Monday, 29 May 2006

Head and neck cancer is one of the most difficult cancers to treat

Head and neck cancer, as its name implies, is a term used to describe a number of malignant (cancerous) tumours that develop in any of the tissues or organs in the head and neck region, such as cancers of the mouth, throat, sinus, nasal cavity, larynx and salivary glands.

Worldwide, head and neck cancers comprise about six per cent of all cancers, and is more common in males, as well as people aged 50 and above. In Malaysia for example, nasopharynx cancer was the second most common form of cancer among men in 2003. Strongly linked to tobacco and alcohol use, head and neck cancers tend to be more prevalent in countries with a higher rate of tobacco and alcohol consumption.

More than 90 per cent of head and neck cancers start developing in the cells that line the mucosal surfaces in the head and neck region. As normal mucosal cells look like scales (squamous) under the microscope, head and neck cancers are often referred to as squamous cell carcinomas.

Debilitating, disfiguring and deadly
About 75 per cent of head and neck cancer patients present to their physician for the first time with advanced cancer, where their chances of survival is significantly lower. This is because the early signs of head and neck cancer are frequently ignored. Five-year survival rates in patients with non-operable tumours are only about 15 to 25 per cent.

Head and neck cancer patients also suffer from a drastic reduction in their quality of life. Due to the location of these cancers, patients often suffer a loss of fundamental bodily functions, such as speech, swallowing/eating, breathing and facial nerve function. Their facial appearance is also marred due to the site of tumour growth.

One of Asia’s most established institutes in treating head and neck cancer is the National Cancer Centre of Singapore (NCCS). Established in 1999 as a one-stop cancer centre offering holistic services for Singaporeans, it has expanded its reach in the region and sees more than 1570 overseas patients each year. The NCCS is especially known for its expertise in treating more complicated cancers, such as liver, head and neck, and lung cancer. About two-thirds of such cancers in Singapore are treated by the NCCS.

Diagnosis and treatment
In NCCS, diagnosis of head and neck cancers usually begins with a physical examination. Further tests include the use of an endoscope to examine areas inside the body, computerized tomography (CT) scan, magnetic resonance imaging (MRI) or PET scan. Samples of blood, urine, or a tissue sample are then taken to confirm the tumour type.

A/Prof London Lucien Ooi, Head of Hepatobiliary, Surgical Oncology and Chief of Hepatobiliary Surgery in National Cancer Centre Singapore (NCCS), said, “An early and accurate diagnosis is critical to ensure a good outcome for the patient, which is why we place a heavy focus in this area,” said Clinical A/Prof Ooi. “It allows us to plan the best treatment options and hence manage the cancer effectively.”

In head and neck cancer, Intensity Modulated Radiation Therapy (IMRT) is the primary mode of treatment. A powerful, cancer-fighting technology, it uses computer-controlled x-ray accelerators to deliver intense radiation doses to a tumour, while minimizing radiation exposure to surround normal tissues. Treatment is carefully planned by using 3D CT images to calculate the dose intensity pattern of the patient. The end result is that the cancer cells are destroyed, while avoiding damaging healthy cells, hence minimizing the side effects in patients. NCCS the first in the region to use IMRT in South East Asia.