Head and neck cancer


Head and neck cancer

What is cancer?

Organs are formed by a collection of cells which divide themselves regularly to replace those that die.

This process of cell division in regulated by mechanisms that, when altered, cause cells and their descendents to start an uncontrolled overactive division, thus invading surrounding tissues and organs (infiltration) and even moving and growing someplace else in the organism (metastasis) forming a malignant tumour or nodule called cancer or neoplasm.

A cancer may grow:

  • Locally, invading neighbour tissues cells-.
  • Spreading through the lymphatic ganglia.
  • Spreading through the blood vessels.

How is the head and neck cancer diagnosed?

The specialist may observe the mucous of the mouth, nose, pharynx and larynx using a laryngeal mirror, a fiberscope or a rigid lens. In case of observing a suspicious tissue, they will perform a biopsy and extract part of it so that a pathologist may observe it through a microscope and verify what kind of tumour it is.

Besides, they will have to palpate the patient’s neck in search of nodules.

Eventually they will require radiologic imaging (tomography, MRI) to verify the extension of the tumour and whether the neck nodules are affected.

Then the specialist will be able to know in which development state the cancer is (staging), which will be used to plan the most adequate treatment.

Head and neck treatment, as happens with most tumours, is multidisciplinary: various specialists work together in combining therapies and offer the patient more probabilities of recovery.

What’s a Head and neck cancer committee?

Head and neck tumours present a heterogeneous and complex group of neoplasms, for they have different locations, prognostics and treatments.

Tumours formed in the nose, paranasal sinuses, oral cavity, nasopharynx, oropharyx and hypopharynx and larynx, as well as those in the neck (adenopathies) and of unknown origin with carcinoma histology are head and neck tumours.

The multidisciplinary diagnosis, treatment and control of these tumours require the coordination of different specialists who have to meet and form a committee.

As a result of these meetings, where the different interventions to be performed regarding each location and stage of the illness have been discussed, a protocolo, which is not definitive and may be modified, is elaborated.

How is a treatment decided?

Because of the great number of variables, the decision must be made only after a complete pre surgery study (electrocardiogram, thoracic radiography...), a radiologic study of the tumour (tomography, MRI, PET) and an anatomo-pathologic study of the biopsy (is that tumour radiosensitive?, how aggressive is it?) are performed.

First of all, the patient’s clinic case is presented, whose health state or personal antecedents may condition or contraindicate certain therapies:

  • The patient’s age, physical and psychological health: whether the patient suffers from renal or hepatic alterations that would contraindicate chemotherapy, whether they could cope with a complicated surgery, whether the location of the tumour has been previously treated with radiation, whether the patient suffers from dementia...
  • The patient’s nutritional state: malnutrition lessens the chances of recovery, hence, be this the case, an endocrinologist must be consulted. If the patient has any difficulty to swallow or it is foreseen that radiology on the neck would cause intense swallowing pain, the patient will need a stomach catheter.
  • Dental state: If radiation is to be applied on the mouth, the patient’s dentist must be informed since it will take 2 years before they can receive any treatment on the maxilla.

Depending on the results of this exhaustive study a certain strategy is to be followed according to the centre's protocol in order to pursue the highest degree of recovery with the least after-effects.

However, the patient must always know the different alternatives that may exist.

The surgical treatment will not only depend on the size and location of the tumour, but on the experience, knowledge and aptness of the surgeon as well.

Treatments

The possible treatments for the head and neck surgery –used alone or combined– are:

  • Chemotherapy: It consists in using drugs to destroy tumoral cells. Such drugs can be administrated orally, intramuscularly or intravenously. This therapy can be used in 3 different ways:
    • As an induction treatment to reduce the size of the tumour and thus making it accessible through surgery and/or radiotherapy.
    • Chemo-radiotherapy: used alongside with radiotherapy to kindle the radiosensitivity.
    • Palliatively, stopping the growth of the tumour already radiated and inextirpable or extended to other organs.
  • Radiotherapy: It consists on using high energy radiation to destroy the tumours. It can be used in 3 different ways:
    • Alone as first treatment.
    • Combined with chemotherapy.
    • As a complement to surgery, usually combined with chemotherapy.

