Head and Neck Cancer

Over 200,000 new cases of cancer is diagnosed yearly in Canada. Head and neck cancer is 6th most common cancer after breast, prostate, colorectal and lung cancer. Head and neck cancer affect many organs including sinuses, mouth, throat, larynx (voice box), swallowing passages, salivary glands, and thyroid gland. Skin cancer including melanoma and others that develop on the face, neck, and scalp are considered head and neck cancers.  Many of these cancers respond well to treatment.

Providing comprehensive and personalized care in treatment and post-treatment patient-centered services the Head and Neck Cancer program of the Department of Otolaryngology Head and Neck Surgery at the Royal Victoria Hospital and our multidisciplinary team made of professionals from:

  • Head and Neck Surgical Oncology
  • Radiation Oncology
  • Medical Oncology
  • Pathology
  • Radiology
  • Speech Therapy
  • Nursing
  • Nutrition

The treatment is personalized and tailored to each patient based on best evidence and individual needs of each patient. In addition to comprehensive array of standard treatments, we offer cutting edge clinical trials to eligible patients. The trials include latest developments in biological therapy, immunotherapy, as well as Transoral (through the mouth), Robotic Surgery (TORS) and Transoral Laser Microsurgery (TLM).

Conditions We Treat

Cancer of Unknown Primary Origin

Cancer of unknown primary origin presents as a lump in the neck, but the origin of the cancer where tumor metastasis (spread to neck) occurred, is not readily apparent because there are no symptoms other than the lump. The goal of head and neck surgeon is to identify the source of the cancer and then direct the treatment.

What is done during investigation: What you need to now.

  • A fine needle aspiration biopsy is done to determine of the neck lump is cancerous.
  • A full examination of the head and neck including the mouth, throat, and flexible endoscopy of the throat is done. 
  • Imaging investigation is done (MRI, CT scan, PET scan).
  • If imaging shows the origin, a directed biopsy of the origin will be done.
  • If imaging does not reveal the origin of the metastasis, more often than not, a small cancer may be hidden deep in the crypts of the tonsil or base of the tongue (the very back end of the tongue joining the throat). A tonsillectomy and/or Robotic assisted lingual tonsillectomy (removal of tonsil tissue at base if tongue) is done. If the origin of the metastasis is identified, the treatment will begin appropriate to the specific origin. If the origin is not discovered the treatment will begin according to the initial location of the tumor in the neck and the biopsy result.

Larynx (Voice box) Cancer

The voice box remains open during breathing and closes during swallowing to protect the airway from choking on food. The vocal cords come together during voice production. The voice box has 3 areas. The area forming the vocal cords (glottis). The area above the vocal cords that spans approximately 4 cm (supraglottic), and the area immediately bellow the vocal cord (subglottis). Depending on the exact location of a cancer the symptoms can vary. 

Hypopharynx Cancer

Hypopharynx (the bottom of the throat) is the area of the throat surrounding the voice box and ends at esophagus ( the food pipe to the stomach). Hypopharynx directs the food during the swallowing into the esophagus. Cancers of the hypopharynx may be isolated to pharynx or may involve the voice box. Similarly cancers of the voice box may involve the hypopharynx.

Larynx Cancer: What you need to know

  • Small laryngeal cancer that is arising from the vocal cords is detected early as it usually presents with hoarseness early on. It is less likely to spread to the lymph nodes of the neck. Due to early detection, the prognosis is favorable. 
  • The cancer of the larynx or the hypopharynx may present with difficulty swallowing, difficulty breathing, pain in the ear, stridor (noisy breathing with abnormal high pitched sound coming from the voice box when breathing), or unexplained weight loss. 
  • Cancer of the voice box and hypopharynx are usually caused by smoking and alcohol use.

Nasal Sinus Cancer

Nasal and sinus cancers arise from within the nose or from the sinuses that surround the nose. Patients with sinus caner usually may present with nasal blockage, bleeding, or symptoms of facial swelling, loosened upper teeth, nasal pain or double vision. 

