oral cancer Singapore.

What is head and neck cancer?

Head and neck cancer refers to a group of several types of cancer that often involves the lining of the mouth, throat or voice box. Although rare, head and neck cancer can develop in the salivary gland or the sinuses. These cells are known as squamous cells and are then classified as squamous cell carcinoma once they transition into cancer cells.

Some of the types of head and neck cancer are:

  • Hypopharyngeal cancer: hypopharyngeal cancer refers to cancer that is formed at the bottom part of the throat. It typically affects men more than women, and accounts for roughly 7% of all upper aerodigestive tract cancers in Singapore.
  • Laryngeal cancer: laryngeal cancer refers to cancer that is formed in the voice box and it is more common in men compared to women.
  • Nasal cavity and paranasal sinus cancer: nasal cavity and paranasal sinus cancer refers to cancer that is formed in the nasal cavity or in the paranasal sinuses. It is the 8th most common type of cancer among men, with roughly 300 new cases are identified annually. The statistics have been on a steady decline due to early detection.
  • Nasopharyngeal cancer: nasopharyngeal cancer indicates cancer of the upper part of the throat, and is the 9th most common type of cancer among Singaporean men.
  • Oral cancer: oral cancer refers to cancer that forms on the lips, gums, and tongue. It also involves the lining of your cheeks and lips, and the top and bottom of the mouth, as well as behind the wisdom teeth. In Singapore, the incidence rate of oral cancer is low, standing at 12.79 in 100,000 per population.
  • Oropharyngeal cancer: oropharyngeal cancer refers to cancer that forms in the middle part of the throat, with tonsil cancer being one of the most common sub-types of oropharyngeal cancer. This type of cancer is more common in middle-aged, or elderly men.
  • Salivary gland cancer: salivary gland cancer refers to cancer that is formed in the salivary gland, which is responsible for producing saliva. However, salivary gland cancer is extremely rare in Singapore, with an annual incidence rate of 1 in 100,000 per population.

In Singapore, more than 800 new head and neck cancer cases are diagnosed annually, with nasopharyngeal cancer ranked as the 8th most common type of cancer among Singaporeans. As with other types of cancer, head and neck cancer carries the threat of metastasising to the lymph nodes in the upper part of the neck.

How is head and neck cancer staged in Singapore?

In Singapore, doctors rely on the TNM staging system to classify head and neck cancers. The system helps doctors identify which stage the cancer is at by referring to:

  • Tumour (T): indicates the size of the cancer, as well as the origin of the cancer, and the extent of the cancer. The severity of the tumour is ranked between T0 (no tumour) and T4 (tumour has invaded to adjacent organs).
  • Nodes (N): indicates if the cancer has spread to the lymph nodes, with the severity ranging between N0 (no spread) and N3 (spread to other lymph nodes).
  • Metastasis (M): indicates if the cancer has metastasised to distant organs, with the severity ranging between M0 (no spread) and M1C (metastasized to other organs).

Once these pieces of information are collected, your medical provider will  then proceed to stage head and neck cancer as per the following:

Pre-cancerous Stage Stage 0: Carcinoma in Situ At this stage, abnormal cells are present in the lining of the affected area, but they remain contained (in situ) and have not yet spread. If left untreated, these cells are highly likely to develop into cancer.
Early Stages Stage 1 The cancer is in its early stages. The cancer measures no more than two centimetres and has not spread to the lymph nodes.
Stage 2 The cancer is larger than two centimeters but no more than four centimeters. Like Stage I, it has not yet reached the lymph nodes.
Advanced Stages Stage 3 The tumour is either larger than four centimetres or has spread to a lymph node on the same side of the neck. The affected lymph node is smaller than three centimetres.
Stage 4 The cancer range in sizes, and may spread to:
  • Nearby tissues or areas within the head and neck.
  • A large lymph node (over three centimetres) on the same side as the cancer, multiple lymph nodes of any size on the same side, or a lymph node of any size on the opposite side.
  • Distant organs beyond the head, and neck, such as the lungs.

What causes head and neck cancer?

Although experts are unsure what exactly causes head and neck cancer, some studies highlighted that the disease occurs when cells in regions, such as the mouth, throat, and voice box, experience genetic mutations, causing them to grow uncontrollably.

Additionally, the primary risk factors for head and neck cancer are alcohol and tobacco use, which increases the likelihood of developing cancers in areas like the oral cavity and hypopharynx (the bottom part of the throat). In fact, most squamous cell carcinomas in the mouth and voice box are linked to these substances. Aside from tobacco use, and alcohol consumption, Human Papillomavirus (HPV) infection is a significant risk factor for oropharyngeal cancers, which affect the tonsils and base of the tongue.

