When cancer strikes at the most visible part of the body.
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.

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.

At NCCS, a team sub-specialising in head and neck cancer is involved in the IMRT process, including the radiation oncologist, medical radiation physicist, dosimetrist, radiation therapist and radiation therapy nurse.

Early detection is the best prevention

Ms. FH Lee, an Australian based in Kuala Lumpur early 1999 was wondering about an ulcer on her tongue that would not heal. A biopsy was done but it did not detect any cancer. After having consulted another dental specialist, she had an operation. It was only in 1999 that she was diagnosed with early stage tongue cancer and flew in to see Prof Soo Khee Chee, Director, NCCS to treat her oral cancer. She had heard about him from internal medicine specialists in KL when an ulcer on her tongue did not heal.

Prof Soo said, “Head and neck cancer is becoming increasingly prevalent across Asia, especially among people who smoke and consume alcohol on a frequent basis. Each cancer treatment is unique and you need experts to select the most appropriate and optimal treatment. In Ms Lee’s case, we decided on surgery, rather than radiotherapy, because hers was in the early stage cancer, and we did not even need to put her on chemotherapy after surgery.”

Today, Ms Lee is glad that her yearly visits to NCCS have shown no sign of cancer. She has embarked on a healthy lifestyle, engages in craft and jets around the world to catch up with relatives.

She said, “I’m really glad I had doctors who had a wealth of experience in treating this type of cancer operating on me. It gave me the confidence to believe that they could cure me and save my life, using the best possible treatment for my condition. My advice to head and neck cancer patients and their families? ”It’s important to see the right specialist to diagnose the problem well and to get treatment early.”

How to spot head and neck cancer

Common symptoms include:

• Difficulty in chewing or pain when swallowing
• Prolonged hoarseness or a change in the voice
• Earache
• Bleeding in the mouth / throat
• Persistent pain in the throat

Less common symptoms include:

• Unhealed mouth sores which persist for more than two weeks
• Lumps on the lips, mouth or throat
• Pain or swelling in the neck or jaw
• Difficulty in moving the tongue or jaw
• Unusual white or red patches in the mouth

Facts on NCCS

• NCCS is a national and regional cancer centre with a nexus of specialised centres, providing patients with a multi-disciplinary treatment approach
• NCCS is the one of the centres in the Asia Pacific region to offer:
• Surgical oncology
• Oncology imaging
• neoadjuvant therapies
• peritonectomy
• contrast-enhanced ultrasound
• sub-specialty pathology on oncology treatment (rare in the region)
• provide a multidisciplinary approach with nexus of specialised centres
• High-end and complicated surgeries calls for high volume of resources to be made available. NCCS treats two-thirds of high-end surgery, especially in the area of liver, head and neck and lung cancer.
• NCCS acts as the training centre for high-end surgery, nursing as well as palliative care for medical professionals in the region.

Readers can visit www.nccs.com.sg or call +65 6436 8000 to find our more about NCCS.

_i Lefebvre J-L. Redefining “State of the Art” in Head and Neck Cancer. Oral presentation, 6 th International Conference on head and Neck Cnacer, 7-11 August, 2004.

About National Cancer Centre Singapore

The National Cancer Centre Singapore (NCCS) is a national and regional centre directed at the prevention and treatment of different cancers including thoracic, hepatobiliary, pancreatic, head and neck cancers . Structurally and operationally designed to provide integrated and holistic patient-centred clinical services, it allows cross-consultation among cancer experts of different specialties. Patients can, therefore, enjoy personalised, prompt and customised cancer treatment recommended by a team of radiation, surgical and medical oncologists (cancer experts) during the same visit and in the same clinic.

As a one stop specialist centre housing Singapore's largest pool of oncologists, it has state of the art equipment and employs the latest therapies including mini transplants and targeted therapies which maximise outcomes and minimise undesirable side effects. NCCS also conducts clinical and basic research as well as public cancer education programmes wholly directed at the prevention and treatment of cancer.

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