Head and neck tumours in children
Cancers involving the head and neck in children sixteen years or younger commonly are a wide range of diseases having different presentation, clinical course and treatment, depending on the underlying diagnosis. They are commonly lymphomas (a cancer affecting the lymph nodes and lymphatic tissue), sarcomas (a cancer arising from muscle, fat or other connective tissue), thyroid cancers, salivary gland cancers and neuroblastomas (a cancer arising from neurological tissue embryological remnant).
How common is it?
Fortunately these are rare; Indian data is scarce, but US data shows that head and neck cancer accounts for around 12% of all new cases of cancer in the country. Although most cancers have no genetic cause or environmental exposure associated with them, there are certain cancers like medullary thyroid cancer, which require familial screening and early treatment, even before the patient develops cancer.
What are the symptoms?
For thyroid cancers the most common symptoms are swelling in front of the neck or a lump in the side of the neck. For parotid cancers, a swelling in front of the ear is the commonest presentation. Other symptoms can be a swelling or lump in the neck or mouth, nasal stuffiness or bleeding, loss of teeth and persistent fever.
What causes it?
Thyroid cancer can be associated with inherited familial cancer syndromes that result in childhood cancers. Ebstein-Barr virus infection is associated with Burkitt’s lymphoma. Most other head and neck cancers are sporadic in this age group, meaning they occur because of random genetic mutations with no familial cause or link.
How do you diagnose it?
Diagnosis requires a team of specialists (pediatric oncologist, surgeon, radiation oncologist, radiologist and pathologist). Establishing a diagnosis usually comprises two parts. The first biopsy of the tumour, which may need to be performed under short general anaesthesia. The second part is imaging of the cancer CT, MRI or PET scans. As these are a diverse group of cancers with many different subtypes, additional testing may be needed on the biopsy, called immunohistochemistry. These are a group of special stains that help identify what kind of tissue the cancer originates from. Based on the biopsy and the imaging, the best possible treatment for the child is determined.
How do you treat it?
Certain cancers, like thyroid and parotid cancers, require surgery as the primary treatment. Depending on the stage and completeness of surgery, additional treatment like radioiodine therapy and radiotherapy may be required. For lymphoma, neuroblastoma and other tumours, chemotherapy is the best treatment option. For certain tumours like sarcomas, chemotherapy may be the initial treatment option and based on the response, the next part of treatment differs; tumours that respond well to the initial chemotherapy receive radiotherapy with chemotherapy while those who don’t receive surgery. Treatment decisions need detailed discussion by experienced specialists who will consider not only cure but which treatment option will result in the least long-term side effects for the child.
Is it curable?
The type of cancer is a major determinant of survival in these patients. Most of these cancers are curable, with good response rates to treatment. Early diagnosis and appropriate treatment by an experienced team result in the best chance of cure and with fewer long-term side effects.
What does the road to recovery look like?
The extent of your treatment will determine how long it takes the child to recover. Surgery for an early tumour may take two weeks to recover from while a major surgery following by radiotherapy and chemotherapy may take months to completely recover from. It is important to think of treatment as a marathon rather than a sprint, and take help from those around you, whether they are medical professionals, or friends and family. Follow-up after treatment is crucial – this is to not only assess your recovery, but also to check for recurrence. Long-term rehabilitation is a very important part of reducing long-term side effects of treatment.