Head and Neck Tumours in Jaipur

What head and neck tumours are and how they develop

Head and neck tumours are abnormal growths that can appear in:

• The thyroid gland
• Salivary glands
• Lymph nodes of the neck
• The lining of the mouth, throat and voice box

Most of these cancers start in the thin layer of cells that line the inside of the mouth, pharynx and larynx. A thyroid nodule is a lump that grows within the thyroid gland at the front of the neck. Many thyroid nodules are found by chance during a routine check or an imaging test for another reason.

In studies, most thyroid nodules turn out not to be cancer. At one large centre, 60 to 70 percent of thyroid biopsies came back benign, about 5 percent were cancerous, and the remaining 25 to 35 percent were indeterminate, meaning the result was not clearly benign or malignant.

Some head and neck squamous cell cancers are linked to human papillomavirus (HPV), especially HPV type 16. HPV-positive tumours behave differently from HPV-negative ones and are staged using a separate system that takes this biology into account.

The stage of a tumour describes how large it is and whether it has spread to nearby lymph nodes or distant parts of the body. Early-stage cancers (Stage I or II) are often smaller and have not spread far.

Symptoms and warning signs that need urgent care the same day

A lump in the neck that does not go away after two to three weeks is the most common reason people seek evaluation. Other symptoms depend on the site of the growth.

You may notice:

• A swelling or pain in the throat
• Difficulty swallowing
• A change in your voice that lasts more than two weeks
• A sore in the mouth that does not heal
• Persistent ear pain on one side

A lump in the front of the neck that moves when you swallow may be a thyroid nodule.

Some symptoms suggest a more urgent problem. Sudden difficulty breathing, noisy breathing (stridor), or a feeling that the airway is narrowing need immediate attention at the emergency department. Heavy bleeding from the mouth or throat, or an inability to swallow your own saliva, also require same-day care.

If you have any of these, go to the nearest emergency department or call for an ambulance without waiting for an outpatient appointment.

Causes and who is at higher risk

Tobacco use in any form — smoking cigarettes, bidis, or chewing tobacco — and heavy alcohol consumption are the main causes of cancers of the oral cavity and larynx. The risk is higher when both habits are present together.

Infection with human papillomavirus, mainly HPV-16, is now the principal cause of a rising subset of oropharyngeal (throat) cancers in many parts of the world, including India. HPV-related throat cancers are increasing in younger people who may not have a history of heavy tobacco or alcohol use.

Other factors that can raise risk include:

• Long-standing irritation from sharp teeth or ill-fitting dentures
• Poor oral hygiene
• Occupational exposure to certain dusts or chemicals

For thyroid nodules, the exact cause is not always known, but radiation exposure to the head, neck or chest in childhood and iodine deficiency in the diet can contribute. Age is a factor: most head and neck cancers are diagnosed after age 50, though HPV-related throat cancers can appear earlier.

Men are affected more often than women, but the gap is narrowing. A family history of thyroid disease or certain genetic syndromes may also increase risk for thyroid nodules.

How head and neck tumours are diagnosed: examination and tests

The first step is a detailed history and a physical examination. Your doctor will feel the neck for lumps, examine the mouth and throat, and may pass a thin flexible tube with a light and camera through the nose to see the back of the nose, throat and voice box. This is called flexible nasopharyngolaryngoscopy and gives a complete view of the upper aerodigestive tract.

If a thyroid nodule or a neck node is felt, an ultrasound scan is usually done next. Ultrasound-guided fine needle aspiration cytology (FNAC) uses a thin needle to take a small sample of cells from the nodule or node under real-time imaging. Local anaesthetic is given to numb the skin before the needle is inserted.

Most people do not feel pain during the procedure. The sample is sent to the laboratory for examination. Rapid on-site evaluation (ROSE) may be used to check that enough cells have been collected before you leave. If the sample is inadequate, the doctor may take another pass.