    Radiotherapy is not only used on the tumour, but also on the lymphatic chains of the neck to treat the illness when it has extended to the ganglions.

  • Open surgery: Traditional surgery. It removes the tumour and the surrounding portion of healthy tissue by means of different surgical techniques.
  • Laser surgery: Through the natural mouth orifice the surgeon reaches the tumour and using a surgical microscope (which amplifies the image) the surgeon uses the CO2 laser to remove the tumours from the oral cavity, tongue, pharynx and larynx with less effects on healthy tissues, thus altering less the anatomy and achieving the same oncologic results of open surgery but often preventing tracheotomy, jaw sectioning, external scars and reducing the function (swallowing, talking) recovery time and the time of hospitalization, which translates to saving money.

Laser surgery can be performed again if the tumour reappears. Microsurgery requires a long formation: the surgeon first of all needs to have mastered traditional open surgery in case the tumour is not accessible through the mouth (anatomic problems, extension of the tumour to vital tissues, etc.). The surgeon must also develop their abilities in the use of the surgical microscope with highly amplified images that help to tell the healthy tissues apart from the tumoral tissues (which allows to sear the tumour adjusting with more precision the resection of the surrounding healthy tissues).

This surgery requires a learning curve (with a gradual increase of the difficulty of the case): the more experience and ability the surgeon possesses, the more complicated cases that surgeon will be able to solve.

What must the patient do once the treatment is over?

Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.

Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.


Larynx cancer

What is larynx cancer?

When the tumoral cells are located in the larynx, it is a larynx cancer.

The larynx is a triangular conduct the vertex of which is Adam’s apple, which connects the pharynx and the trachea, and where the vocal chords are located. The human being can make them vibrate expulsing air from the lungs, and the sound they make can be modulated with the mouth, nose and pharynx to form the voice.

The larynx has three areas or regions:

  • Flottis, which is in the middle and contains the vocal chords.
  • Supraglottic region, which is a tissue located above the glottis and contains the epiglottis, which works as a lid that blocks the glottis so that food can go down the oesophagus without entering the lungs.
  • Subglottic region, which is under the glottis and connects with the trachea.

Which are the symptoms of larynx cancer?

The symptoms of a larynx cancer depend on the placement and extension of the tumour:

  • When the tumour is supraglottic, deglutition (swallowing) is affected, there’s irritation on the parynx, localized pain when swallowing that can reach the ear.
  • When the glottis is affected the initial symptom is disphonia or hoarseness. In both cases, if the tumour is in a more advanced stage, there can be breathing difficulties and dyspnea.
  • A lump (nodule) may appear on the neck.

How is it diagnosed?

The specialist will introduce a tube topped with a camera through the mouth or the nose to observe the larynx (laryngoscope). If any anomalous tissue is found, a fragment will be extracted (biopsy) and a pathologist will examine it to confirm the presence of cancerous cells. The neck will also be palpated in search of nodules.

What is its prognosis like?

Compared to other types of cancer, the prognosis of larynx cancer is relatively good, especially if it is detected early.

The possibilities of recovery will depend on:

  • The region of the larynx where the cancer is located.
  • Whether the cancer is just in the larynx or it has spread (stage of metastasis).
  • The patient’s health.

Larynx cancer staging

Once the cancer is diagnosed, the specialist will require radiologic studies (tomography, MRI, PET) in order to know the extension of the tumour and whether there is metastasis. Then the stage will be determined and the most adequate treatment will be planned.

  • Stage I: the cancer is only affecting one area of the larynx and there is no metastasis.
  • Stage II: the cancer has invaded a neighbour region and there is no metastasis.
  • Stage III: any of the following situations:
    • Immobilized vocal cord.
    • The cancer has invaded neighbour tissues.
    • There is metastasis on a lymphatic nodule of the same side of the neck as the cancer and is smaller than 3cm.
  • Stage IV: any of the following situations:
    • The cancer has invaded the surrounding tissues, such as the pharynx or neck tissues.
    • The cancer has spread to more than one lymphatic nodule on the same side of the neck or both sides or any lymphatic nodule bigger than 6 cm.
    • The cancer has reached other parts of the body.
  • Recurrent: the cancer has spread after being treated. It can regrow both in the larynx and any other part of the body.

Which are the treatments?

