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Diagnosis and Treatments for Thyroid Cancer

Thyroid cancer forms in the tissues of the thyroid gland, which is located in the front of the throat, below the cartilage known as Adam’s apple. Though thyroid cancer is not considered a type of head and neck cancer, it is typically treated by an otolaryngology-trained oncologist who also treats malignancies of the mouth, nose, tonsils, sinuses, salivary glands, and lymph nodes of the neck. Symptoms of thyroid cancer may include neck pain, voice changes, breathing difficulties, coughing, or trouble swallowing.

The thyroid gland produces several important hormones, including the thyroid hormone, which is involved in controlling body temperature, weight, energy level, and heart rate. The thyroid gland also produces calcitonin, which helps the body use calcium.

Surgery

Types of surgeries may be used to treat thyroid cancer:

HEMITHYROIDECTOMY:

For small, well-differentiated tumors that have not spread beyond the thyroid gland, a lobectomy may sometimes be performed. In this type of thyroid cancer surgery, the lobe containing the cancer is removed, leaving the other healthy lobe behind. This may reduce the need to take thyroid hormone treatment after surgery since a functioning part of the thyroid remains.

TOTAL Thyroidectomy:

In this procedure, most or all of the thyroid gland is removed by surgery (total, near-total, or subtotal thyroidectomy). This type of surgery for thyroid cancer is used for most patients. However, because very little or no functioning thyroid tissue is left behind, patients will need to take daily thyroid hormone replacement pills afterward.

Lymph node removal:

When the surgeon suspects that the thyroid cancer cells have spread to nearby lymph nodes, they will remove the enlarged or suspicious nodes in order to remove as much cancer as possible. This thyroid cancer surgical procedure is usually performed at the same time as the surgery on the primary tumor.

Radiation Therapy

External beam radiation therapy (EBRT):

It directs the radiation from outside the body to cancerous tissues inside the body. It is a cancer treatment option that uses doses of radiation to destroy cancerous cells and shrink tumors. Examples of EBRT include 3D conformal radiation therapy, IMRT, IGRT, TomoTherapy®, and stereotactic radiosurgery.

Intensity-modulated radiation therapy (IMRT):

Uses advanced software to plan a precise dose of radiation, based on tumor size, shape, and location. A computer-controlled device called a linear accelerator delivers radiation in sculpted doses that match the 3D geometrical shape of the tumor, including concave and complex shapes. If you have previously had radiation therapy for thyroid cancer and are experiencing recurrent tumors in the treated area, IMRT may be an option for you. Compared to standard radiotherapy, IMRT allows our radiation oncologists to use higher radiation doses than traditional therapies would allow in these areas. At the same time, IMRT helps to spare more of the surrounding healthy tissue from harmful doses of radiation.

TomoTherapy:

Combines a form of intensity-modulated radiation therapy (IMRT), with the accuracy of computed tomography (CT) scanning technology, in one machine. With this technology, we deliver more precise radiation to match complex tumor shapes while avoiding sensitive structures. Using built-in CT scanning to confirm the shape and position of the tumor before each treatment, TomoTherapy may reduce radiation exposure to healthy tissues and organs.

Click here to see more about APCC and its therapy.

[certainhologramobservation]

Proton Therapy for Adenoid Cystic Carcinoma

Adenoid cystic carcinomas are slowly growing, locally aggressive cancers that arise in salivary glands. They have a tendency to spread along nerves and also to metastasize to the lungs. The common location for adenoid cystic cancers is in the major salivary glands, parotid and submandibular glands being the most common. However, they may also occur in other locations in the head-neck region including the palate, nose and paranasal sinuses.

The primary treatment of adenoid cystic carcinoma is surgery. Radiotherapy is administered in the postoperative setting and for inoperable lesions. Proton therapy has a special role, in that the outcomes of proton therapy are excellent in postoperative and inoperable patients.

Proton therapy

Apollo Proton Cancer Centre is equipped with facilities and expertise for both proton therapy as well as radiotherapy.

