In medical parlance, these refer to a range of tumors arising from organs located below the brain to the level of the collar bone in the neck. Within this anatomical region, the majority of patients whom I treat tend to present with diseases arising from the face, nose, oral cavity, throat, salivary glands and neck structures such as the throat, thyroid, parathyroid and lymphatic tissue.
In terms of causes, such diseases or tumors can be broadly divided into benign or cancerous, congenital or acquired. It is the Head and Neck surgeon's responsibility to firstly determine the problem area and then ascertain the causation.
The diagram illustrates the typical areas that a Head and Neck surgeon treats. This is a surgeon who has undergone specialized training to operate in these areas after completing basic surgical training either as a General Surgeon or an ENT surgeon.
A common misconception is that the Head and Neck surgeon also treats diseases arising from the brain and the spine in the neck. Only neurosurgeons or orthopaedic surgeons are trained to perform surgery in these areas.
In the initial stages of a tumor arising from these areas, it may be too small to produce any symptoms. As such, the tumor remains undetected until it grows to a discernible size. The symptoms that patients experience are typically related to the organ of origin.
These may include:
Anyone with the above symptoms should be examined by a general surgeon who is familiar with the complex head and neck anatomy. Specialized equipment may be required to perform further evaluations in the clinic setting. These include flexible nasoendoscopy and bedside ultrasound, both of which are available in our clinic. In order for a diagnosis to be made, additional investigations such as a fine needle aspiration biopsy or a tissue biopsy made be performed, usually under local anaesthesia.
Further investigations are often required to aid in the assessment. These may include:
The treatment plan for head and neck cancers is tailored according to the organ of origin as well as the stage of the cancer. In general, surgery is the mainstay of treatment apart from some cancers where there is a need to preserve the organ function. The larynx (voice box) is one such example. Radiotherapy and chemotherapy are also effective treatment options when surgery is not feasible. In advanced cancers, a combination approach using surgery, radiotherapy and chemotherapy is often used. Because of the complex nature of these cancers as well as the need for combination therapy, a close working relationship between the surgical oncologist as well as medical and radiation oncologists is important.
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