The traditional larynx cancer treatment, the sixth most frequent on males, has been surgical and not much more than 40 years ago it consisted in the total resection of the larynx.

Nowadays this therapy is practised less regularly and is usually replaced by other surgical techniques that respect the organ of the respiratory system and the vocal apparatus and its functions.

One of these surgical alternatives is a transoral resection by microendoscopy assisted by a CO2 laser.

This is a cost-effective technique with small tumours in early stages (since the patients only stay one day at the hospital) compared to radiotherapy, which causes side effects on the oral cavity and the larynx. With this technique the probabilities of success are of the 95%.

When the tumour is more advanced it is a reliable alternative to radical open surgeries like laryngectomy and total laryngectomy. Patients have a better life quality since the tracheotomy is avoided.

In those cases treated with microsurgery the results and survival are very good, just as or better than those of other procedures based on total laryngectomy or massive radiotherapy and chemotherapy (which often lead to surgery and a total laryngectomy).

Withal, conventional surgery is still needed in some circumstances and, although total laryngectomies are not as used now as they were, they still have to be performed in some cases.

The first two or three years are very important. If within this time there is no local recurrence, approximately 90% of the patients will be recovered. Nevertheless, a long-term control must take place, since even though the tumour might be completely removed there is still a chance of recurrence or of formation of a second primary tumour.

The possible treatments for larynx cancer –used alone or combined– are:

  • Chemotherapy: It consists on the use of drugs to destroy tumoral cells. Such drugs can be administrated orally, intramuscularly or intravenously. This therapy can be used in 3 different ways:
    • As an induction treatment to reduce the size of the tumour and thus making it accessible through surgery and/or radiotherapy.
    • Chemo-radiotherapy: used alongside with radiotherapy to kindle the radiosensitivity.
    • Chemo-radiotherapy: used alongside with radiotherapy to kindle the radiosensitivity.
  • Radiotherapy: It consists on using high energy radiation to destroy the tumours. It can be used in 3 different ways:
    • Alone as first treatment.
    • Combined with chemotherapy.
    • As a complement to surgery, usually combined with chemotherapy. It increases the possibilities of recovery since it prevents the microscopic presence of the illness in the surrounding tissues.

    Radiotherapy is not only used on the tumour, but also on the lymphatic chains of the neck to treat the illness when it has spread to the ganglions.

  • Open surgery: Traditional surgery. It removes the tumour and the surrounding portion of healthy tissue by means of different surgical techniques:
    • Cordeoctomy: Removal of the affected vocal cord. It requires temporal tracheotomy.
    • Supraglottic laryngectomy: only the supraglottic region is removed. It requires temporary tracheostomy.
    • Hemilaryngectomy or partial laryngectomy: Part of the larynx is removed. Requires temporal tracheotomy.
    • Total laryngectomy: total removal of the larynx.
    • Total pharyngolaryngectomy: total removal of the larynx and pharynx.

    The last two procedures suppose a permanent tracheotomy. The patient may be able to talk again by:

    • Esophageal speech: The speaker pushes air into and band back up the esophagus to articulate sounds.
    • Placement of a phonation valve.
  • LASER surgery: through the natural mouth orifice the surgeon reaches the tumour and using a surgical microscope (which amplifies the image) the surgeon uses the CO2 laser to remove larynx tumourslarynx with less effects on healthy tissues, thus altering less the anatomy and achieving the same oncologic results of open surgery but often preventing tracheotomy, jaw sectioning, external scars and reducing the function (swallowing, talking) recovery time and the time of hospitalization, which translates to saving money.

    Laser surgery can be performed again if the tumour reappears. Microsurgery requires a long formation: the surgeon first of all needs to have mastered traditional open surgery in case the tumour is not accessible through the mouth (anatomic problems, extension of the tumour to vital tissues, etc.). The surgeon must also develop their abilities in the use of the surgical microscope with highly amplified images that help to tell the healthy tissues apart from the tumoral tissues (which allows to sear the tumour adjusting with more precision the resection of the surrounding healthy tissues).

    This surgery requires a learning curve (with a gradual increase of the difficulty of the case): the more experience and ability the surgeon possesses, the more complicated cases that surgeon will be able to solve.
  • Surgical treatment of the neck ganglions. Cervical ganglion removal: Always through open surgery, a dissection is performed of every muscular, vascular and nervous structure of the neck and the fat and fascia of the neck ganglions is removed.