Proton therapy has a special role in the treatment of adenoid cystic cancer. This is because of multiple factors, which relate to the nature of the tumour, its interaction with proton therapy. In addition, since adenoid cystic cancers can travel along cranial nerves that arise in the brain, the target for radiotherapy/proton therapy is in proximity to the brain. Proton therapy ensures that the required dose can be administered adjacent to the brain, with less dose going to the brain. This results in better outcomes than other forms of radiotherapy, even in the treatment of inoperable patients.

Proton therapy, administered over 6–7 weeks helps reduce the dose to all neighbouring critical structures. This results in substantially decreasing the risk of early side effects and late consequences of treatment. During the period of treatment, less dose to critical structures equates with a reduction in the risk of blisters in the mouth and throat, less requirement of strong pain killers, less chance of weight loss, tube feeding, hospital admission or treatment interruption.

At APCC, proton therapy is administered using the latest pencil beam scanning technology on an IBA Proteus Plus. The sophisticated treatment unit comprises 2 gantries that can rotate around the patient and deliver proton therapy from multiple angles and a specialised treatment couch that is capable of moving and rotating to position the patient accurately for treatment. The treatment unit is equipped with various forms of imaging, X-rays, Cone beam CT and surface imaging to ensure accurate delivery of radiotherapy.

In addition to proton therapy, patients may receive treatment for adenoid cystic cancers on the RadixactTomotherapy unit, using helical tomotherapy. This advanced image-guided radiotherapy technique is based on photons or X-rays, with a high degree of modulation to reduce dose to normal structures.

At APCC, all head neck proton and radiation treatments are carried out under the care of head neck specialised expert doctors who are supported by a team of medical physicists and radiotherapy technologists. At APCC, the treating team is supported by a group of services that help in the holistic management of head neck cancer patients.

[certainhologramobservation]

Treatment for Lip and Oral Cavity Cancer

Lip and oral cavity cancer is a disease in which malignant (cancer) cells form in the lips or mouth. Tobacco and alcohol use can affect the risk of lip and oral cavity cancer.

Signs of lip and oral cavity cancer include a sore or lump on the lips or in the mouth.

Treatment options depend on the following:

The stage of cancer.

The size of the tumor and where it is in the lip or oral cavity.

whether the patient’s appearance and ability to talk and eat can stay the same.

The patient’s age and general health.

Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

External radiation therapy uses a machine outside the body to send radiation toward cancer.

Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy is used to treat lip and oral cavity cancer.

Radiation therapy may work better in patients who have stopped smoking before beginning treatment. It is also important for patients to have a dental exam before radiation therapy begins so that existing problems can be treated.

Chemotherapy

Chemo (typically combined with radiation therapy) may be used instead of surgery as the main treatment for some cancers. (This is called chemoradiation).

Chemo (combined with radiation therapy) may be given after surgery to try to kill any small deposits of cancer cells that may have been left behind. This is known as adjuvant chemotherapy.

Chemo (sometimes with radiation therapy) may be used to try to shrink some larger cancers before surgery. This is called neoadjuvant or induction chemotherapy. In some cases, this makes it possible to use less radical surgery and remove less tissue. This can lead to fewer serious side effects from surgery.

Chemo (with or without radiation therapy) can be used to treat cancers that are too large or have spread too far to be removed by surgery. The goal is to slow the growth of cancer for as long as possible and to help relieve any symptoms the cancer is causing.

Click here to see more about APCC and its therapy.

[certainhologramobservation]

Salivary Gland Tumours

The role of radiotherapy in salivary gland tumors:

This is a diverse group of tumors that are primarily treated with surgery. The commonest site for a salivary gland tumor is the parotid gland; however submandibular gland tumors are more likely to be malignant.

There are many histopathological types of salivary gland cancer such as adenoid cystic carcinoma, mucoepidermoid carcinoma adenocarcinoma, carcinoma ex pleomorphic adenoma. Adenoid cystic carcinoma has some peculiar characteristics, which are mentioned on a separate page.

Radiotherapy is indicated in all patients suffering from adenoid cystic carcinoma and in others in histologies, if high-risk features are noted in the examination of the tissue removed surgically. Radiotherapy for salivary gland tumors is unilateral i.e., treatment is directed only to the affected side of the face and neck. Radiotherapy may also be used to treat inoperable lesions.