If the biopsy result is indeterminate, molecular testing for gene mutations or fusions can help decide whether surgery is needed or the nodule can be watched. If the biopsy is unlikely to be cancer, your doctor will continue to monitor the nodule with repeat ultrasounds.

For deeper lesions or to assess the extent of a known cancer, contrast-enhanced CT or MRI of the neck is used for cross-sectional staging. All confirmed cancers are discussed at a multidisciplinary tumour board where surgical, radiation and medical oncologists agree on a joint plan.

Non-surgical treatment options and when surgery is advised

Treatment depends on the type, site, stage and your overall health. For many early-stage cancers of the oral cavity, surgery to remove the tumour with a margin of healthy tissue is the primary approach, often followed by radiation or chemoradiation.

For cancers of the pharynx and larynx, the standard primary treatment is radiation combined with chemotherapy (chemoradiation) to preserve the organ and its function. In HPV-positive oropharyngeal cancer, radiotherapy plus cisplatin is the standard of care for eligible patients and is associated with high survival rates.

When chemotherapy cannot be given due to other health problems, the EGFR antibody cetuximab may be used with radiation in HPV-negative disease. For recurrent or metastatic disease that has progressed after platinum-based chemotherapy, immune checkpoint inhibitors such as pembrolizumab are approved options.

Surgery is advised when a confirmed diagnosis has been made through imaging and biopsy, and the tumour size, location and stage make it removable. Early-stage cancers (Stage I or II) are often more amenable to surgical removal.

Surgery may also be recommended to relieve symptoms such as difficulty swallowing, breathing problems or severe pain, even if the cancer cannot be completely removed. If previous treatment with chemotherapy or radiation has not controlled the tumour, surgery may be considered to remove remaining disease. Your surgeon will assess whether you are fit enough to tolerate the operation. The specific type of cancer — for example squamous cell carcinoma or adenocarcinoma — also influences the decision.

Surgical procedures can include:

• Tumour resection
• Neck dissection to remove affected lymph nodes
• Laryngectomy
• Mandibulectomy
• Maxillectomy
• Reconstructive surgery to restore appearance and function

Endoscopic approaches through the mouth or nose may be used for selected throat or nasal cavity tumours and can lead to quicker recovery and less postoperative pain. Your surgeon will explain which approach suits your situation.

Preparing for head and neck tumour surgery

Your surgeon will explain the operation and ask you to sign a consent form. Before surgery you will have blood tests, an electrocardiogram and a chest X-ray to check that you are fit for anaesthesia.

If you take blood thinners, tell your doctor; they may want you to stop them a few days before the biopsy or operation to lower the chance of bleeding. You will usually be asked not to eat or drink for six to eight hours before the procedure.

Bring your regular medicines, any imaging films or reports, your insurance card and a list of questions. An attendant should plan to stay with you on the day of surgery and for the first night if you are admitted.

How head and neck tumour surgery is done

The exact operation depends on the site and stage of the tumour. Your surgeon will advise which approach suits you. Common options include tumour resection, where the growth is removed with a margin of healthy tissue, and neck dissection to remove lymph nodes that may contain cancer.

For cancers of the larynx, a partial or total laryngectomy may be needed; this can affect speech and breathing. When the jaw bones are involved, a mandibulectomy or maxillectomy may be performed. Reconstructive surgery is often done at the same time to restore appearance and function.

Endoscopic techniques through the nose or mouth can be used for some throat or nasal tumours and may allow quicker recovery. On the day of surgery you will change into a gown, an intravenous line will be placed, and you will be taken to the modular operation theatre.

General anaesthesia is used for major resections; local anaesthesia may be used for a biopsy. The operation time varies with the extent of surgery. After the procedure you will be moved to the recovery area and then to a ward or the intensive care unit for monitoring.

