Radiation Therapy for

Head & Neck Cancer

Delivering my very best expertise with compassion and dignity.

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What are the types of head and neck cancers?

Head and neck cancers begin in the cells that line the inner surface of the head and neck area, and are further identified by the sites in which they begin.

  • Oral – Lips, front two-thirds of the tongue, gums, lining inside the cheeks, floor of the mouth under the tongue, the hard palate, and the small area behind the wisdom teeth.
  • Laryngeal – Cartilage and tissues located just below the pharynx in the neck, containing the voicebox.
  • Nasopharyngeal – Upper part of the pharynx, which is behind the nose.
  • Oropharyngeal – Middle part of the pharynx, includes back of pharynx, base of the tongue and the tonsils.
  • Hypopharyngeal – Lower part of the pharynx.

Overview

Head and neck cancers refer to a broad category of cancers that occur in the head and neck region. These forms of cancer begin in the cells that line the inner surface of the head and neck area and are further identified by the sites in which they begin.

 

The common types of head and neck cancers in Singapore include:

 

Oral cancer

 

Encompass the lips, front two-thirds of the tongue, gums, lining inside the cheeks, the floor of the mouth under the tongue, the hard palate, and the small area behind the wisdom teeth.

 

Laryngeal cancer

 

Encompass the cartilage and tissues located just below the pharynx in the neck, containing the voicebox.

 

Nasopharyngeal cancer

 

Encompass the upper part of the pharynx, which is located behind the nose. 

 

Oropharyngeal cancer

 

Encompass the middle part of the pharynx, including the back of the pharynx, the base of the tongue, and the tonsils. 

 

Hypopharyngeal

 

Encompass the lower part of the pharynx.

 

It is advisable to undergo regular cancer screening to minimise your risks of developing these forms of cancer. Early detection is also critical in ensuring the effectiveness of cancer treatment, including nasopharyngeal cancer treatment. Your oncology doctor can analyse your condition and prescribe a suitable treatment plan.

 

Signs and symptoms of head and neck cancers

 

The symptoms of the various types of head and neck cancers can vary from person to person. Therefore, it is crucial for you to understand the signs of each cancer type to safeguard your health and ensure early detection if necessary.

 

Oral cancer

  • White or red patches and ulceration on the gum, tongue, or lining of the mouth
  • Swelling of the jaw
  • Unusual pain or bleeding

 

Laryngeal cancer

  • Prolonged throat pain when swallowing
  • Hoarseness of voice
  • Ear pain

 

Nasopharyngeal cancer

  • Frequent headaches
  • Nasal bleeding or blood in sputum
  • Pain or ringing in the ears or reduced hearing
  • Neck lump(s)
  • Numbness in one side of the face

 

Oropharyngeal / Hypopharyngeal cancer

  • Ear or throat pain
  • Weight loss
  • Abdominal pain
  • Nausea and vomiting

 

If you noticed any of the above symptoms, it is best to schedule an appointment with an oncology doctor for prompt evaluation. Additionally, we advise going for regular cancer screenings to minimise your risk of developing cancer. If cancerous cells are spotted, your doctor can arrange for prompt treatment. For example, if you have nasopharyngeal cancer, undergoing nasopharyngeal cancer treatment early can increase the effectiveness of the treatment. 

 

Head and neck cancers – the risk factors

 

There are various factors – both internal and external – that may increase one’s risk of developing head and neck cancer. However, it is vital to note that while these risk factors can influence the development of cancer, they do not directly cause cancer. A person can possess little to no risk factors but still develop the disease. Therefore, it is vital for you to understand your risk factors and discuss them with your doctor so that you can make more informed healthcare and lifestyle choices. 

 

Alcohol and tobacco usage

 

Alcohol and tobacco use (including second-hand smoke) are factors that contribute significantly to the development of head and neck cancers, especially cancers of the oral cavity, hypopharynx, and throat. Those who engage in both alcohol and tobacco consumption are at greater risk than those who use either alcohol or tobacco alone. 

 

Human papilloma virus (HPV)

 

Studies have indicated that those infected with HPV possess a greater risk of developing head and neck cancers. There are various HPV strains, with specific strains more strongly associated with certain types of cancers. 

 

Epstein-Barr virus (EBV)

 

Those with EBV – which is more commonly known as the virus that causes mononucleosis – have a greater risk of developing nasopharyngeal cancer.

 

Occupational exposure

 

Occupational hazards, such as exposure to wood dust, can increase one’s risk of developing nasopharyngeal cancer. Other environmental hazards, such as exposure to asbestos and synthetic fibres, have also been associated with various forms of head and neck cancers. 

 

Demographics

 

Those with a family history of head and neck cancers are more likely to develop these diseases themselves. Additionally, a person’s gender and age may increase one’s risks. Men are 2 to 3 times more likely to develop head and neck cancers. Those over the age of 40 are also at higher risk. 