Nasal Cancer and Sinus Cancer: What You Need to Know

  • Many kinds of different tumor may arise from the nose and sinuses, both benign and cancerous. 
  • Like most cancers early detection is important as nasal cancers may affect the eye or brain. 
  • The treatment of most types of sinus cancer usually involved surgery followed by radiotherapy. In some types of cancer, chemotherapy or chemotherapy with radiotherapy may be used before surgery. When surgery is appropriate for sinus and nasal cancer, it is carried out by endoscopic surgery or open surgery depending in many factors, including the extent of the tumor based on detailed imaging findings.

Oral Cancer

Oral cancers include cancers arising from all different parts of the oral cavity. These areas include the front two thirds of the tongue, the floor of the mouth, the palate (roof of the mouth), the gingival, the inner aspects of the lips and cheek, and the area behind the molar teeth. 

Oral Cancer: What You Need to Know

Patients with oral cancer usually present with a non-healing ulcer in the mouth, a lump, a red lesion, pain, pain in ear, or difficulty with swallowing.

Tobacco consumption including tobacco smoking and chewing, and alcohol are usual causes of oral cancer. Poor dental hygiene and chronic inflammation may contribute it. Most oral cancers are treated with surgery and radiotherapy following surgery.

Oropharyngeal (throat) Cancer

Oropharyngeal Cancer affects the structures in the back of the throat, including the base of tongue (the back one third of the tongue), tonsils, posterior pharyngeal (throat) wall, and soft palate. Cancer of the oropharynx is usually found in tobacco users or patients with human papilloma virus (HPV). In the last 3 decades there has been increasing incidence of oropharyngeal cancer related to HPV.

Oropharyngeal Cancer: What You Need to Know

  • The vast majority of oropharyngeal cancers arise from the tonsils and back one third of the tongue (base of the tongue). 
  • Majority of cancers in this area are squamous cell carcinoma. There are 2 types of oropharyngeal cancer, HPV-positive which forms the vast majority and HPV-negative. HPV negative cancers are usually caused by tobacco.
  • The HPV-positive cancers behave differently than HPV negative cancer and generally are more responsive to treatment.
  • Treatment of oropharyngeal cancer may be done with surgery. The surgery is typically transoral robotic surgery and neck dissection. This may be followed by radiotherapy. The treatment may also be radiotherapy with chemotherapy. 

Salivary gland Cancer

There are 3 main salivary glands. The parotid glands are in front and bellow the ear. The submandibular glands are below the jaw bone, and the sublingual glands are bellow the lining of the floor of the mouth. Most salivary gland tumors arise in these glands. There are also many minor salivary glands all over the mouth, nasal cavity, and throat that can also give rise to salivary gland tumors.

Salivary Gland Cancer: What You Need to Know

  • About 755 of parotid glands and half of submandibular glands are benign. About 75% of tumors of minor salivary gland are cancerous.
  • A fine need aspiration biopsy from the major salivary glands or an incisional biopsy from inor salivary gland is used to make the diagnosis.
  • Great majority of salivary gland tumors present as only a lump or mass without any pain or other symptoms. There are many kinds of salivary gland cancers. The most common are mucoepidermoid cancer, adenoid cystic cancer, and adenocarcinoma.
  • The first line of treatment for salivary gland cancers is surgery. Depending in the type of the cancer, the area it is arising from, and other features radiotherapy is used after surgery. 

Skin Cancer

Skin cancers are among the most common cancers and its incidence is rising worldwide. The skin cancers inclide melanoma and non-melanoma cancers which are either squamous cell cancer of basal cell cancer. These cancers are caused by ultraviolet radiation exposure from sun rays and tanning salons. 

Skin Cancer of the Head and Neck: What You Need to Know

  • Basal cell cancer is the most common type of skin cancer. This is very slow growing cancer that is locally aggressive and can destroy the tissue in its way. This is typically treated with surgery.
  • Squamous cell cancer is the second most common skin cancer. It is more aggressive and has capacity to metastasize (spread), and may require more extensive surgery than basal cell cancer. 
  • Melanoma is the least common but is most aggressive. The most effective way of prevention is to avoid excessive sun exposure and use sun blocks. Melanoma treatment includes surgery.

