Monday, September 28, 2009

Knowing the signs will save your neck

Sagittal section of human vocal tractImage via Wikipedia

When seemingly trivial ailments such as a sore throat may mean cancer

Eveline Gan

THE sign seemed innocuous at first - a sore throat, which Mr L H Sim thought nothing of. But, unlike most sore throats, the discomfort didn't go away.

Mr Sim gradually lost his voice and appetite, too, which prompted him to seek medical attention.

A biopsy taken from a lump in his throat confirmed the 60-year-old car-cushion manufacturer's worst fears - he had third-stage throat cancer, a type of head and neck cancer.

The others in this category include cancer of the oral cavity, nasal cavity, throat, sinuses, larynx or voice box, thyroid and salivary glands.

Head and neck cancer afflicts about 500 Singaporeans each year, but the symptoms are hard to detect. That's because, like the case of Mr Sim, they seem to be trivial ailments.

A sore throat, stuffy nose or mouth ulcer might hardly be cause for alarm, but these could be signs of more insidious medical conditions.

To raise awareness of the disease, which is the sixth most common cancer to afflict men in Singapore, two public forums this Saturday will address issues and treatment options of the various forms of head and neck cancer (see health listings).

"Some of the early symptoms of head and neck cancer are similar to those of common ailments like upper respiratory tract infection and may be ignored," said medical oncologist Dr Leong Swan Swan, who had treated Mr Sim.

"This may cause delays in seeking medical attention and hence more advanced cancers at diagnosis," added the doctor, who is based at Gleneagles Medical Centre's Oncocare Cancer Centre.

About half of head and neck cancers occur in the mouth - mostly on the tongue, floor of the mouth and cheeks, said Assistant Professor Victor Fan, consultant at the National University Hospital's department of oral and maxillofacial surgery.


While a person with early-stage oral cancer may sometimes have no symptoms, a sign to look out for is a non-healing mouth ulcer, said Asst Prof Fan.

"The ulcers that most people get typically heal within 10 to 14 days. Any ulcer that doesn't heal in two weeks is suspicious," he added.

Other warning signs include a persistent sore throat or congested nose, as well as unusual lumps, and red or white patches in the mouth.

In more advanced cases, said Asst Prof Fan, the patient may have difficulty swallowing or slurred speech, especially those who have tongue cancer. Others may have abnormal lumps in the neck.

With many of head and neck cancer symptoms resembling common ailments, when should one sound the alarm?

"Symptoms due to common ailments should resolve spontaneously, or after medication. If they persist, it is always good to seek medical attention," said Dr Leong.

Head and neck cancers are usually diagnosed by specialists, such as an otolaryngologist or a head and neck surgeon, who may perform a biopsy on a suspicious lump or lesion. For oral cancer, a trained dentist can detect warning signs in the mouth, especially those in hidden corners.

With early diagnosis, head and neck cancers are curable, both doctors stressed.

Another plus point is that treatment of the early-stage cancer tends to be less traumatic for patients, said Assistant Prof Fan. The cure rate also drops dramatically if the cancer spreads to other parts of the body.

Traditional treatments involve surgery, radiotherapy or chemo-radiotherapy. According to Dr Leong, new options - such as drugs that target and destroy some types of cancer cells while causing little harm to normal cells - have become available for treatment.

After undergoing chemotherapy and radiotherapy, Mr Sim is now recovering. However, the side effect of his radiotherapy - which left him in excruciating pain and unable to eat or drink properly because his throat and neck were badly burned and scarred inside out - is something he will have to grapple with for a long time.

Quit smoking, drinking ... and chewing betel nuts

Research has found that smoking and alcohol consumption are two of the top causes of oral cancer, which forms about half of all head and neck cancer diagnoses.

According to Assistant Professor Victor Fan, your risk of oral cancer is six times higher than an average person if you smoke heavily, and up to 24 times higher if you smoke and consume more than 30 glasses of alcohol per week.

Other risk factors may be linked to heavy consumption of preserved foods such as salted fish, and viral causes such as human papillomavirus (HPV) infection and Epstein-Barr virus.

The chewing of betel nuts - which contains nicotine - may also increase the risk of cancer.

From TODAY, Health – Tuesday, 01-Sep-2009
In collaboration with Health Promotion Board