ENT, HEAD AND NECK CANCER (ONCOLOGY) “Oncology”   is   the   branch   of   medicine   that   deals   with   tumour   or   cancer.      A   “tumour”   can   be   malignant (cancerous) or benign (non-cancerous). Therefore,   ENT   Oncology   deals   with   tumours   in   the   ear,   nose,   mouth,   throat   and   the   head,   salivary   glands, neck (including voice box/larynx and thyroid) regions. The   number   1   head   and   neck   cancer   in   Malaysia   is   nasopharyngeal   cancer   (NPC) .   Other   common   cancers include oral cavity cancers (eg. tongue, floor of mouth, buccal region). Based   on   the   2006   Malaysian   Cancer   Registry,   the   commonest   Head   & Neck Cancers (by frequency) were: 1. Nasopharyngeal Cancer (NPC) (981 cases) 2. Thyroid Cancer (891) 3. Oral Cancer (428) 4. Laryngeal Cancer (216) 5. Salivary Gland Cancer (142) 6. Pharyngeal Cancer (113) 7. Sinonasal Cancer (113) The   commonest   histological   type   of   ENT,   head   and   neck   cancer   is   squamous   cell   cancer   (SCC).   Though cancer   can   arise   in   anyone   (unfortunately),   tobacco   smoking,   excessive   alcohol   intake,   betel   nut   chewing are major risk factors for cancers in the ENT, head and neck regions. ENT,   head   and   neck   cancer   symptoms   largely   depend   on   the   location   on   the   tumor   or   the   involved   organ   in the spread (medical term “metastasis”) of the cancer. Symptoms can include but not limited to: • non-healing and/or painless ulcer in the mouth • bleeding ulcer • persistent red or whitish patch in the mouth • progressive/persistent hoarse voice • progressive/persistent pain or difficulty swallowing • nose/ear bleeds and blockage, especially if one sided and persistent despite treatment • progressively enlarging mass/lump in the neck • skin lesions or moles that change color or increase in size Early   detection   while   the   cancer   is   still   in   its   early   stage   offers   the   best   chance   of   cure.   A   full   video endoscopic   examination   of   the   upper   aerodigestive   tract   via   flexible   nasopharyngolaryngoscope   (FNPLS) is   usually   warranted.   Narrow   Band   Imaging   (NBI)   endoscopy   also   offers   an   extra   advantage   in   the   early detection of cancer lesion. Occasionally,   endoscopic   examination   of   the   bronchus   (bronchoscopy)   and   esophagus   (esophagoscopy) may   be   needed.   If   a   sweliing   is   present   eg.   in   the   salivary   glands,   neck   lymph   nodes,   thyroid   gland,   a   Fine Needle   Aspiration   Cytology   (FNAC)   is   also   commonly   performed   to   assess   the   nature   of   the   swelling. Diagnosis   is   usually   made   after   a   biopsy   of   the   tumour   with   a   histopathological   report   to   confirm   the cancerous   nature   of   the   tumour.   Further   investigations   can   include   CT   scans   and/or   MRI   of   the   relevant regions   to   delineate   the   extent   of   the   local   tumour.   It   is   also   important   to   exclude   spread/metastasis   to nearby lymph nodes (eg. cervical/neck lymph nodes) and distant sites (eg.lung, liver, verterbra) Treatment   is   very   much   tailored   to   the   extent   of   local   cancer   disease   and   the   stage   of   spread   of   the   disease to   the   rest   of   the   body.   Treatment   can   be   in   the   form   of   surgery,   radiotherapy,   chemotherapy,   either   as   a sole modality or combined approaches, depending on the type of cancer

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Cancer of the right salivary (parotid) gland

Another case of cancer involving the neck  lymph nodes - just before surgery

A normal endoscopic view of the area behind the nose (nasopharynx) - a common area where the nasopharyngeal cancer (NPC) begins.

This is how nasopharyngeal cancer/carcinoma (NPC) looks like under the microscope.

This is how a nasopharyngeal mass can look like on the nasal video endoscope

Last update:  10/1/13