Disease Overview (Causes and Symptoms)
- Definition summary: A general term for a group of malignant tumors occurring in the head and neck region (excluding the brain and eyeballs)—including the face, nose, mouth, pharynx, larynx, salivary glands, thyroid, and other areas.
- Main causes and risk factors
- Smoking: The strongest risk factor (mucosal exposure in areas such as the oral cavity, larynx, and pharynx).
- Alcohol consumption: Particularly affects the hypopharynx and larynx; when combined with smoking, it increases risk and worsens prognosis (synergistic effect).
- Viruses: Nasopharyngeal cancer is associated with EBV (Epstein–Barr virus); HPV (human papillomavirus) is detected in a substantial proportion of oropharyngeal (tonsil and base-of-tongue) squamous cell carcinomas (approximately 15–50%).
- Other factors: Gastroesophageal reflux, previous radiation exposure, nutritional deficiencies (vitamins and iron), occupational exposure, and others.
- Pathophysiology: Most are squamous cell carcinomas of the mucosa (oral cavity, pharynx, larynx, etc.), while tissues such as the salivary glands and thyroid may develop dysplasia → possible local invasion and lymph node metastasis. Distant metastases mainly occur in the lungs, bones, liver, and other organs.
- Main symptoms (representative symptoms by site)
- Oral cavity: Lump in the mouth, persistent pain/bleeding, difficulty swallowing, lump in the neck or below the ear
- Nasopharynx: Palpable lymph nodes in the neck (metastasis) → nasal congestion/nosebleeds, tinnitus/hearing loss, facial nerve symptoms, and others
- Oropharynx·hypopharynx: Foreign-body sensation, painful swallowing, phlegm·blood-streaked sputum, hoarseness, lump in the neck
- Larynx: Persistent voice changes (weeks to months), noisy breathing, foreign-body sensation
- Salivary glands: Mass around the ear or under the jaw; facial paralysis in advanced cases
Treatment Methods and Precautions
- Treatment principles after diagnosis: Depending on the tumor location, stage, and whether functional preservation (voice and swallowing) is possible, surgical and nonsurgical treatments (radiation therapy and chemotherapy) may be used alone or in combination.
- Main treatment options
- Surgery: Commonly used as first-line treatment for oral and salivary gland cancers, among others (partial resection, extensive resection, neck lymph node dissection, etc.).
- Radiation therapy (RT): Used as first-line treatment for nasopharyngeal cancer, among others, and also used as adjuvant radiation therapy after surgery.
- Chemotherapy (CT): Used as adjuvant treatment before or after surgery, or concurrently with radiation therapy (concurrent chemoradiation therapy, CRT) to preserve voice and swallowing function. Representative medication: cisplatin-based combination therapy.
- Targeted therapy·immunotherapy: In recurrent or metastatic disease, EGFR-targeted treatment (e.g., cetuximab) or PD-1 inhibitors (e.g., pembrolizumab) may be used.
- Rehabilitative surgery/devices: An electrolarynx (electronic vocal cords), tracheoesophageal puncture (TEP), and voice-assist devices, among others (voice replacement after total laryngectomy).
- Treatment precautions and self-management
- Establish a rehabilitation plan before and after treatment (speech therapy·swallowing rehabilitation) to preserve voice and swallowing function.
- Tracheostoma care: Learn lifelong stoma care and prevent infection and pulmonary complications.
- Gastrostomy tube (PEG) care: Disinfect the insertion site, monitor nutritional status, and receive education on side effects such as diarrhea.
- Nutritional management: Maintaining body weight and nutritional status affects treatment response and complications.
- No smoking·alcohol: Both before and after treatment, smoking and alcohol consumption increase the risk of recurrence and complications.
Checkpoints Before an Outpatient Visit (Including Items to Bring·Sample Questions)
- Recommended items to bring
- List of currently taken medications (including prescription drugs, over-the-counter drugs, and supplements)
- Previous test results (ultrasound, CT/MRI, biopsy results, PET-CT, etc.) or test CDs/reports
- Records of when symptoms began and how they have changed (voice changes, difficulty swallowing, changes in mass size, etc.)
- Smoking·alcohol history and occupational history (possible exposure to chemicals)
- Records of weight changes and food intake
- Please confirm at the outpatient visit
- When and how the symptoms began to change (course over time)
- Accompanying symptoms such as pain, bleeding, difficulty breathing, and fever
- History of previous surgery, radiation, and chemotherapy
- Test preparation guidance (examples)
- If endoscopy·biopsy is planned, follow fasting instructions; if taking anticoagulants, notify the doctor in advance
Examples of General Questions to Ask the Doctor
- What is the exact diagnosis of this disease (histologic type·stage)?
- What treatment options are recommended, and what are the advantages and disadvantages of each treatment?
- What treatment side effects can be expected, and what measures can be taken to reduce them?
- What is the prognosis for voice·swallowing function after treatment? How will rehabilitation proceed?
- What lifestyle changes should I make to reduce the risk of recurrence?
Examples of Disease-Specific Questions
- Preserving my voice is important to me. Could you explain the possibility of voice changes caused by surgery and ways to preserve my voice (partial resection vs. combined nonsurgical treatment)?
- Do you recommend HPV or EBV testing (and the effects of the results on treatment·prognosis)? In cases of HPV-related cancer, what are the recommendations regarding vaccination?