    There are different removals depending on the localisation of the tumour and the existence of metastasis in the ganglions, on the area of the neck and the structures that show invasion of the tumour.

What does the patient have to do one the treatment is over?

Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.

Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.

Dr. Máiz has a wide experience in the treatment of larynx tumours both by conventional surgery and CO2 laser transoral microsurgery.


Pharynx cancer

What is pharynx cancer?

When the tumoral cells are located in the pharynx tissues, it is a pharynx cancer.

The pharynx is a tube-shaped organ which starts behind the nose and goes down the throat until the oesophagus. This organ includes the soft palate, which is the back of the mouth, the base of the tongue and the amygdales. Its function is allowing the entrance of air into the trachea and of food into the oesophagus.

Pharynx cancer includes nasopharynx cancer (superior part of the throat behind the nose), oropharyx cancer (middle part of the pharynx) and hypopharynx cancer (the lower part of the pharynx including the pyriform sinuses).

Which are the symptoms of pharynx cancer?

The symptoms depend on the localisation and extension of the tumour:

  • Nasopharynx:
    • Nasal obstruction.
    • Epistaxis (ear bleeding).
    • Blocked ear.
  • Oropharynx:
    • Painful swallowing.
    • Alteration of the sound of the voice.
    • Blood in saliva.
  • Hypopharynx:
    • Painful swallowing (the pain may irradiate to the ear).
    • Alteration of the sound of the voice.
    • Hoarseness, if it already affects a vocal cord.
    • Breathing difficulties.

In all cases a nodule (lump) may appear on the neck.

How is it diagnosed?

The specialist will introduce a tube topped with a camera through the mouth or the nose to observe the larynx (pharyngoscope). If any anomalous tissue is found, a fragment will be extracted (biopsy) and a pathologist will examine it to confirm the presence of cancerous cells. The neck will also be palpated in search of nodules.

Pharynx cancer staging

  • Stage I: tumour smaller than 2 cm without lymphatic metastasis.
  • Stage II: tumour between 2 and 4 cm without metastasis.
  • Stage III: tumour bigger than 4 cm, or smaller with metastasis.
  • Stage IV: the cancer has spread towards the tissues surrounding the pharynx; lymphatic ganglions may or not be affected.

Which are the treatments?

Nasopharynx tumours will be treated with chemo-radiotherapy.

Small oropharynx and hypopharynx tumours will be treated with surgery if possible, as long as the resection required by the tumour does not entail the impossibility of restoring deglutition (swallowing).

In these cases the use of CO2 laser transoral microsurgery facilitates the removal of tumours with less loss of healthy tissues and usually does not need sectioning the jaw, practicing tracheotomy or rebuilding the defect created using the usual flaps, which shortens the postoperative period and leaves less after-effects.

The neck ganglions will be treated by regular surgical dissection. In most of the cases it will be convenient a complementary chemo-radiotherapy after 3-4 weeks to increase the percentage of recovery.

When the tumour is very advanced and its resection may endanger deglutition, chemo-radiotherapy will be applied. In case of partial persistence of the tumour CO2 laser transoral microsurgery will be performed to remove it.

Microsurgery through the mouth requires a long formation: the surgeon, first of all, needs to have mastered traditional open surgery in case the tumour is not accessible through the mouth (anatomic problems, extension of the tumour to vital tissues, etc.). The surgeon must also develop their abilities in the use of the surgical microscope with highly amplified images that help to tell the healthy tissues apart from the tumoral tissues (which allows to sear the tumour adjusting with more precision the resection of the surrounding healthy tissues).

This surgery requires a learning curve (with a gradual increase of the difficulty of the case): the more experience and ability the surgeon possesses, the more complicated cases that surgeon will be able to solve.

In some cases the surgical removal of the tumour must be needed, including all or part of the vocal cords (laryngectomy). Many patients also need deglutition therapy after the treatment in order to help them get used to the changes in the structure of their throat.

What must the patient do once the treatment is over?

Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.

Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.

Dr. Máiz has a wide experience in the treatment of pharynx tumours both by conventional surgery and CO2 laser transoral microsurgery.


