Head and neck cancer is a general term for a group of cancers that develop in the squamous cells that compose the mucous lining of the head and neck. Because of the type of cell in which this cancer develops, it is known as Squamous Cell Carcinoma of the Head and Neck (SCCHN). Squamous cells divide quickly and are therefore highly prone to cancer. SCCHN makes up approximately 3% of cancer cases in the United States.
There are many places in the head and neck where these carcinomas can develop, and cancers are usually classified by their place of origin. Patients may develop carcinomas in the
- Oral cavity, including the lips, gums, cheek lining, floor, or roof of the mouth
- Pharynx, the tube connecting the nose to the esophagus
- Larynx, known as the voice box and protected by a flap of skin called the epiglottis
- Paranasal sinuses or nasal cavity
- Salivary glands on the floor of the mouth or near the jawbone
Alcohol and tobacco use are closely linked to the development of all of the preceding kinds of cancer except cancer of the salivary glands. Lack of oral hygiene, radiation exposure, and a diet consisting of large amounts of preserved or salty foods may contribute to the development of this cancer, among other risk factors.
Symptoms for SCCHN will depend upon the placement of the tumor or abnormality, but usually present as pain or changes in the mouth, throat, or head. They may include any combination of
- Persistent sore throat or difficulty swallowing or breathing
- Frequent nose bleeds or unexplained nasal discharge
- Hoarseness of the voice or change in vocal tone
- Blood in the phlegm or saliva
- Bad odor in the mouth despite good oral hygiene
- Ear pain or difficulty hearing
- Red or white patch or lump in the mouth or throat
- Weakness or numbness in the head or neck
- Unexplained weight loss
Like any individual symptoms, these conditions often do not indicate cancer, but some other ailment that may need to be treated by a doctor.
In order to diagnose SCCHN, a doctor will first perform a physical examination of the head, neck, nose, throat, and mouth with small instruments, lights, and mirrors. Blood and urine samples may be taken and analyzed as well. In order to get a clearer picture of the throat, a physician may additionally perform an endoscopy, in which a flexible tube with a camera attached is inserted into the nose and throat or esophagus for visual evaluation.
If a mass or abnormality is discovered, a biopsy of the growth will be taken. A tissue sample is extracted from the affected area and analyzed under a microscope to determine whether or not the mass is cancerous. The doctor may then advise advanced imaging techniques to get a better picture of the cancer, such as an x-ray, CT scan, and/or MRI.
The treatment for head and neck cancer varies widely depending on the patient's age and health, medical history, and particular variety of cancer, but will include some combination of surgery, radiation, chemotherapy, and targeted therapy. Surgery can range from minimally invasive laser removal of a tumor in its early stages to major tissue removal, in which part of the jaw, pharynx, or tongue is removed and reconstructed with plastic surgery.
Radiation can be used as an entire treatment or in conjunction with surgery before or after a procedure to reduce cancerous cells and tissue. Chemotherapy is generally only used as a supportive or secondary option in advanced cases of SCCHN in conjunction with or after surgery and radiation. Targeted drugs are more exact than chemo drugs, as they are focused on particular tumor characteristics rather than attacking all quickly growing and dividing cells in the body. 650
Taxotere as a Treatment for SCCHN
Taxotere is almost always used as a late stage option for those with head and neck cancer. Patients in this position usually have a life expectancy of 6-12 months, so chemotherapy is implemented to extend this window without causing the patient too much undue pain or discomfort from side effects. Taxotere was approved in the treatment of SCCHN in 2006 by the FDA for inoperable tumors which have advanced locally. In early clinical trials the use of Taxotere extended a patient's life without progression of the disease by three months. Taxotere is usually used with cisplatin, followed in some circumstances by carboplatin and radiation sessions. Today, Taxotere can be used as a first or second line treatment in advanced or recurrent SCCHN. Adding Taxotere to drug regimens can increase a patient's survival, but can also increase toxicity and side effects like lowered white blood cell counts (neutropenia).