Health

That lump in the throat, unprovoked nose bleeds could be signs of cancer

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3 years ago

Could you shed some light on the types of cancers that occur in the head and neck region?

Head and neck cancer refers to several types of cancers that affect the head and neck areas of the body. Head and neck cancer includes cancers of the nasal cavity (the hollow area inside the nose) and paranasal sinuses (air filling cavities surrounding the eyes), oropharynx (throat), oral cavity, larynx (voice box), saliver glands, as well as the area at the back of the nose and mouth.

We must talk more about cancers in these parts of the body because most of the patients with head and neck cancers present late to the hospital, and based on that we are unable to cure many of these patients. We can cure these patients with much confidence when the cancer is picked at the early stages, say stages 1 and 2. Of every 10 patients, we end up curing about 8 to 9 of them that present with stage 1 and stage 2. This does not include the chances of the person dying later from unrelated causes.

If the patient presents at stage 3 or stage 4, which we often refer to as the late stage (advanced stage), there is nothing much you can do when cancer is at an advanced stage. Even if at these advanced stages you successfully treat, there is a tendency that such a person may still have a recurrence or residual cancer and or develop another cancer later in the future

What cancer means is that there is a loss of control in the cell growth, leading to a rapid proliferation of the tumour cells whereas the growth of the normal cells is under well-controlled physiological processes.

How common are cancers of the head and neck region?

There is no national data on this due to an inappropriate cancer registry in Nigeria. Globally, head and neck cancers constitute between eight to 30 percent of all cancers. It varies between different countries and regions. Even its prevalence varies from one hospital to another in Nigeria due to poor awareness of these cancers. Awareness is higher with cancers of the breast, cervix, lung and prostate. Late diagnosis and presentation of persons with head and neck cancers come with a lot of ill health and deaths.

What are the signs and symptoms of head and neck cancers?

Head and neck cancer is a big masquerade; most of the symptoms are not specific at the early stage. Also, symptoms of head and neck cancer depend on the area where cancer develops and how it spreads. For example, tumours in the voice box or throat may appear as a lump in the throat. Also, when the voice box is affected, there may be a change in the voice or hoarseness, difficulty or pain when swallowing or difficulty with breathing. The main symptom of salivary gland cancer is a lump or swelling on or near the ear, jaw, or in mouth or neck.

Cancer cells may cause sores in the mouth or swelling of the jaw. Also, other common symptoms of cancers of the head and neck include a lump in the nose, neck or throat, with or without pain, a persistent sore throat, frequent coughing due to aspiration, ear pain or aural mass, persistent blood-stained nasal discharge accompanied by persistent nasal blockage, congestion and unilateral unprovoked nose bleed. Pulsatile ringing sensation in the ears may also accompany certain head and neck tumours. Red or white patches in the mouth could be pre-cancerous lesions.

It could also be the bad breath that’s unexplained by hygiene, and trouble breathing. Unfortunately, when individuals experience such symptoms as frequent unilateral nose bleeds, ear (aura) mass, persistent blood-stained nasal discharge or a change in the voice (hoarseness), they may not pay attention to it. Also, in some instances, some doctors will treat the frequent nose bleeds or catarrh as normal or as a viral infection. Howbeit, if a symptom is persistent for two weeks or does not subside, even after treatment, the best is to refer such a case to a specialist.

Sadly, aside from people’s poor health-seeking behaviour and the fact that sick people keep moving from one private hospital to another because there is no proper referral or delay seeking care, many because of the belief that some conditions or even those that appear as a frank cancer are due to spiritual attack also delay care. But, if the person with these symptoms goes to a hospital, the next thing will be that the individual will be referred to see a specialist.

The point is that having a persistent foreign body sensation or a lump in your throat is not normal. Ordinarily, if you are swallowing, you should not be having any pain. It is an indication that there may be something in the throat. Initially, a hoarse voice may be attributed to voice abuse or misuse. But if it does not resolve within 2 weeks, you have to see a general practitioner (GP) to refer you to a specialist because that hoarseness may be because there is a growth in the voice box.

Even if the individual has a benign tumour, which is slow growing over time, about 10 percent of them can undergo changes and become cancer later in life. So, in case of any swelling or functional impairment, try to see a specialist.

Are there particular things that put people at risk of cancers of the neck and head region?

Factors that predispose to cancers of the neck and head region include smoking and excessive alcohol intake. Smoking presents the greatest risk of developing head and neck cancer. Second-hand smoke also may increase the risk. Chewing tobacco and betel nuts as well as snuffing and cigars have been linked with mouth cancer. The combined use of tobacco and alcohol acts synergistically to further increase the chances of developing head and neck cancers.

People infected with the human papillomavirus (HPV) are at higher risk for some throat and mouth cancers. Besides HPV infection, some other infections linked to cancers of the head and neck include the Epstein-Barr virus (EBV). Also, poor nutrition, including a diet that is deficient in Vitamins A, C and E; oral sex and exposure to radiation increase the risk of developing cancer. If a child is exposed to salted meat and vegetables from childhood, there is a tendency that the child can develop cancer of the back of the nose later in life.

Cancer that occurs in families more often than would be expected by chance is termed Familial Cancer Syndromes (FCS). These rare cancers often occur at an early age. People with certain syndromes (such as LI-Fraumeni syndrome, Gardner syndrome) caused by inherited defects in certain genes have a very high risk of head and neck cancer, iron deficiency anaemia, especially in females within reproductive age is implicated in cancer of the hypopharynx (the lowest point of the throat).

How can individuals prevent these cancers? And is there any role for screening?

Taking a diet that contains Vitamins A, C and E, which are antioxidants that can boost the body’s immunity against cancer. People should reduce their intake of alcohol to the barest minimum or better still stop. The use of tobacco in all its forms or oral sex should be avoided. Exposure to radiation or industrial chemicals and wood dust at the workplace should be minimized. A regular medical check-up at least once a year is very important. A yearly comprehensive medical check-up entails tests to ascertain the functions of all the organs and systems of the body. There is no specific cost-effective screening for head and neck cancer for now.

How does one recognize the expert to turn to when in need of specialist care?

In Nigeria, we still have issues with the referral system such as delays in referring patients to specialists, but where you can be sure to at least see a general practitioner are the government hospitals. But if you want to go to any private hospital, find out about that hospital, the speciality and the designation of the attending doctor. Some may even write it on their signboard.

But if you are not sure, go in there and find out from the doctor. In government hospitals, they don’t have anything at stake, so they will easily refer you to the appropriate place if need be. The specialist will evaluate you, get to the root of the problem and offer the definitive treatment.

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