Proton therapy has a significant advantage in the treatment of this tumor in that the radiation dose received by the opposite side of the face and neck is substantially less, of the order of more than 80% reduction in dose. This result is less inflammation of the inner lining of the cheek, palate, tongue and less dose to the voice box. Salivary gland tumors often occur in young adolescents and adults and the reduction in the radiation being received by the opposite side has an additional advantage of decreasing the risk of developing radiation-induced cancer.

[certainhologramobservation]

Diagnosis and Treatment for Larynx Cancer

The larynx is a part of the throat, between the base of the tongue and the trachea. The larynx contains the vocal cords, which vibrate and make the sound when air is directed against them. The sound echoes through the pharynx, mouth, and nose to make a person’s voice.

There are three main parts of the larynx:

Supraglottis: The upper part of the larynx above the vocal cords, including the epiglottis.

Glottis: The middle part of the larynx is where the vocal cords are located.

Subglottis: The lower part of the larynx is between the vocal cords and the trachea (windpipe). Laryngeal cancer forms in the tissues of the larynx (area of the throat that contains the vocal cords). The larynx includes the supraglottis, glottis (vocal cords), and subglottis. Cancer may spread to nearby tissues or to the thyroid, trachea, or esophagus. It may also spread to the lymph nodes in the neck, the carotid artery, the upper part of the spinal column, the chest, and other parts of the body. Most laryngeal cancers form in squamous cells, the thin, flat cells lining the inside of the larynx.

Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Radiation therapy may work better in patients who have stopped smoking before beginning treatment. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. A blood test to check the thyroid hormone level in the body may be done before and after therapy to make sure the thyroid gland is working properly.

Surgery

Surgery (removing cancer in an operation) is a common treatment for all stages of laryngeal cancer. The following surgical procedures may be used:

LASER Cordectomy: Surgery to remove the vocal cords only.

Supraglottic laryngectomy: Surgery to remove the supraglottis only.

Hemilaryngectomy: Surgery to remove half of the larynx (voice box). A hemilaryngectomy saves the voice.

Partial laryngectomy: Surgery to remove part of the larynx (voice box). A partial laryngectomy helps keep the patient’s ability to talk.

Total laryngectomy & Voice rehabilitation: Surgery to remove the whole larynx. During this operation, a hole is made in the front of the neck to allow the patient to breathe. and an artificial voice box is inserted which helps the patient to speak.

Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor in the larynx.

After the doctor removes all cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that cancer will come back, is called adjuvant therapy.

[certainhologramobservation]

Diagnosis and Treatments for Thyroid Cancer

Thyroid cancer forms in the tissues of the thyroid gland, which is located in the front of the throat, below the cartilage known as Adam’s apple. Though thyroid cancer is not considered a type of head and neck cancer, it is typically treated by an otolaryngology-trained oncologist who also treats malignancies of the mouth, nose, tonsils, sinuses, salivary glands, and lymph nodes of the neck. Symptoms of thyroid cancer may include neck pain, voice changes, breathing difficulties, coughing, or trouble swallowing.

The thyroid gland produces several important hormones, including the thyroid hormone, which is involved in controlling body temperature, weight, energy level, and heart rate. The thyroid gland also produces calcitonin, which helps the body use calcium.

Surgery

Types of surgeries may be used to treat thyroid cancer:

HEMITHYROIDECTOMY:

For small, well-differentiated tumors that have not spread beyond the thyroid gland, a lobectomy may sometimes be performed. In this type of thyroid cancer surgery, the lobe containing the cancer is removed, leaving the other healthy lobe behind. This may reduce the need to take thyroid hormone treatment after surgery since a functioning part of the thyroid remains.

TOTAL Thyroidectomy:

In this procedure, most or all of the thyroid gland is removed by surgery (total, near-total, or subtotal thyroidectomy). This type of surgery for thyroid cancer is used for most patients. However, because very little or no functioning thyroid tissue is left behind, patients will need to take daily thyroid hormone replacement pills afterward.

