HEAD AND NECK

CANCER
LEVELS OF PREVENTION

ORAL AND
OROPHARYNGEAL
CANCER

ST

LEVEL OF PREVENTION

1.Always brush and floss teeth regularly.An

unhealthy mouth reduces your immune system and
inhibits the bodys ability to fight off potential cancers.
2.Do not smoke (or chew) any type of tobacco
product.
3.Drink alcohol in moderation(one to two drinks per
day) and never binge drink. The risk of developing oral
cancer increases with the amount and length of time
alcohol and tobacco products are used.
4.Limit exposure to the sun.We all know we need to
use sunscreen, Always use UV-A/B-blocking sun
protection on the lips when in the sun. Repeated
exposure increases the risk of cancer on the lips,

6.Choose cancer-fighting foods in your diet.The American Institute

for Cancer Research to lots of beans, berries, cruciferous vegetables (like
cabbage and broccoli), dark green leafy vegetables, flaxseed, garlic,
grapes, green tea, soy and tomatoes for their role in cancer prevention.
7.How you prepare those foods is also important in the
prevention of cancer.Replace frying and grilling with baking, boiling or
steaming.
8.See your dentist or dental hygienist regularly(at least every six
months)oral cancer screening should be done.
9.Conduct a self exam at least once a month. Buy a handy mouth
mirror (available at most pharmacies) for those hard-to-see areas. Be
sure to check the back and sides of your tongue. If you see or feel
anything suspicious lumps, bumps, tender areas, white, red or grey
patches, see your dentist to have it checked.

7. Avoid HPV infection

The risk of infection of the mouth and throat with the
human papilloma virus (HPV) is increased in those who
have oral sex and multiple sex partners. These
infections are also more common in smokers, which
may be because the smoke damages their immune
system or the cells that line the oral cavity. These
infections are common and rarely cause symptoms.
8. Wear properly fitted dentures
Avoiding sources of oral irritation (such as dentures that

SECONDARY PREVENTION
Physical examination.Dentists and doctors often find lip and oral cavity
cancers during routine check-ups. If a person shows signs of oral or
oropharyngeal cancer, the doctor will take a complete medical history, asking
about the patients symptoms and risk factors. The doctor will feel for any
lumps on the neck, lips, gums, and cheeks. Since patients with oral or
oropharyngeal cancer have a higher risk of other cancers elsewhere in the
head and neck region, the area behind the nose, the larynx (voice box), and
the lymph nodes of the neck are also examined.
Endoscopy.This test allows the doctor to see inside the mouth and throat.
Typically, a thin, flexible tube with an attached light and view lens, called an
endoscope, is inserted through the nose to examine the head and neck areas.
Sometimes, a rigid endoscope, which is a hollow tube with a light and view
lens, is placed into the back of the mouth to see the back of the throat in more
detail. The examination has different names depending on the area of the body
that is examined, such as laryngoscopy to view the larynx, pharyngoscopy to
view the pharynx, or nasopharyngoscopy to view the nasopharynx.

 Oral brush biopsy. During routine dental examinations, some

dentists are using a newer, simple technique to detect oral cancer in
which the dentist uses a small brush to gather cell samples of a
suspicious area. The specimen is then sent to a laboratory for
analysis. This oral brush biopsy procedure is easy and can be done in
the dentists chair with very little or no pain. If cancer is found using
this method, it is recommended that a traditional biopsy be done to
confirm the results.
X-ray.An x-ray is a way to create a picture of the structures inside of
the body, using a small amount of radiation. A dentist may take
extensive x-rays of the mouth, including a panorex (panoramic view;
see below).

 Barium swallow. There are two types of these tests that are generally used to look
at the oropharynx and check a patients swallowing. The first is a traditional barium
swallow. During an x-ray exam, the patient is asked to swallow liquid barium so the
doctor can look for any changes in the structure of the oral cavity and throat and see
whether the liquid passes easily to the stomach. A modified barium swallow, or
videofluoroscopy, is used to evaluate swallowing. The patient is asked to swallow
liquid barium, pudding, and a cracker coated with barium.
Panorex.This is a rotating, or panoramic, x-ray of the upper and lower jawbones to
detect bone destruction from cancer or to evaluate teeth before radiation therapy or
chemotherapy.
Computed tomography(CT or CAT) scan.A CT scan creates a three-dimensional
picture of the inside of the body with an x-ray machine. A computer then combines
these images into a detailed, cross-sectional view that shows any abnormalities or
tumors. A CT scan can also be used to measure the tumors size, help the doctor
decide whether the tumor can be surgically removed, and show whether the cancer
has spread to lymph nodes in the neck or lower jawbone. Sometimes, a special dye
called a contrast medium is given before the scan to provide better detail on the
image. This dye can be injected into a patients vein or given as a liquid to swallow.