Mouth or oral cavity cancer

What is mouth or oral cavity cancer?

The oral cancer is the cancer located in the oral cavity (the mouth area) and the oropharynx (the throat area of back of the mouth).

Physic exploration must be an integral part of medical and odontologic exams since is early detection is crucial. In general, cancerous lesions smaller than 15 mm of diameter can be easily cured.

The oral cavity is formed by the following parts:

  • Lips, teeth and gums.
  • Lips and cheeks inner coating (oral mucosa).
  • Mouth floor (under the tongue).
  • Superior part of the mouth (hard palate).
  • A small zone behind the wisdom teeth (retromolar space).

The oropharynx is formed by:

  • The back third of the tongue.
  • The soft palate.
  • The tonsils.
  • The rear part of the throat.

Which are the symptoms?

The symptoms may vary from one person to another, however the most common are the following:

  • A lip or mouth ulcer that will not heal.
  • A red or white spot on the gums, tongue or the oral mucosa.
  • A lump on the lip, mouth or throat.
  • Bleeding, pain or numbness on unusual areas of the mouth.
  • Mandible swelling.
  • Ear pain.
  • Chronic throat pain.
  • Painful or difficult swallowing or masticating.

Oral cancer symptoms may be preceded by others caused by other disorders or medical problems. A specialist must be consulted in case of any doubt to ensure a correct diagnosis.

How is it diagnosed?

The specialist will perform a biopsy to extract affected tissue which will be examined through microscope by a pathologist who will confirm the presence of cancerous cells. Radiologic imaging will be required (Tomography, MRI, PET) to verify in which stage the tumour is.

Oral cancer staging

  • Stage I: the tumour is smaller than 2 cm and there is no metastasis.
  • Stage II: tumour between 2 and 4 cm without metastasis.
  • Stage III: tumour bigger than 4 cm, or smaller with metastasis.
  • Stage IV: the cancer has spread towards the surrounding tissues or the metastasis is bigger than 3 cm.

How is it treated?

Small oral cavity or oropharynx tumours will be treated with surgery if possible, as long as the resection required by the tumour does not entail the impossibility of restoring deglutition (swallowing).

In these cases the use of CO2 laser transoral microsurgery facilitates the removal of tumours with less loss of healthy tissues and usually does not need sectioning the jaw, practicing tracheotomy or rebuilding the defect created using the usual flaps, which shortens the postoperative period and leaves less after-effects.

The neck ganglions will be treated by regular surgical dissection. In most of the cases it will be convenient a complementary chemo-radiotherapy after 3-4 weeks to increase the percentage of recovery.

If the tumour is very advanced and its resection may endanger deglutition, chemo-radiotherapy will be applied. In case of partial persistence of the tumour CO2 laser transoral microsurgery will be performed to remove it.

Microsurgery through the mouth requires a long formation: the surgeon, first of all, needs to have mastered traditional open surgery in case the tumour is not accessible through the mouth (anatomic problems, extension of the tumour to vital tissues, etc.). The surgeon must also develop their abilities in the use of the surgical microscope with highly amplified images that help to tell the healthy tissues apart from the tumoral tissues (which allows to sear the tumour adjusting with more precision the resection of the surrounding healthy tissues).

This surgery requires a learning curve (with a gradual increase of the difficulty of the case): the more experience and ability the surgeon possesses, the more complicated cases that surgeon will be able to solve.

In some cases the surgical removal of the tumour must be needed, including all or part of the vocal cords (laryngectomy). Many patients also need deglutition therapy after the treatment in order to help them get used to the changes in the structure of their throat.

Rehabilitation

Rehabilitation may be different from one patient to another depending on which treatment has been applied, the localization of the cancer and its staging. Rehabilitation may include:

  • Dietetic advising:
    Many patients who are recovering from oral cancer surgery experience difficulties when eating; hence small meals consisting on soft and damp food are often advised.
  • Surgery:
    Some patients may profit by reconstructive or plastic surgery to rebuild the mouth bones and tissues in order to recover their normal appearance.
  • Prostheses:
    When reconstructive or plastic surgery is not an option, patients may use dental or otherwise facial prostheses to get back their normal appearance. Prostheses may need special training in order to learn how to use them.
  • Language and deglutition therapy:
    If the patient has difficulties with talking or swallowing after the surgery, language and deglutition therapies may help them to relearn how to perform such tasks.