Lymph node removal:

When the surgeon suspects that the thyroid cancer cells have spread to nearby lymph nodes, they will remove the enlarged or suspicious nodes in order to remove as much cancer as possible. This thyroid cancer surgical procedure is usually performed at the same time as the surgery on the primary tumor.

Radiation Therapy

External beam radiation therapy (EBRT):

It directs the radiation from outside the body to cancerous tissues inside the body. It is a cancer treatment option that uses doses of radiation to destroy cancerous cells and shrink tumors. Examples of EBRT include 3D conformal radiation therapy, IMRT, IGRT, TomoTherapy®, and stereotactic radiosurgery.

Intensity-modulated radiation therapy (IMRT):

Uses advanced software to plan a precise dose of radiation, based on tumor size, shape, and location. A computer-controlled device called a linear accelerator delivers radiation in sculpted doses that match the 3D geometrical shape of the tumor, including concave and complex shapes. If you have previously had radiation therapy for thyroid cancer and are experiencing recurrent tumors in the treated area, IMRT may be an option for you. Compared to standard radiotherapy, IMRT allows our radiation oncologists to use higher radiation doses than traditional therapies would allow in these areas. At the same time, IMRT helps to spare more of the surrounding healthy tissue from harmful doses of radiation.

TomoTherapy:

Combines a form of intensity-modulated radiation therapy (IMRT), with the accuracy of computed tomography (CT) scanning technology, in one machine. With this technology, we deliver more precise radiation to match complex tumor shapes while avoiding sensitive structures. Using built-in CT scanning to confirm the shape and position of the tumor before each treatment, TomoTherapy may reduce radiation exposure to healthy tissues and organs.

Click here to see more about APCC and its therapy.

[certainhologramobservation]

Treatment for Nasopharynx Cancer

The primary treatment of cancer of the nasopharynx that is confined to the local site and neck is radiotherapy. Chemotherapy is also administered prior to and along with radiotherapy and is described in detail below.

Apollo Proton Cancer Centre is equipped with facilities and expertise for both Proton therapy as well as photon radiotherapy.

The nasopharynx is surrounded by critical structures responsible for saliva, swallowing, hearing, vision, cognition as well as neural tissues, brain, brainstem, and spinal cord. In addition, the cheek and throat lining lies close to the nasopharynx and can be affected when cancer of the site is being treated.

Proton therapy, administered over 6-7 weeks helps reduce the dose to all neighboring critical structures. This results in substantially decreasing the risk of early side effects and late consequences of treatment. During the period of treatment, less dose to critical structures equates with a reduction in the risk of blisters in the mouth and throat, less requirement of strong pain killers, less chance of weight loss, tube feeding, hospital admission, or treatment interruption. At APCC, proton therapy is administered using the latest pencil beam scanning technology on an IBA Proteus Plus. The sophisticated treatment unit comprises 2 gantries that can rotate around the patient and deliver proton therapy from multiple angles and a specialized treatment couch that is capable of moving and rotating to position the patient accurately for treatment. The treatment unit is equipped with various forms of imaging, X-rays, Cone beam CT and surface imaging to ensure accurate delivery of radiotherapy.

In addition to proton therapy, patients may receive treatment for nasopharyngeal cancer on the RadixactTomotherapy unit, using helical tomotherapy. This advanced image-guided radiotherapy technique is based on photons or X-rays, with a high degree of modulation to reduce dose to normal structures.

At APCC, all head neck proton and radiation treatments are carried out under the care of head-neck specialized expert doctors who are supported by a team of medical physicists and radiotherapy technologists. At APCC, the treating team is supported by a group of services that help in the holistic management of head neck cancer patients.

Click Here to see more about APCC and its therapy.

[certainhologramobservation]

Treatment for Oropharynx Cancer

The primary treatment of cancer of the oropharynx i.e tonsil or base tongue cancer, that is confined to the local site and neck is radiotherapy. Chemotherapy is administered along with radiation for most patients except those with very early stage radiation. Selected patients with early-stage tonsillar cancer may undergo Trans Oral Robotic Surgery (TORS) instead of radiotherapy.

Apollo Proton Cancer Centre is equipped with facilities and expertise for both proton therapy as well as photon radiotherapy.