 Magnetic resonance imaging (MRI).An MRI uses magnetic fields,

not x-rays, to produce detailed images of the body, especially images of
soft tissue, such as the tonsils and base of the tongue. MRI can also be
used to measure the tumors size. A special dye called a contrast
medium is given before the scan to create a clearer picture. This dye
can be injected into a patients vein or given as a liquid to swallow.
Ultrasound.An ultrasound uses sound waves to create a picture of the
internal organs. This test can detect the spread of cancer to the lymph
nodes in the neck, called the cervical lymph nodes.
Positron emission tomography (PET) scan.A PET scan is a way to
create pictures of organs and tissues inside the body. A small amount of
a radioactive sugar substance is injected into the patients body. This
sugar substance is taken up by cells that use the most energy. Because
cancer tends to use energy actively, it absorbs more of the radioactive
substance. A scanner then detects this substance to produce images of
the inside of the body.

Nasal and Paranasal

cancer

1st level of prevention

Limit consumption of salted, preserved fish. It is especially important
not to give these foods to very young children.
Do not smoke. Avoid exposure to second hand smoke.
Exercise regularly
Wear protective facemask to reduce breathing in potentially harmful
substance
Avoid smoking
Avoid exposure to industrial related hazards (Wood
dusts,leather,nickel )
Avoid having multiple sexual partners (increased risk of acquiring HPV)
Eating healthy diet full of fruits and vegetables

Secondary level of prevention

Physical examandhistory: An exam of the body to check general signs of
health, including checking for signs of disease, such as lumps or anything else
that seems unusual. A history of the patients health habits and past illnesses
and treatments will also be taken.
Physical exam of the nose, face, and neck: An exam in which the doctor
looks into the nose with a small, long-handled mirror to check
forabnormalareas and checks the face and neck for lumps or swollenlymph
nodes.
X-raysof the head and neck: An x-ray is a type of energy beam that can go
through the body and onto film, making a picture of areas inside the body.
MRI(magnetic resonance imaging): A procedure that uses a magnet,radio
waves, and a computer to make a series of detailed pictures of areas inside
the body. This procedure is also called nuclear magnetic resonance imaging
(NMRI).

 Biopsy: The removal of cells or tissues so they can be viewed under

amicroscopeby a pathologistto check for signs of cancer. There are
three types of biopsy:
Fine-needle aspiration (FNA) biopsy: The removal of tissue
orfluidusing a thin needle.
Incisional biopsy: The removal of part of an area of tissue that
doesnt look normal.
Excisional biopsy: The removal of an entire area of tissue that
doesnt look normal.
Nasoscopy: A procedure to look inside the nose for abnormal areas.
Anasoscopeis inserted into the nose. A nasoscope is a thin, tube-like
instrument with a light and alensfor viewing. A special tool on the
nasoscope may be used to remove samples of tissue. The tissues
samples are viewed under a microscope by a pathologist to check for
signs of cancer.

laryngeal and
hypopharyngeal
cancers

1ST LEVEL OF PREVENTION

1. Avoid HPV infection
The risk of HPV infection of the throat is increased in
those who have oral sex and multiple sex partners.
Smokers are more susceptible to HPV infections,
probably because the smoke damages their immune
system or the cells that line the throat. These infections
are common and rarely cause symptoms. Although HPV
infection is linked to some cases of cancer of the larynx
or hypopharynx, most people with HPV infections of the
throat do not go on to develop this cancer. In addition,
most cancers of the larynx and hypopharynx are not

2. Eat healthy diet- Eating a balanced, healthy diet may help lower
your risk of these cancersStrong evidence shows that vegetables and
fruits probably protect against cancers of the mouth and throat
3. Avoid smoking- Avoiding exposure to tobacco (bynot smokingand
avoidingsecondhand smoke) lowers the risk of these cancers.
4. Avoid alcohol Drinking- Heavy alcohol useis a risk factor on its
own. It also greatly increases the cancer-causing effect of tobacco
smoke, so it is especially important to avoid the combination of
drinking and smoking.
5. For people who work with chemicals linked to these cancers,
having plenty of workplace ventilation and using industrial respirators
are important protective measures.

Secondary level of prevention

Direct (flexible) laryngoscopy:For this exam,a fiberoptic laryngoscope a thin, flexible, lighted tube
inserted through the mouth or nose to look at the larynx
and nearby areas.
Indirect laryngoscopy:In this exam, the doctor uses
special small mirrors to view the larynx and nearby
areas.
Panendoscopy is a procedure that combines
laryngoscopy, esophagoscopy, and (at times)
bronchoscopy. This lets the doctor thoroughly examine
the entire area around the larynx and hypopharynx,

Endoscopic biopsy
The larynx and hypopharynx are deep inside the neck,
so removing samples for biopsy
Fine needle aspiration (FNA) biopsy
This type of biopsy is not used to remove samples in the
larynx or hypopharynx, but it may be done to find the
cause of an enlarged lymph node in the neck. A thin,
hollow needle is placed through the skin into a mass (or
tumor) to get cells for a biopsy. The cells are then
looked at under a microscope.

 Computed tomography (CT) scan- The CT scan (also known as

a CAT scan) uses x-rays to produce detailed cross-sectional images
of your body. Instead of taking one picture like a standard x-ray
MRI- use radio waves and strong magnets instead of x-rays. The
energy from the radio waves is absorbed and then released in a
pattern formed by the type of tissue and by certain diseases
Barium swallow- This is often the first test done if someone is
having a problem with swallowing. For this test, drinking a chalky
liquid called barium to coat the walls of the throat and esophagus.
A series of x-rays of the throat and esophagus is taken as you
swallow. The barium can help show abnormal areas in the throat.

