Dr Tay Hin Ngan
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Head and neck cancers, or ENT (ear, nose and throat) cancers, may not always cross our minds when we are looking out for cancer symptoms. Obvious signs and symptoms of some of these cancers may also be absent or trivialised at the start, which delays their diagnosis.
Being informed about the signs and symptoms these cancers present is therefore useful in helping you detect a potential issue, so you can get a diagnosis and start treatment as soon as possible.
Read on to learn about some common ENT cancers such as nasopharyngeal cancer, throat cancer, voice box cancer and thyroid cancer, their warning signs and treatment options.
Nasopharyngeal cancer ranks among the top 10 cancers faced by men aged 30 – 59 years in Singapore*. It occurs when the cells in the tissues behind the nose, just above the mouth and throat, become cancerous.
*National Registry of Diseases Office: Incidence of cancer among men from 2015 – 2019
Nasopharyngeal cancer may mimic other more common conditions, and is often undetected until its advanced stages.
Below are some signs and symptoms to look out for:
Certain risk factors that can increase one’s chance of developing nasopharyngeal cancer include:
*EBV infection is a common viral infection that usually results in mild symptoms like fever and sore throat, and has been linked to nasopharyngeal cancer development. On its own, EBV does not cause nasopharyngeal cancer. However, it is the interaction between EBV and other factors such as genetic susceptibility and / or environmental risk factors that may subsequently lead to development of nasopharyngeal cancer.
Diagnosis begins with a general examination by your doctor, who will ask you more about your symptoms, and check for any swollen lymph nodes. Diagnostic tests may be required to determine the presence of the cancer. Examples of such tests include:
If cancer is confirmed, your doctor would administer further tests such as CT (Computed Tomography) scan, MRI (Magnetic Resonance Imaging) and PET (Positron Emission Tomography) scan to determine the stage of the cancer, so that appropriate treatment can be given.
Early stage nasopharyngeal cancer is usually treated with radiation therapy, while advanced stages of the cancer will involve treatment with a combination of radiation therapy and chemotherapy. Surgery is reserved for residual disease – when some cancer remains after treatment, or recurrence – when the cancer returns after the previous course of treatment.
These refer to tumours developing in the throat (around the voice box) or in the voice box itself. The voice box is divided into the area above the vocal cords (supraglottis), the vocal cords themselves (glottis) and the area under the vocal cords (subglottis).
The voice box allows us to swallow and speak, and symptoms would typically affect these functions.
Signs and symptoms to look out for include the following:
Factors associated with an increased risk of cancer include:
Diagnosis begins with a discussion of your medical history and symptoms experienced. Following this, a physical examination will be conducted to check for sores and lumps in the mouth, or swollen lymph nodes in the neck.
Further checks that may be administered include:
If throat or voice box cancer is found, your doctor would administer further tests such as CT scan, MRI and PET scan to determine the stage and extent of the cancer, so that the appropriate treatment plan can be advised.
Treatment would be recommended depending on where the cancer is located, the size of the tumour(s), cancer stage, and overall health. Early stage cancers may require surgical removal of the tumour or radiation therapy. Advanced stage cancer would involve surgical removal of the tumour, then a combination of radiotherapy and chemotherapy. Following this, surgery may also be recommended to remove any residual or recurrent cancer cells.
Thyroid cancer is the 8th most frequent cancer amongst women in Singapore. It affects the thyroid gland, which is located at the base of the neck, just below the Adam’s apple. The thyroid produces hormones that regulate the heart rate, blood pressure, cholesterol levels, body temperature and weight.
Thyroid cancer occurs when cells in the thyroid gland mutate and grow, forming tumours. Most thyroid cancers are highly treatable, especially in younger patients, with excellent long-term cure rates.
In its initial stages, thyroid cancer presents few to no symptoms. However, as the cancer develops, patients may notice a lump or mass in the neck. Most thyroid lumps are benign, but further investigation would be necessary to differentiate between cancer and non-cancerous lumps. Some signs to look out for include:
Factors that can increase one’s risk of thyroid cancer include:
Diagnosis begins with a discussion of any symptoms, family history of thyroid issues, and any exposure to risk factors. Your doctor may conduct a physical examination of your neck to check for abnormalities, such as the presence of a thyroid nodule (lump). Additionally, your doctor may request for one or more of the following tests:
Other imaging scans such as CT scan or MRI may be necessary if the cancer is suspected to have spread to the lymph nodes in the neck.
The treatment recommended would depend on the size and type of thyroid cancer, and whether the cancer has spread beyond the thyroid. Treatment procedures include:
While the symptoms mentioned in this article are not always due to cancer, and may be caused by many common illnesses, stay alert and look into symptoms that seem unusual to you, especially when they are new symptoms that do not go away after some time (usually 1 month). Cancer treatments have higher rates of success when the cancer is diagnosed early. Should you need medical advice, consult an ENT (Otorhinolaryngology) specialist.