 

If you notice you possess high-risk factors, we advise you to go for regular cancer screenings to minimise your risks of developing cancer. If cancerous cells are spotted, your oncology doctor can arrange for prompt treatment. For example, if you develop nasopharyngeal cancer, undergoing nasopharyngeal cancer treatment early can increase the effectiveness of the treatment.

 

Prevention

 

Although it is impossible to completely prevent head and neck cancers, you can lower your risks of developing the diseases. Here are some steps you can take to minimise your risks.

 

Stop the consumption of all tobacco and alcohol products

 

Stopping the consumption of tobacco and alcohol is crucial to reducing your risk of developing cancer. Naturally, we understand that some may find it challenging to go cold turkey. You can seek advice from your doctor on reducing your tobacco and alcohol consumption if you find it difficult to quit.

 

Use sunscreen regularly

 

Prolonged exposure to UV rays is linked to skin cancer and cancer in the lip area. Therefore, it is advisable to apply sunscreen and lip balm with an adequate sun protection factor (SPF) regularly.

 

Get vaccinated against HPV

 

Getting yourself vaccinated against HPV can lower your risks of developing specific forms of head and neck cancers. 

 

At the end of the day, the best form of prevention is to undergo regular cancer screenings. Early detection is key to ensuring successful cancer treatments.

 

What are the different types of treatment?

 

The treatment prescribed by the oncology doctor will depend on the type of head and neck cancer, the stage of cancer, as well as the general medical condition of the patient. Let us share some of the common cancer treatment options in Singapore.

 

Oropharyngeal and Hypopharyngeal cancer

  • Radiation therapy, with or without chemotherapy, plays a major role in the treatment of oropharynx and hypopharynx cancer
  • As these diseases are often diagnosed in more advanced stages, surgery may be needed. However, this option carries significant risk, as it can cause excessive functional impairment.

 

Nasopharyngeal cancer

  • Radiation therapy is commonly used in the treatment of nasopharyngeal cancer. Many patients may also benefit from the addition of chemotherapy to radiation therapy.
  • Nasopharyngeal cancer is highly curable with radiation therapy if discovered early.

 

Oral and Laryngeal cancer

  • Cancers originating from the larynx, lip, and oral cavity, including the tongue, can be treated with surgery or radiation alone in their early stages.
  • Radiation therapy is often used with chemotherapy for advanced stages of the diseases, with or without surgery.

 

We advise you to take your time to learn and understand the available treatment options before discussing them with your oncology doctor. Do not hesitate to clarify any doubts and questions that you may have and ask what you can expect while receiving the treatment.

 

What are the common signs and symptoms

  • Oral

    White or red patches, and ulceration on gums, tongue, or lining of the mouth, Swelling of the jaw, Unusual pain or bleeding

  • Laryngeal

    Prolonged throat pain when swallowing, Hoarseness of voice, Ear pain

  • Nasopharyngeal

    Frequent headaches, Nasal bleeding or blood in sputum, Pain or ringing in the ears or reduced hearing, Neck lump(s), Numbness in one side of the face

  • Oropharyngeal / Hypopharyngeal

    Ear or throat pain, Weight loss, Abdominal pain, Nausea and vomiting

What are the different types of treatment?

Treatment depends on the type of head and neck cancer, the stage of cancer as well as the general medical condition of the patient.

Oropharyngeal and Hypopharyngeal cancer

  • Radiation therapy, with or without chemotherapy, plays a major role in the treatment of cancers of the oropharynx and hypopharynx.
  • As these diseases are often diagnosed in more advanced stages, surgery may be needed but may cause excessive functional abnormality.

Nasopharyngeal cancer

  • Radiation therapy is the most important treatment method for nasopharyngeal cancer. Many patients may also benefit from the addition of chemotherapy to radiation therapy.
  • Nasopharyngeal cancer is highly curable with radiation therapy if discovered early.

Oral and Laryngeal cancer

  • Cancers originated from the larynx, lip and oral cavity including the tongue can be treated with surgery or radiation alone in their early stages.
  • Radiation therapy is often used with chemotherapy for advanced diseases, with or without surgery.

What is Radiation Therapy?

Prostate cancer radiation treatment is an option recommended for patients diagnosed with prostate cancer. It uses high-energy X-rays generated from a radiation therapy machine called a LINAC to destroy cancer cells. Prostate cancer radiation treatment has long been used to kill tumours without the need for surgical operations. It inhibits cancer cells from multiplying by delivering ionising radiation to destroy cancer cells while minimising radiation damage to normal tissues. When these cancer cells die, the body naturally eliminates them. Healthy, normal tissues are then able to repair themselves in a way that cancer cells cannot, leading to a much higher proportion of tumour cell death compared to normal cells.

How is Radiation Therapy done?

Consultation

The Radiation Oncologist determines the most appropriate method and discusses with you the treatment intent, schedule, risks and side-effects.

Mark-Up and Simulation

A CT scan of the treatment area will be obtained, while a face mask is used to ensure accurate positioning during your daily treatment.

Treatment Planning

A multidisciplinary team produces a customised treatment plan for you.