While tobacco, alcohol, and HPV are key causes, experts have yet to come to a conclusive decision on all the factors involved in the formation of head and neck cancers. However, what is known is that genetic changes in the DNA of cells in the head and neck area can lead to unchecked growth, allowing cancerous cells to multiply rapidly, form tumours, invade healthy tissue and potentially spread to other parts of the body.

cancer Singapore.
Oropharyngeal

Who is at risk of head and neck cancer?

There are certain groups of people who are more prone to developing head and neck cancer. This includes:

  • Age: your chances of developing head and neck cancer are increased if you are 50 years old, and older.
  • Alcohol consumption: if you consume alcohol excessively, then you are highly likely to develop head and neck cancer in your lifetime.
  • Ancestry: if you have Asian ancestry, then you are more than likely to develop head and neck cancer.
  • Betel nut: if you have a habit of betel nuts chewing, then you have a higher risk of developing head and neck cancer as it contains arecoline, an alkaloid that is genotoxic that damages the DNA as well as for causing inflammation in the mucosal lining of the mouth and throat.
  • Chemical exposure: inhaling or being exposed to chemicals, such as chlorinated, oxygenated, and petroleum solvents, increases your chances of developing head and neck cancer.
  • Diet: if you consume a diet that is low in fruits and vegetables, high in salt and processed meat, then your risks of developing head and neck cancer are higher.
  • Gender: men are three times more at risk of developing head and neck cancer compared to women.
  • Genetics: your risk of developing head and neck cancer is higher if you have a family history of head and neck cancer.
  • HPV infection: if you have a history or are diagnosed with HPV infection, then your risk of developing head and neck cancer is higher.
  • Medical conditions: if you are diagnosed with gastro-oesophageal reflux disease (GERD), Fanconi anaemia, or dyskeratosis congenital syndrome, then you have a higher risk of developing head and neck syndrome.
  • Poor oral hygiene: your chances of developing head and neck cancer are increased if you have poor oral hygiene.
  • Radiation exposure: being exposed to radiation increases the risk of developing head and neck cancer.
  • Smoking: smokers are more likely to develop head and neck surgery compared to non-smokers.
betel chew Singapore.
Betel nut chewing has been associated with increasing the risk of head and neck cancer due to tobacco additives, arecolines and for causing chronic inflammation in the mucosal lining of the mouth and throat.

What are the symptoms of head and neck cancer?

Some of the common symptoms of head and neck cancer include, but are not limited to:

  • Bloody saliva, or phlegm.
  • Changes to the voice (hoarseness).
  • Difficulties speaking, or breathing.
  • Facial numbness.
  • Frequent headaches.
  • Frequent sinus infection.
  • Lump in the mouth, throat, or neck
  • Nosebleeds.
  • Pain in the upper teeth.
  • Pain when chewing, or swallowing.
  • Persistent earaches, or ear infections.
  • Persistent mouth, or tongue sore.
  • Persistent neck pain.
  • Persistent sore throat.
  • Swelling in the side of the face, jaw, and neck.
  • White or red patches on the tongue, gums, and inside of the mouth.

Although these symptoms are universal and can indicate a multitude of other medical conditions, it is important to seek medical attention to receive a proper diagnosis.

If you have been experiencing some of these symptoms, contact us today to schedule an examination.

How is head and neck cancer diagnosed in Singapore?

biopsy Singapore.
A fine needle biopsy can confirm a head and neck cancer diagnosis.

Early detection is crucial when it comes to preventing and treating head and neck cancer. At NC Tan Surgery, we utilise an array of diagnostic methods to detect the disease, including but not limited to:

  • Physical examination: a physical examination entails checking your nasal cavities,  oral cavities, tongue, throat, and neck. During the examination, our doctor will inspect your lips, gums, cheeks, and neck for lumps.
  • Imaging tests: our doctors may order imaging tests to be done to have a closer look at the inside of your head, and neck. Depending on the area to be examined, our doctors may recommend one of the following imaging tests: 
    • Computed tomography (CT) scan: CT scans produce detailed cross-sectional images of the head and neck. Similarly, they can detect malignant tumours and provide data on the size, as well as determine how progressive the disease is.
    • Magnetic resonance imaging (MRI): MRIs produce detailed images of soft tissues. This is advantageous when looking for potential malignant tumours in areas with complex anatomy, such as the neck.
    • Positron emission tomography (PET) scan: PET scans can highlight cancer cells’ metabolic activity, thereby enabling doctors to determine how far the disease has spread.
  • Lab tests: a blood test may be conducted to identify HPV or Epstein-Barr virus (EBV) infections. Additionally, our doctors may also order biomarker testing to determine the presence of proteins that may indicate head and neck cancers.
  • Endoscopy: by using an endoscope, our doctor can closely examine your nasal cavity, throat and other areas that exhibit symptoms, and look for any potential abnormalities.
  • Fine-need biopsy: a fine-need biopsy involves the use of a thin needle and a syringe to extract cells, tissues, and fluids. These collected samples are then sent to a pathologist  to be examined for cancer cells under a microscope.

