilitation specialists (speech, swallowing therapy, nutrition) for optimal results.