Head And Neck Squamous Cell Carcinoma And The Future: The Role Of Surgery

Think of your head and neck as the control center for your body's most important functions, like seeing, hearing, smelling, tasting, speaking, swallowing, and breathing. It's like a complex network of roads and bridges, with nerves, muscles, and blood vessels connecting everything.

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neck can cause trouble for the whole system. While this interconnection allows for seamless and smooth functioning, it also creates a susceptibility disturbance in one area which may quickly cascade and impact other body parts. 

One such disruption is squamous cell carcinoma (SCC), a type of cancer that initiates in the thin, flat cells lining various surfaces in the head and neck, including the skin, lips, mouth, throat, and voice box. The fundamental reason behind SCC is sun exposure, particularly for skin cancers. However, for head and neck SCC, the major risk factors include:

Dr Rajeev Sharan, HOD - Head and Neck Cancer and Thyroid surgery, HCG Cancer Centre, Kolkata shares the role of surgery in head and neck squamous cell carcinoma:

• Tobacco use (smoking and chewing)
• Excessive alcohol consumption, and 
• Infection with the human papillomavirus (HPV)

Signs and symptoms to look after:

• Change in voice
• Non-healing ulcer in oral cavity (> 2 weeks) 
• Recurring lumps or sores in the mouth, throat, or neck
• Difficulty in swallowing or breathing
• Unexplained earaches or constant ringing in ears
• Loose teeth 
• Red or white spots inside the mouth

Staging, prognosis, and treatment options: 

Early-stage disease (stage I & II):70 to 90 % (5 years disease-free survival) &single modality treatment 
Advanced stage disease (stage III & IV):50 t0 70 % (5 years disease-free survival) &Multimodal treatment

As we know oral cancer represents almost 70 % of HNSCC, and in such cases undoubtedly upfront surgery is the initial treatment option. In the advanced stage after surgery, there is the role of radiation therapy and chemotherapy in an adjuvant setting to achieve better control. Other locations of tumour like the larynx (voice box), and pharynx in early-stage disease RT /CCRT as well as in surgery in selected cases are the treatment options but in the advanced stages again surgery plays a major role. 

Surgical approaches to head and neck squamous cell carcinoma:

The main goal of head and neck squamous cell carcinoma surgical treatment is the complete removal of the tumour and a margin of surrounding healthy tissues. This minimizes the risk of cancer recurrence. There’s a spectrum of surgical approaches, tailored to the tumour’s location, size, and stage. Here’s a glimpse into some of the common procedures:

• Excision: This form of surgery includes removing the cancer tumour and a surrounding margin of healthy tissues. The specific approach can vary depending on the stage and location of the cancer.

• Laser Surgery: This minimally invasive technique uses a laser to destroy cancerous tissue. It may be suitable for early-stage tumours, particularly in the larynx, due to its precision.

• Transoral Robotic Surgery (TORS): This surgical approach utilizes robotic instruments for improved visualisation and dexterity during surgery in the mouth and throat. It offers advantages like faster recovery and better preservation of function.

• Neck Dissection: If there’s a risk of cancer spreading to the lymph nodes in the neck, a neck dissection might be performed. This involves removing some or all of the lymph nodes in the area.

• Remote access surgery: Recently minimal invasive surgery is getting popular and in head neck cancer cases to prevent scar in front of the neck (Scarless neck), ENDOSCOPE/ ROBOT assisted surgery is being performed from behind the ear (retro auricular) or through the axilla.

Reconstruction: Restoring form and function 

The surgery for head and neck squamous cell carcinoma can sometimes necessitate removing healthy tissues along with the tumour. This can impact the patient’s appearance and ability to speak, swallow, or breathe. Fortunately, reconstructive surgery can be performed alongside tumour removal to restore these functions and improve cosmetic outcomes.

• Skin Grafts: Using healthy skin from another part of the body to cover the surgical site.

• Flap Surgery: Transferring a flap of tissue with its blood supply from another location to rebuild the affected area.

• Prosthetic Implants: Using artificial materials to replace missing structures, such as jawbone.

Beyond Surgery: A multimodal approach:

Surgery is often just one part of the treatment plan for HNSCC:
• Radiation Therapy: Radiation therapy is used to destroy and kill malignant cells using high-energy beams.
• Chemotherapy: Effective medications are used to kill tumour cells throughout the body.

The specific combination of these treatments depends on the individual case and is determined by the doctors. 

Diet and fight against Squamous Cell Carcinoma

While a specific diet cannot cure cancer, maintaining a healthy diet rich in fruits, vegetables, and whole grains can provide fundamental nutrients to support the body during treatment and promote overall health and well-being. Additionally, limiting processed foods, red meat and sugary drinks may be beneficial. Consulting a doctor or a dietician can help create a personalized diet plan that complements your treatment journey.

Tobacco and alcohol use is associated with almost 70 % of cases of HNSCC. So little change in our lifestyle (No Smoking or Cessation of smoking) would have a big impact on the likelihood of occurrence of HNSCC.
Surgery plays a vital role in the fight against head and neck squamous cell carcinoma. By precisely removing the tumour and potentially using reconstructive techniques, surgery offers the possibility of a cure and improved quality of life for patients.

Therefore, Avoidance of risk factors and early diagnosis/referral of adequate treatment are keys to enhancing quality of life and success rate in HNSCC.

It is important to note that this article provides only general information and should not be considered a substitute for medical advice. Always consult with a qualified doctor for diagnosis and treatment planning.