 Chest x-ray- A chest x-ray may be done to see if the

cancer has spread to the lungs.
Positron emission tomography (PET) scan-A PET
scan may be used to look for possible areas of cancer
spread, especially if there is a good chance that the
cancer is more advanced.

Thyroid cancer

1st level of prevention

Avoid/minimize exposure to radiation- ex. CT scan pack about 500
times the radiation of x-rays
X-rays and CT scans should be minimized in children and only used if
absolutely needed to diagnose a threatening condition or disease.
When x-rays or other radiological studies are necessary, the lowest
dose of radiation that still provides a clear picture should always be
used.
Eat foods that are high in iodine content such as organic Yogurt, dried
seaweeds, tuna, eggs, and potatoes- iodine deficiency causes the
thyroid gland to swell initially (known as goiter), but chronic (longterm) deficiency promotes nodules and increases the risk of cancer.

 Avoid smoking and drinking alcohol

Exercise regularly

Secondary level of prevention

Physical examination.The doctor will feel the neck, thyroid, throat, and
lymph nodes (the tiny, bean-shaped organs that help fight infection) in the
neck for unusual growths or swelling. If surgery is recommended, the
larynx may be examined at the same time with a laryngoscope, a thin,
flexible tube with a light.
Blood tests.There areseveral types of blood tests that may be done
during diagnosis and to monitor the patient during and after treatment.
This includes tests calledtumor marker tests. Tumor markers are
substances found at higher than normal levels in the blood, urine, or body
tissues of some people with cancer.
Thyroid hormone levels. As explained in theOverview, thyroid hormones
regulate a persons metabolism. The doctor will use this test to find out the current
levels of the thyroid hormones triiodothyronine (T3) and thyroxine (T4) in the body.
TSH.This blood test measures the level of thyroid-stimulating hormone (TSH), a
hormone produced by the pituitary gland near the brain. If the body is in need of
thyroid hormone, the pituitary gland releases TSH to stimulate production.

 Tg and TgAb. Thyroglobulin (Tg) is a protein made

naturally by the thyroid. After treatment, there should
be very low levels of thyroglobulin in the blood since the
goal of treatment is to remove all thyroid cells. A tumor
marker test may be done to measure the bodys Tg level
before, during, and/or after treatment. There is also a
test for thyroglobulin antibodies (TgAb), which are
proteins produced by the body to attack thyroglobulin
that occur in some patients. If TgAb is found, it is known
to interfere with the results of the Tg level test.

 Ultrasound.An ultrasound uses sound waves to create a

picture of the internal organs. An ultrasound wand or
probe is guided over the skin of the neck area. Highfrequency sound waves create a pattern of echoes that
show the doctor the thyroid gland size and specific
information about any nodules, including whether a
nodule is solid or a fluid-filled sac called a cyst.
Thyroid scanis a nuclear medicine test that uses a
radioactive iodine tracer to examine the structure and
function of thethyroidgland.

 Biopsy.A biopsy is the removal of a small amount of tissue for examination under
a microscope. Other tests can suggest that cancer is present, but only a biopsy can
make a definite diagnosis. The way to determine whether a nodule is malignant or
benign is through a biopsy. During this procedure, the doctor removes cells from
the nodule that are then examined by a cytopathologist. A cytopathologist is a
doctor who specializes in analyzing cells and tissue to diagnose disease.
A biopsy for thyroid nodules will be done one of two ways:

Fine needle aspiration. It is an important diagnostic step to determine

if a thyroid nodule is benign or malignant. A local anesthetic may be
injected into the skin to numb the area before the biopsy. The doctor
inserts a thin needle into the nodule and removes cells and some fluid.
The procedure may be repeated two or three times to obtain samples
from different areas of the nodule.
Surgical biopsy.If the needle aspiration biopsy is not clear, the doctor
may suggest a biopsy in which the nodule and possibly the affected lobe
of the thyroid will be removed. This procedure is usually done under
general anesthesia; it may require a hospital stay.

 Radionuclide scanning.This test may also be called a full-body scan

or a radioactive iodine (also called I-131 or RAI) scan. It is used most
often to learn more about a thyroid nodule. In this test, the patient
swallows a very small, harmless amount of radioactive iodine, which is
absorbed by thyroid cells. This makes the thyroid cells appear on the
scan image, allowing the doctor to see differences between those cells
and other body structures.
X-ray.An x-ray is a way to create a picture of the structures inside of
the body, using a small amount of radiation. For instance, a chest x-ray
can help doctors determine if the cancer has spread to the lungs.
Positron emission tomography (PET) scan.A PET scan is a way to
create pictures of organs and tissues inside the body. A small amount of
a radioactive sugar substance is injected into the patients body. This
sugar substance is taken up by cells that use the most energy. Because
cancer tends to use energy actively, it absorbs more of the radioactive
substance. A scanner then detects this substance to produce images of
the inside of the body.