Head and Neck Cancers
Within the Belfast Health and Social Care Trust, patients with suspected head and neck cancers are referred to the Royal Victoria Hospital. Head and neck cancers are treated by a large and experienced team including Ear, Nose and Throat (ENT) surgeons, plastic surgeons, maxillo facial surgeons, head and neck clinical nurse specialists, radiologists, oncologists, specialist radiographers, speech and language therapy, dieticians, dental and administrative staff.
The team treat patients from across Northern Ireland who have head and neck cancers.
Please note that this section details services provided to adult patients of the Belfast Health and Social Care Trust. Please follow the link for information on Children’s Cancers
About 90% of head and neck cancers are of a type called squamous cell carcinoma. These start in the cells that form the lining of the mouth, nose, throat or ear, or the surface layer covering the tongue. There are many different areas that cancer can occur in the tissue and organs of the head and neck.
Cancer of the Nose and Paranasal Sinuses
Cancer of the nose can develop in the nostrils or the lining the nose.
The paranasal sinuses include the bones of the face and related structures. The sinuses are comprised of air spaces. Cancer can develop in the lining of the sinuses.
The highest part of the throat which lies behind the nose is called the nasopharynx. Cancer can develop here.
Cancer of the Ear
Cancer of the ear canal is a rare cancer but can present in patients with long standing ear symptoms.
Cancer of the Salivary Glands
The salivary glands make saliva (spit) and empty it into the mouth through openings called ducts. This keeps the mouth moist and helps food to slide down the gullet, into the stomach. Saliva makes food moist, which helps with chewing and swallowing. It helps with food digestion. It also cleans the mouth and contains antibodies that can kill germs.
Salivary gland cancer is a rare disease in which cancer cells form in the tissues of the salivary glands. It may cause symptoms including:
- A lump in the ear, cheek, jaw, lip, or inside the mouth
Cancer of the Voice Box (Larynx)
As we breathe in air through the nose and mouth, it is warmed and moistened, and then passes through the larynx and down the windpipe to the lungs. Cancer of the larynx is usually a type of squamous cell carcinoma. This means the thin flat cells that line the voice box have become cancerous.
Cancer of the Thyroid Gland
Thyroid cancer according to Macmillan Cancer Support (2011) has 1,900 cases diagnosed each year in the UK. There are four common types of thyroid cancer: Papillary, Follicular, Medullary and Anaplastic.
Cancers of the Oral Cavity (including lips and mouth)
The oral cavity includes the lips and the mouth. Cancer can occur in the tongue, the roof of the mouth (the hard palate), the floor of the mouth (under the tongue), the gums, and the inner lining of the lips and cheeks (sometimes referred to as the buccal mucosa).
This develops in the oropharynx, the part of the throat that is directly behind the mouth. It includes the soft part of the roof of the mouth (the soft palate), the base of the tongue (the part that can’t be seen), the side walls of the throat (where the tonsils are found) and the back wall of the throat (also called the posterior pharyngeal wall).
Head and neck cancers can also develop from other types of cells:
- Lymphomas develop from the cells of the lymphatic system.
- Adenocarcinomas develop from cells that form the lining of glands in the body.
- Sarcomas develop from the cells which make up muscles, cartilage or blood vessels.
- Melanomas start from cells called melanocytes, which give colour to the eyes and skin.
If a GP assesses a patient and suspects they may have cancer of the head and neck area, they will be referred to the Ear, Nose and Throat (ENT) department in the Royal Victoria Hospital or Belfast City Hospital.
Patients will be given a date and time to attend either the Belfast City Hospital or the Royal Victoria Hospital.
Investigations and diagnosis
As part of diagnosis and management of head and neck cancer investigations a number of investigations may be necessary. These include:
It is practice of the head and neck cancer team to organise imaging investigations for all patients with cancer, and different patients will need different tests. Tests and scans are done at the Royal Victoria Hospital or the Belfast City Hospital.
To effectively treat cancer, a number of specialists need to work together in order to gain an accurate diagnosis and to decide the best treatment plan for patients. These specialists work together in what is known as a multi-disciplinary team.
The Head and Neck Multidisciplinary Team (MDT) meets weekly in the Royal Victoria Hospital to discuss patients who have suspected, recurrent or confirmed head and neck cancer. Detailed discussions between the members of the team take place and the results and information for all patients are discussed in detail, in order to determine the best treatment plan.
The team is made of a range of specialists including; Ear, Nose and Throat (ENT)surgeons, plastic surgeons, maxillo facial surgeons, Head and Neck clinical nurse specialists, radiologists, oncologists, specialist radiographers, speech and language therapy, dieticians, dental and administrative staff.
A record of the team’s discussion will be sent to a patient’s GP.
Treatments offered to patients with head and neck cancer will depend on individual cases and the stage of cancer. This will be discussed in detail with every patient by one of our medical team once a diagnosis has been made. Please follow one of the links below for more information on treatment types:
- Specialist Palliative Care
Before patients undergo any treatment, they must give consent for the treatment to proceed. This is an important process to ensure that patients understand the nature of their treatment and the risks involved.
Patients coming to Royal Victoria Hospital for surgery may be asked to come up for a pre-operative assessment appointment in the outpatients clinic to ensure they are fit and safe for surgery.
In some cases patients are asked to have an anaesthetic assessment. If patients require this then it may be advised that they should be admitted overnight. This is all mandatory within our practice within the hospital so patients should not worry if this happens. Our team of specialist nurses will be on hand to answer any questions and to care for patients during each part of their pathway.
For many patients with head and neck cancer, surgery may be the most appropriate treatment.
Specialist head and neck cancer surgery for Northern Ireland is provided at the Royal Victoria Hospital by specialist by head and neck surgeons. Patients are prioritised by:
- Clinical care pathway
- Clinical urgency
- Theatre availability
- Job specialisation of surgeon
Patients are given an approximate date of surgery or waiting time by their surgeon and will be kept up to date by the appointments office.
Surgical procedures are different for each type of head and neck cancer.
Recovery is different for everyone and it depends on the type of treatment patients have had. It will usually take some time to recover from treatment. There may be physical changes in the way patients look, and possibly changes in some of the essential activities of daily life such as speech or eating. There will also be emotional changes to deal with so it’s important that patients give themselves time to adjust.
The Belfast Health and Social Care Trust provides support services to help patients in all the aspects of their life that are affected by cancer. For more information on these support services, please follow this link.
The Trust also operates Support and Information Centres where you can get help.
If you are a smoker, it is important to try to give up. Smoking is the main cause of head and neck cancers and continuing to smoke puts you at greater risk of developing a second cancer. It may also significantly reduce the effectiveness of your current treatment, worsen the side effects and increase the risk of your cancer coming back. Giving up smoking can be very difficult, especially at times of stress.
After treatment has finished, patients will be asked to come back up to the hospital for check-ups. Check-ups are a good opportunity for patients to discuss any worries or problems they may have. Patients should go to their GP or specialist doctor for advice if they have a symptom between follow-up visits that they cannot explain, or that they are worried about.
It’s important to have a nutritious and well-balanced diet with plenty of fresh fruit and vegetables, even if appetite and interest in food has been reduced by treatment. The clinical nurse specialists at the Belfast Health and Social Care Trust can refer patients to see a dietician who will be able to give advice on ways to eat well and can help with any problems patients may have.
Useful information and tips on living with cancer can be found on the Macmillan Support Cancer website.
A list of useful supportive websites relating to Head and Neck Cancer has been provided below. Please follow one of the links: