Oncology

Oncology

What are ENT Cancers?

ENT (ear, nose, throat) cancers are also known as head and neck cancers. They are a group of cancers that affect the soft tissue organs in the head and neck region.

The National Registry of Diseases Office states that nasopharyngeal cancer (nose cancer), thyroid cancer, and lymphoid cancer (which often occurs in the neck) rank in the 10 most common cancers in Singapore. Nose cancer is more common in men, thyroid cancer is more common in women, and lymphoid cancers occur in both genders. There is about a 1 in 100 chance of developing one of these cancers by the age of 75.

Signs & Symotoms

Lump in the neck – Most lumps developing in the neck are benign (non-cancerous). However, a lump that stays for more than 2 weeks, is painless, or keeps growing, should be seen by a doctor.

Lumps in the neck can occur in nose, thyroid and lymphoid cancers, as well as other ENT cancers. The position of the lump in the neck may give a clue to its cause. For example, a lump in the lower front part of the neck may come from the thyroid gland, especially if it moves up and down when swallowing. Not all lumps in the neck are signs of cancer, there are other causes like an inflamed gland. However, cancer or not, a lump in the neck should still be checked by a doctor.

Nosebleeds – Nosebleeds usually occur because of injury to the nose lining, often due to dry weather, infection or allergy, which can cause people to rub or scratch their noses more. However nosebleeds can also be a sign of nose cancer, especially if the bleeding keeps happening, occurs in small amounts, or occurs with a headache or unusual smell, then it is important to get checked. Nosebleeds sometimes drain backwards into the throat, causing blood-stained phlegm.

Swelling or ulcer in the mouth – A swelling, ulcer or sore area in the mouth that does not go away within a week should be looked at by a doctor. This is important if there is also a lump in the neck. Ulcers that come and go in different areas of the mouth are typically non-cancerous, and known as aphthous ulcers.

Hoarse voice – Hoarseness of the voice can occur with cancers of the voice box, it can also be a sign of thyroid cancer. This is because nerves to the vocal cords run closely behind the thyroid gland and can be affected by cancer within the gland. While most voice changes are not due to cancer, it should be seen to by a doctor if the hoarse voice persists.

thyroid gland sits just below the voice box
Difficulty swallowing – A feeling that something is stuck in the throat, or even difficulty swallowing food, can be a sign of cancer of the throat and should be looked at by a doctor. A swallowing x-ray or an oesophagoscopy (direct examination of the food passage with a scope) may be needed to find the cause.

This can be done in the clinic using a technique known as transnasal oesophagoscopy (TNE). This involves passing a thin flexible camera through the nose, while the patient is awake, to view the oesophagus and stomach.

examining the ear
Pain or blockage in the ear – Pain or blockage in the ear does not always mean a problem with the ear, but can be due to disease or a tumour in the nose or throat. Nose cancers can present with a blocked ear or sometimes unexplained pain or discomfort around the ear as the only symptom. Examining the ear will help tell the difference between a problem within the ear or the surrounding area.

Diagnosis & Assessment

If you have any of the symptoms above, a full ENT examination is recommended.

thyroid ultrasound scan
When there is a lump in the neck, its cause can often be found by having an experienced doctor examine it. Some lumps can be left alone or treated with medication, while others may need a further investigation. In the case of a thyroid lump, an ultrasound scan and a fine needle biopsy can help decide the chance of cancer, and therefore the need for surgical removal. Not all neck lumps must be removed, but sometimes surgery is needed to confirm the diagnosis. Some neck lumps can be removed under local anaesthesia, while others may need to be done under general anaesthesia (full body anaesthesia). Sometimes, a CT or MRI scan can provide helpful information before deciding whether to remove the lump.

Nasal endoscopy is usually part of the examination and necessary if nose cancer is suspected or needs to be ruled out. It involves passing a thin flexible camera into the nose to examine the nose and throat. The examination only takes a few minutes and is usually painless. The examination can only reach the level of the voice box, to view further into the oesophagus (food passage), an oesophagoscopy may be recommended.

For suspected cancer inside the nose or throat, a tissue sample must be sent to the laboratory to confirm the diagnosis. For nose cancer, this may be done in the clinic using local anaesthesia and an endoscope to guide the biopsy. With cancers deep in the throat, eg. at the voice box, general anaesthesia and special instruments are usually needed to reach the area.

Treatment & Care

ENT cancers can be treated successfully, and the earlier cancer is diagnosed, the easier it is to treat and cure. Early treatment is also likely to have fewer side effects. It is important to seek medical advice early if you find any warning signs as this can mean an earlier diagnosis if a cancer is present.

Surgery, radiotherapy and chemotherapy are the main treatments for head and neck cancers. The exact treatment option is decided by the doctor according to the type and extent of the cancer.

Nasopharyngeal Cancer
Radiotherapy and chemotherapy (given directly into a vein) are usually given over several weeks to treat the cancer.

Because of its location in the back of the nose, surgery is not normally used to treat nasopharyngeal cancer but it is needed to confirm the diagnosis.

Thyroid Cancer
Surgery is needed to remove the cancer and any involved lymph nodes in the neck.

Radioactive iodine treatment is often given several weeks after surgery to clear remaining cancer cells in the body. This is taken by the patient in capsule or liquid form and it targets and kills any remaining thyroid cancer cells.

Lymphoma
Chemotherapy is usually needed as the lymph system, which occurs throughout the whole body, is involved. Radiotherapy may be used when the cancer only involves one part of the body.

Other treatments such as antibody or immunotherapy may be used. This involves a medication, which sticks to cancer cells and causes the immune system to attack the cells.