Head and neck cancer
Clinical update on new National Institute for Health and Care Excellence (NICE) quality standards on head and neck cancer.
Clinical update on new National Institute for Health and Care Excellence (NICE) quality standards on head and neck cancer
Head and neck cancers include those of the mouth and throat, and rarer forms affecting the sinuses, salivary glands, nose or middle ear. According to the Oracle Cancer Trust, head and neck cancer is the UK's sixth most common type, with 31 people diagnosed every day, equating to more than 11,000 a year.
In March, NICE published new quality standards on head and neck cancer, for those aged 16 or above. Covering assessment, diagnosis and management, it includes cancer of the upper aerodigestive tract. Four statements provide standards on nutritional status, clinical staging, sentinel lymph node biopsy and choice of treatment.
There are more than 30 areas in the head and neck where cancer can develop, so symptoms depend on its location. Mouth cancers are the most common. The most likely symptoms are a lump or ulcer that doesn't heal, or pain or discomfort that doesn't go away. Other signs include a white or red patch, difficulty with chewing, swallowing or speaking and bleeding. The main areas of the throat that can be affected by cancer are the oropharynx, hypopharynx or nasopharynx. Common symptoms include a lump in the neck, a persistent sore throat and difficulty swallowing.
Drinking heavily and smoking over many years, especially together, are the main risk factors and are linked to three-quarters of head and neck cancers, says the charity, Macmillan. Others include: holding a pipe or cigarette on your lip, chewing tobacco, HPV infection, prolonged exposure to hardwood and leather dust, and formaldehyde, long-term exposure to sunlight and reduced immunity, including having had an organ transplant. Men are at greater risk, as are those who have a close relative with head or neck cancer, with those aged over 50 more commonly affected. Poor mouth hygiene or dental disease may also slightly increase the likelihood of mouth cancer.
How you can help your patient
For patients, a diagnosis of head and neck cancer can be emotionally and physically debilitating. Breathing, eating and communicating can be affected and treatment is visible. While every patient adapts to an altered appearance differently, some may develop depression, anxiety and social isolation. Nurses play a key role in improving patients' psychological well-being, understanding what the real problems are and helping them to adjust.
University College London Hospitals NHS Foundation Trust lead Macmillan clinical nurse specialist for head and neck cancer Sarah Orr:
'Sentinel lymph node biopsies are new to head and neck cancer, although they have been used for breast cancer and melanoma. In theory, they reduce the need for a neck dissection and are a much less traumatic procedure. As there is currently a lack of expertise within the UK, very few centres provide this at the moment, but the likelihood is that patients will ask about it as a recommended treatment. Nurses need to be aware, possibly suggesting a referral to a centre where it is offered.
'Head and neck cancer is very visible and affects daily activities, and often a patient's ability to socialise and work. Nurses play a pivotal role in supporting patients and their families adjust to a 'new normal', with a good quality of life and the confidence to move on.'
Find out more
- NICE Head and neck cancer (March 2017)
- British Association of Head and Neck Oncologists
- Head and Neck Cancer Foundation
- Oracle Cancer Trust