Sarcomas of head and neck

Sarcomas are uncommon cancers. They are classified depending on the specific tissue the arise from. There are many different types arising from bone, cartilage, soft tissue, and fat. 15-20% of sarcomas present in head and neck and many arise from any area of head and neck. 

Sarcoma of the Head and Neck: What You Need to Know

  • Sarcomas of head and neck affect most commonly the paranasal sinuses and the neck.
  • The most common symptom is a painless lump, a facial mass, nasal obstruction, change in voice, difficulty swallowing. However many other benign conditions are more likely it cause these symptoms with sarcomas being very rare. 
  • A biopsy and imaging is used for diagnosis of sarcomas.
  • Most sarcomas are treated with surgery and radiotherapy, and some require chemotherapy.
  • In children the most common sarcomas are rhabdomyosarcoma (arising from muscle cells). In adults, the most common sarcomas are osteosarcomas (arising from bone), angiosarcoma (arising from blood vessels), malignant fibrous histiocytoma and fibrosarcoma (both arising from soft tissue).

Thyroid Cancer

Thyroid is located in lower midline of the neck and is the organ responsible for producing the thyroid hormone. It has 2 lobes connected in the middle. It site over and next to the traches and esophagus. It runs over the voice box nerves (recurrent laryngeal nerves)

Thyroid Cancer: What You Need to Know

  • Thyroid nodule or lump is the most common presenting symptom of thyroid cancer. While thyroid nodules are very common, the vast majority are benign nodules (nodular goiter).
  • There has been increasing incidence of thyroid cancer in last few decades. However, the apparent increase is partly due to increasing discovery of thyroid nodules by the physicians during routine frequent ultrasound examinations of thyroid that may have previously gone undiagnosed and never grow enough to be apparent clinically.
  • An ultrasound examination of thyroid and a fine needle aspiration biopsy is done to diagnose thyroid cancer. The vast majority of thyroid cancers are papillary thyroid cancer accounting for over 90% of thyroid cancers. The second most common is follicular thyroid cancer. Both of these are considered highly treatable cancer with good prognosis. The other types include medullary carcinoma, and very rare anaplastic carcinoma.
  • The treatment of thyroid cancer is surgery. The surgery may include removing half the thyroid (the involved side) called hemithyroidectomy, or the entire thyroid called total thyroidectomy. This depends on factors such as type and stage of the cancer, and whether the tumor has spread to the lymph glands of the neck. Radioactive iodine treatment may be used after surgery 

Benign (non-cancerous) tumors

There are many types of benign (non-cancerous) tumors that affect the head and neck region. These include tumors arising from saliva glands, nerves, blood vessels, fat, or any other type of tissue. The treatment of benign tumors is generally surgery. However, some harmless ones that do not show any growth are sometimes observed. 

Hyperparathyroidism

Parathyroid is an organ important and central to calcium regulation. It consists of 4 small glands, 3-5 mm each, 2 on each side of the neck behind the thyroid gland. In rare occasions, there may be an extra fifth gland. Hyper-functioning parathyroid gland results in elevated calcium levels in the blood. Patients typically are found to have high blood calcium levels that spark investigation for hyperparathyroidism. In most circumstanced (93%-95%) the cause of hyperparathyroidism is a parathyroid adenoma. This is a benign tumor. In this condition one of the 4 glands has become larger and formed a benign (non-cancerous) tumor that secrets too much parathyroid hormone leading to high blood Ca levels. This is called parathyroid adenoma

Parathyroid adenoma: What You Need to Know

  • A single parathyroid adenoma is the cause of great majority, more than 90%, of hyper-functioning of the parathyroid gland
  • A parathyroid sestamibi scan with CT scan is done to identify which of the 4 parathyroid gland is the cause. The goal is to identify left side, right side, upper or lower localization of the adenoma.
  • An ultrasound of the thyroid and parathyroid is also done to help confirm the localization of the parathyroid adenoma.
  • When surgery indicated, based on established criteria, it can be done in directed and minimally invasive manner removing the adenoma