How is head and neck cancer treated in Singapore?

Once a diagnosis has been confirmed, our doctor will outline a comprehensive and personalised treatment plan to effectively treat head and neck cancer. Some of the treatment options that are available are:

  • Surgery: performed to remove the cancer along with some of the surrounding healthy tissues to ensure the cancer is effectively excised. In the event of suspicion that the cancer has spread, removal of the lymph nodes may also be necessary.
  • Reconstructive surgery: reconstructive surgery is often scheduled to reverse the damages caused by the disease and restore its functions. Additionally, some patients may be required to undergo rehabilitation therapy to enable them to re-learn how to speak, and swallow.
  • Chemotherapy: chemotherapy uses a combination of several cancer-killing drugs– it is often recommended for advanced head and neck cancer.
  • Immunotherapy: immunotherapy uses drugs that boost the immune system’s ability to detect, and destroy cancer cells. In most cases, immunotherapy is recommended when head and neck cancer has spread to other parts of the body.
  • Radiation therapy: radiation therapy uses high-energy beams to directly and precisely kill cancer cells. Radiation therapy can either be a standalone treatment or a complementary treatment to either surgery or chemotherapy.
  • Targeted therapy: targeted therapy uses drugs that attack specific chemicals that are found in cancer cells. These drugs work by blocking these chemicals and gradually killing the cancer cells.

At NC Tan Surgery, we strive to provide our patients with high standards of comprehensive care, while offering comfort and ease. If you have recently been diagnosed with head and neck cancer or would like to seek a second opinion, schedule an appointment with us to speak to our specialist today.

Frequently Asked Questions

Yes, head and neck cancers can be painful. Generally, patients with head and neck cancer often feel some pain or discomfort in the mouth. They may also experience some bleeding, a sore throat or a persistent earache. However, head and neck cancers can be painless as well.

Yes, there are some side effects to consider. Some of the side effects may include:

  • Depending on the location of the cancer, surgical treatment may alter your appearance and lead to possible post-surgery side effects such as speaking or breathing difficulties, and trouble eating or swallowing.
  • Chemotherapy can cause several side effects, such as excessive fatigue, hair loss, change in appetite and nausea or vomiting episodes.
  • Radiation therapy may result in sore and sensitive skin, sore mouth and throat, dry mouth with thick and sticky saliva, bad breath, loss of taste, and a hoarse voice.

You will be guided closely on how to navigate these side effects should they affect you personally. It is important to note that every patient experiences cancer treatment differently.

Head and neck cancer is one of the most curable diseases, provided it is detected early. Hence, it is pertinent to have your symptoms examined when they begin to manifest or for patients with high-risk factors to undergo routine screening.
The survival rate depends heavily on how progressive the disease is and how soon or how late it is detected. Whilst there isn’t a singular statistic for all head and neck cancer prognosis, rest assured the outcome is often optimistic when the condition is detected in early stages.

You can prevent head and neck cancer by taking some of these precautionary measures:

  • Get the HPV vaccine.
  • Practice good oral hygiene.
  • Quit smoking.
  • Reduce your alcohol intake.

The primary differences between the three are:

CharacteristicsHead and Neck CancerHead and Neck TumourHead and Neck Lump
DefinitionA malignant growth that occurs in the head and neck region, including the throat, mouth, and nose.An abnormal growth in the head and neck region that is often benign (non-cancerous).Swelling or masses in the head and neck, often associated with various conditions, both serious (e.g., cancer) or benign (e.g., infections).
CausesPrimarily caused by tobacco use, alcohol consumption, HPV infection, and genetic factors.Caused by uncontrolled cell growth, with different triggers depending on the type.May be caused by infections, inflammation, cysts, or other benign conditions; sometimes can indicate cancer.
PrognosisPrognosis varies based on cancer type, stage, and response to treatment. Early detection improves outcomes.Benign tumours have excellent prognosis.Lumps caused by infections or benign conditions generally have a good prognosis, while cancerous lumps require treatment for better outcomes.

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    Farrer Park Medical Centre

    1 Farrer Park Station Road
    #14-02 Connexion Singapore 217562

    Clinic Hours

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