What does the patient have to do one the treatment is over?

Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.

Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.

Dr. Máiz has a wide experience in the treatment of oral cavity tumours both by conventional surgery and CO2 laser transoral microsurgery.


Tongue cancer

What is tongue cancer?

In this type of cancer the tumoral cells grow on the tongue.

Tongue cancer is usually grouped with other oral cancers such as tongue, palate, cheek, moth floor and gum cancer, known as oral cavity cancers.

Which are its symptoms?

The symptoms of tongue cancer may include:

  • Non painful tongue ulcers or wounds that will not heal in 15 days on a male patient smoker and drinker with poor dental hygiene or some dental piece in bad conditions or a grazing prosthesis must be consulted with a doctor and subsequently a specialist. The earlier it is diagnosed, the higher are the probabilities of recovery.
  • Swallowing difficulties.
  • Numb tongue.
  • Changes on the speech due to the impoverished mobility of the tongue.
  • Other symptoms as: local pain, ear pain, mandible pain and a lump on the neck. These symptoms are usually related to bigger lesions, hence the prognosis is worse.

How is it diagnosed?

The specialist will perform a biopsy to extract affected tissue which will be examined through microscope by a pathologist who will confirm the presence of cancerous cells. Radiologic imaging will be required (Tomography, MRI, PET) to verify in which stage the tumour is.

Tongue cancer staging

  • Stage I: the tumour is smaller than 2 cm and there is no metastasis.
  • Stage II: tumour between 2 and 4 cm without metastasis.
  • Stage III: tumour bigger than 4 cm, or smaller with metastasis.
  • Stage IV: the cancer has spread towards the surrounding tissues or the metastasis is bigger than 3 cm.

How is it treated?

Small tongue tumours will be treated with surgery if possible, as long as the resection required by the tumour does not entail the impossibility of restoring deglutition (swallowing).

In these cases the use of CO2 laser transoral microsurgery facilitates the removal of tumours with less loss of healthy tissues and usually does not need sectioning the jaw, practicing tracheotomy or rebuilding the defect created using the usual flaps, which shortens the postoperative period and leaves less after-effects.

The neck ganglions will be treated by regular surgical dissection. In most of the cases it will be convenient a complementary chemo-radiotherapy after 3-4 weeks to increase the percentage of recovery.

If the tumour is very advanced and its resection may endanger deglutition, chemo-radiotherapy will be applied. In case of partial persistence of the tumour CO2 laser transoral microsurgery will be performed to remove it.

Microsurgery through the mouth requires a long formation: the surgeon, first of all, needs to have mastered traditional open surgery in case the tumour is not accessible through the mouth (anatomic problems, extension of the tumour to vital tissues, etc.). The surgeon must also develop their abilities in the use of the surgical microscope with highly amplified images that help to tell the healthy tissues apart from the tumoral tissues (which allows to sear the tumour adjusting with more precision the resection of the surrounding healthy tissues).

This surgery requires a learning curve (with a gradual increase of the difficulty of the case): the more experience and ability the surgeon possesses, the more complicated cases that surgeon will be able to solve.

In some cases the surgical removal of the tumour must be needed, including all or part of the vocal cords (laryngectomy). Many patients also need deglutition therapy after the treatment in order to help them get used to the changes in the structure of their throat.

Radiotherapy

Radiation is used to kill cancerous cells and shrink tumours. The method is more frequently used when the cancer is behind the tongue. The patient must receive external radiation and a brachytherapy implant to heal the cancer. Sometimes chemotherapy is combined with radiation especially when the cancer has spread to the lymphatic glands.

Rehabilitation

Rehabilitation after tongue cancer is mostly based on therapies to make tongue movement, chewing and swallowing easier.

What does the patient have to do one the treatment is over?

Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.

Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.

Dr. Máiz has a wide experience in the treatment of tongue tumours both by conventional surgery and CO2 laser transoral microsurgery.


Paranasal sinuses and nasal cavity cancer

What is paranasal sinuses and nasal cavity cancer?

