Head and Neck Squamous Cell Carcinoma and the Future: The Role of Surgery

by Dr Rajeev Sharan, HOD - head and neck cancer and thyroid surgery, HCG Cancer Centre, Kolkata

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 together. But just like a traffic jam on one road can affect the flow of traffic on others, any problem in your head or 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 parts of the body. 

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:
•    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 
Advance 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 case undoubtfully upfront surgery is the initial treatment option. In advance stage after surgery, there is role of radiation therapy and chemotherapy in adjuvant setting to achieve better control.  Other location of tumour like larynx (voice box), pharynx in early-stage disease RT /CCRT as well as in surgery in selected cases are the treatment options but in advanced stage 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 tumor and a margin of surrounding healthy tissues. This minimizes the risk of cancer recurrence. There’s a spectrum of surgical approaches, tailored to the tumor’s location, size and stage. Here’s a glimpse into some of the common procedures:

•    Excision: This form of surgery includes removing the cancer tumor 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 laser to destroy cancerous tissue. It may be suitable for early-stage tumors, 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 spread 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 neck (Scarless neck), ENDOSCOPE/ ROBOT assisted surgery is being performed from behind the ear (retro auricular) or through axilla.

Reconstruction: Restoring form and function 
The surgery for head and neck squamous cell carcinoma can sometimes necessitate removing healthy tissues along with the tumor. This can impact the patient’s appearance and ability to speak, swallow, or breath. Fortunately, reconstructive surgery can be performed alongside the 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 own 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 tumor cells throughout the body.

The specific combination of these treatment 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, 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.

As tobacco and alcohol use is associated with almost 70 % 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 fight against head and neck squamous cell carcinoma. By precisely removing the tumor and potentially using reconstructive techniques, surgery offers the possibility of cure and improved quality of life for patients. 

Therefore, Avoidance of risk factors, Early diagnosis/referral and Adequate treatment are keys to enhance
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 as a substitute for medical advice. Always consult with a qualified doctor for diagnosis and treatment planning.