Treatment

Radiation therapy for head and neck cancer is delivered daily (Mondays to Fridays) for two to seven weeks depending on the treatment intent (curative or palliative). Each treatment session lasts 20 to 25 minutes.

Follow-Up

Your first follow-up appointment varies depending on how you do during treatment, and is usually about four to eight weeks after you have completed the course of radiation therapy.

What are the types of radiation therapy available for head & neck cancer?

3-Dimensional Conformal Radiation Therapy (3DCRT)

3DCRT delivers very precise doses of radiation to the head and neck area and spares surrounding normal tissue through a machine called a linear accelerator.

Intensity Modulated Radiation Therapy (IMRT)

IMRT involves varying (or modulating) the intensity of the radiation being delivered during treatment. Compared to 3DCRT, this technique can deliver more tightly focused radiation beams to cancerous tumours while reducing the amount of radiation to surrounding healthy tissues.

"I guarantee my very best expertise delivered with compassion and dignity as we journey TOGETHER to BEAT this dreaded illness."

- Dr Johann Tang

Make An Enquiry

Got Queries? Book an appointment with Dr Johann Tang by filling up this form. We'll get on a call with you as soon as possible.

Prefer to talk? Call us directly at +65 6690 6811
or email us at drjohanntang@gmail.com

What are the potential side effects?

You will experience minimal side effects in the first one to two weeks of your radiation therapy course. Many of these side effects will improve over time and some can be controlled with medication. Inform your doctor or nurse if you are experiencing any discomfort so they can help you better.

  • Redness, irritation and sores in the mouth
  • Dry and thickened saliva
  • Difficulty in swallowing
  • Change/loss in taste
  • Swelling of soft tissues
  • Change in texture of the skin
  • Fatigue

Late side effects, such as hardening of the neck skin, hearing loss or decrease in thyroid hormone levels, can concur months to years after treatment in some patients. There are other rare side effects, such as damage to nerves or the jaw bone, which may affect less than five percent of our patients.

Caring for yourself during and after Radiation therapy

  • Stop smoking

    Immediate benefits of less airway irritation with less cough and shortness of breath.

  • Stay active

    Even gently short bouts of activity helps! Improves mood, reduces fatigue, and helps with appetite.

  • Check your medications

    Inform your doctor if you are taking medications, to make sure that they are safe to use during radiation therapy.

  • Be careful caring for the affected area

    Avoid hot or cold packs and only use lotions and ointments after checking with your doctor or nurse. Clean the affected area with lukewarm water and mild soap

  • Enlist support

    Mental and emotional health is as important as physical health. It might be helpful to talk to counsellors or join a cancer support group.

  • Have a caregiver who can manage your care

    It is good to have someone who can help to keep track of hospital appointments and medications prescribed.

  • Rest well

    Get plenty of rest during treatment.

  • Eat well

    Avoid hot, spicy and acidic food. Eat soft food with a high liquid content eg. ice cream, congee or soup. Eat a balanced diet of small frequent meals.

"I guarantee my very best expertise delivered with compassion and dignity as we journey TOGETHER to BEAT this dreaded illness."

- Dr Johann Tang

Make An Enquiry

Got Queries? Book an appointment with Dr Johann Tang by filling up this form. We'll get on a call with you as soon as possible.

Prefer to talk? Call us directly at +65 6690 6811
or email us at drjohanntang@gmail.com

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Contact Dr Johann Tang

ME Novena Specialist Group
@ Mt. Elizabeth Novena Hospital
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FAQs

Many forms of nasopharyngeal cancers can be cured if they are found and treated early. The success of nasopharyngeal cancer treatment depends on various factors, including the location and stage of the tumour.

If the cancer is located only in the nasopharynx, the 5-year survival rate is 80-90%. However, if the cancer cells have spread to nearby tissues or organs and/or regional lymph nodes, the 5-year survival rate drops to 60-70%. If there is further spread of the cancer cells to other parts of the body, the 5-year survival rate is 20-30%. This is why early detection and prompt nasopharyngeal cancer treatmen are essential.

It is vital to note that the rate of growth of the cancerous cells depends on various factors, and it differs for every person. To slow down or eradicate the growth of these cancerous cells, early detection and administration of nasopharyngeal cancer treatment are pivotal.

Nasopharyngeal cancer is often aggressive and can grow and spread quickly. Usually, the earlier the disease is detected, the higher the success rate of curing the illness. This is because nasopharyngeal cancer treatment is most effective when administered promptly.

Cancer develops when one or more genetic mutations cause normal cells to grow out of control, invade the surrounding tissues, and eventually spread (metastasise) to other parts of the body. In nasopharyngeal carcinomas, this process begins in the mucosa cells that line the surface of the nasopharynx.

Yes, direct brain involvement from nasopharyngeal carcinomas can happen and may have severe neurological consequences. Therefore, it is crucial to detect the disease early to ensure that prompt nasopharyngeal cancer treatment is administered. This increases one’s chances of beating the disease.