Risks and possible complications of head and neck tumour surgery

All operations carry risks. Bleeding and infection can occur at the wound site. Nerve injury may lead to weakness of the face, shoulder or tongue, depending on the area operated. Swallowing difficulty, voice change or breathing problems can happen, especially after laryngectomy or extensive resection. A fistula (leak of saliva) may form in the neck and usually heals with dressings.

Flap failure is a risk when reconstructive tissue is transferred. In studies of systemic therapy for advanced disease, common side effects included fatigue, hypothyroidism and skin reactions; severe (grade 3 or worse) treatment-related adverse events occurred in fewer patients receiving pembrolizumab than with standard chemotherapy. Treatment-related deaths have been reported in clinical trials of immunotherapy and targeted therapy.

In a trial comparing cetuximab with cisplatin given with radiotherapy, acute moderate to severe toxicity was seen in about 77% of patients in each arm, and late moderate to severe toxicity in about 16% to 20%. Your surgical team will discuss the risks that apply to your operation and the steps taken to reduce them.

Recovery and aftercare after head and neck tumour surgery

After a biopsy you can usually resume normal activities the same day. Keep the dressing on for four hours and do not let the area get wet for 24 hours. If you have pain once the anaesthesia wears off, paracetamol or an ice pack for 20 minutes at a time can help.

After major surgery you will stay in hospital for several days. Drains, a feeding tube or a tracheostomy tube may be in place; nurses will teach you and your attendant how to care for them. You will start with sips of water and progress to a soft diet as swallowing returns.

Physiotherapy and speech therapy begin early to help with shoulder movement, swallowing and voice. Before discharge you will receive written instructions on wound care, medicines and follow-up dates. Call the hospital if you develop fever, increasing neck swelling, redness or discharge from the wound, difficulty breathing, or if the feeding tube or tracheostomy tube becomes blocked or falls out.

Full recovery can take several weeks; your surgeon will guide you on when to return to work and normal activity.

Results of head and neck tumour surgery

Surgery aims to remove the cancer completely. In early-stage oral cavity cancers (Stage I or II), surgery alone often achieves good control. For locally advanced disease, treatment is usually multimodal: surgery followed by chemoradiotherapy for oral cavity cancers, and primary chemoradiotherapy for pharynx and larynx cancers.

In studies of HPV-positive oropharyngeal carcinoma treated with radiotherapy plus cisplatin, five-year overall survival was about 85% and five-year progression-free survival about 78%. Radiotherapy plus cetuximab showed inferior overall survival and progression-free survival compared with cisplatin in the same setting.

For recurrent or metastatic head and neck squamous cell carcinoma, pembrolizumab improved median overall survival to 8.4 months versus 6.9 months with standard chemotherapy in one large trial. In radioactive iodine-refractory thyroid cancer, lenvatinib prolonged median progression-free survival to 18.3 months compared with 3.6 months with placebo.

These figures come from groups of patients in clinical trials; your own outcome depends on the tumour type, stage, HPV status and your general health. Your multidisciplinary tumour board will discuss the expected results for your specific case.

Cost and insurance for head and neck tumour care in Jaipur

The typical price range for evaluation and biopsy at Jaipur Hospital is ₹2,000 to ₹15,000. The final cost depends on the type of investigation, whether imaging or endoscopy is needed, and if a biopsy is performed. Major surgery for head and neck cancer in India typically costs between ₹1,50,000 and ₹5,00,000.

Studies show that out-of-pocket expenditure for head and neck cancer patients averages around ₹37,845, with radiotherapy alone costing ₹31,000 to ₹42,000 depending on the technique, and additional indirect costs such as travel and lodging averaging ₹18,000 to ₹22,000. Surgery followed by adjuvant therapy incurs higher drug and consumable expenses.

Jaipur Hospital accepts:

• RGHS
• MAA Yojana
• CGHS
• A panel of private insurers and TPAs

The hospital has a 24-hour in-house pharmacy and diagnostic laboratory. Please ask the admissions team for an estimate based on your planned treatment.