In this type of cancer the tumorous cells are located on the paranasal sinuses tissues and the nasal cavitiy tissues. The paranasal sinuses are little hollow spaces around the nose, coated with mucous, which contain mucus producing cells and amplify the voice. The nasal cavity is the nose passage through which the air reaches the throat when one breathes.

There are various paranasal sinuses: frontal sinuses, maxillary sinuses, ethmoid sinuses and sphenoid sinuses.

Which are its symptoms?

It is necessary to visit a doctor if the paranasal sinuses are blocked (which cause a feeling of pressure on regions of the face), if the patient has a sinus infection, if there is nose bleeding, a wound that doesn’t heal inside the nose, frequent headaches, pain in the paranasal sinus region, swollen eyes or any other difficulty in eye movement, pain in the upper teeth or teeth problems.

How is it diagnosed?

If the patient has the symptoms, the doctor must examine the nose with a rhinoscope or nasoscope in order to see inside the nose. If there is abnormal tissue, the specialist must practise a biopsy so that the pathologist may examine it under the microscope and confirm the presence of cancerous cells. Radiologic imaging will be required (Tomography, MRI, PET) to verify in which stage the tumour is.

Staging

Once the cancer is diagnosed, more tests will be performed in order to determine whether the cancerous cells have spread, i.e, in which stage the cancer is. Knowing its stage is needed to plan an adequate treatment. There is not a system to classify nasal cavity cancer and some less common paranasal sinuses cancers. The one used with maxillary sinus caner (the most common) is the following:

  • Stage I: the cancer is only on the sinus and has not spread towards any other osseous part of the sinus. The cancer has not spread towards any lymphatic ganglion.
  • Stage II: the cancer has begun to destroy the boned of the paranasal sinus walls, but hasn’t reached any lymphatic ganglion.
  • Stage III: any of the following situations:
    • The cancer has spread beyond the bones around the paranasal sinus and to on lymphatic ganglion of the same side of the neck as the cancer and it is smaller than 3 cm.
    • The cancer has spread to the tissues surrounding the sinus either with or without affecting a ganglion.
  • Stage IV: any of the following situations:
    • The cancer has reached the surrounding tissues, other paranasal sinuses. It may or may not have reached the lymphatic ganglions.
    • There is cancer only on the paranasal sinuses, but it has reached more than one lymphatic ganglion of one or both sides of the neck or any lymphatic ganglion bigger than 6 cm.
    • The cancer has reached other parts of the body.
  • Recurrent: the cancer has reappeared after being treated. It can reappear on the paranasal sinuses, the nasal cavity or any other part of the body.

Which are the treatments?

Three types of treatment are used:

  • Surgery (removing the cancer).
  • Radiotherapy (using elevated doses of X rays or other high energy radiations to destroy the tumours).
  • Chemotherapy (using drugs to destroy the cancerous cells).

Surgery is usually used with paranasal sinus cancer or nasal cavity cancer. Depending on the placement and extension the doctor may have to cut part of the bone or tissue surrounding the cancer. If it has spread to the neck lymphatic ganglions, those lymphatic ganglions can be extracted (lymphatic ganglion dissection).

Radiotherapy is also a common paranasal sinus and nasal cavity cancer treatment. It consists in using elevated doses of X rays or other high energy radiations to reduce the tumours.

Chemotherapy consists on the use of drugs to destroy tumoral cells. Such drugs can be administrated orally, intramuscularly or intravenously. Chemotherapy is considered a systemic treatment since the drugs are introduced into the bloodstream and travel through all the body, thus it destroys the cancerous cells located anywhere in the body.

The most chosen treatment is surgery (as long as it allows the resection of the whole tumour) followed by simultaneous radiotherapy and chemotherapy. If the tumour cannot be seared, radio-chemoherapy will be used in the first place. When the cancer is diagnosed early, the tumour is affecting only the nasal cavity and has not invaded cranial structures, it can be removed by endoscopic surgery (through the nose). If the tumour has invaded the base of the cranium it may be needed acollaboration between the neurosurgeon and the othorhinolaryngologist (craniofacial approach).

What does the patient have to do one the treatment is over?

Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.

Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.

Dr. Máiz has a wide experience in the treatment of these tumours by conventional surgery. He is also a member of the Multidisciplinary Unit of the Base of the Cranium of Céntro Médico Teknon.