The normal organs that are close to the tonsil and base tongue are the salivary glands, the lining of the cheek and throat, the voice box (larynx)the muscles associated with swallowing, and the spinal cord. In certain situations, treatment may also be required adjacent to the inner ear.

Proton therapy, administered over 6-7 weeks helps reduce the dose to all neighboring critical structures. This results in substantially decreasing the risk of early side effects and late consequences of treatment. During the period of treatment, less dose to critical structures equates with a reduction in the risk of blisters in the mouth and throat, less requirement of strong pain killers, less chance of weight loss, tube feeding, hospital admission, or treatment interruption. There are a number of retrospective studies that have noted this; our experience at APCC has been similar.

At APCC, proton therapy is administered using the latest pencil beam scanning technology on an IBA Proteus Plus. The sophisticated treatment unit comprises 2 gantries that can rotate around the patient and deliver proton therapy from multiple angles and a specialized treatment couch that is capable of moving and rotating to position the patient accurately for treatment. The treatment unit is equipped with various forms of imaging, X-rays, Cone beam CT and surface imaging to ensure accurate delivery of radiotherapy.

Surgery

Commonly throat cancer is used for a group of cancers affecting the oropharynx (back of the mouth) and hypopharynx (upper end of the food pipe), this includes tonsil cancers and base of tongue cancers.

Traditional surgical approaches to these cancers affect the critical function of speech and swallowing.

HPV (Virus) is being increasingly associated as a causative agent for throat (tonsil) cancer, and these HPV-associated cancers have a better outcome resulting in better long-time survival.

At APCC we discuss these cancer cases in a Multi-disciplinary team approach and provide a comprehensive treatment plan (Radiation (Proton/Photon) / surgery (transoral robotic)) along with a focus on functional rehabilitation (speech and swallowing).

Transoral Robotic Surgery

Transoral Robotic Surgery involves the removal of cancers affecting the back of the mouth and throat using a surgical robot. The Robotic arms are controlled by the surgeon in a master (surgeon) slave (robot) engagement.

The robotic system provides high definition magnified vision to the inaccessible areas where the human hand cannot reach comfortably, resulting in a quicker and easy recovery following cancer surgery.

[certainhologramobservation]

Treatment for Oral Cancer

Treatment choice depends on the following 3 factors:

the general health of the patient

site and size of the cancer

whether cancer has spread to other parts of the body or not

Surgery

This includes the following:

Resection

Neck dissection

Reconstruction

Resection:

This involves the removal of the entire tumor with a cuff of surrounding healthy tissue to obtain negative margins.

Neck Dissection:

This involves the removal of lymph nodes from the neck which may be involved by cancer.

Reconstruction:

Many times, cancer surgery may involve the removal of jawbones, skin, tongue, and surrounding tissues. These missing structures will be replaced via reconstructive surgery to restore form and function.

Proton Therapy

Apollo Proton Cancer Centre is equipped with facilities and expertise for both Proton therapy as well as radiotherapy.

Radiotherapy and proton therapy are usually administered after surgery in patients with cancer of the tongue, cheek, or gums. In this situation, the role of proton therapy/radiotherapy is to prevent cancer cells from re-growing, thus improving the chance of the patient remaining disease-free.

Cells that form the lining of the oral cavity are shed daily. When exposed to radiation, they are not replenished at the usual rate, thus resulting in raw areas in the lining of the mouth, i.e. cheeks, lips, palate. Since this region is very richly endowed with nerve endings these raw areas are painful. Radiotherapy can result in inflammation of the cheek lining, thick saliva, weight loss, swallowing difficulties. Modern radiotherapy techniques aim to reduce these side effects of radiotherapy.

Proton therapy, administered over 6-7 weeks helps reduce the dose to all neighboring critical structures. This results in substantially decreasing the risk of early side effects and late consequences of treatment. During the period of treatment, less dose to critical structures equates with a reduction in the risk of blisters in the mouth and throat, less requirement of strong pain killers, less chance of weight loss, tube feeding, hospital admission, or treatment interruption.

In the long run, patients undergoing proton therapy for tonsil/base tongue cancer have been noted to be able to have a much better chance of resuming their normal life. The same benefit is likely to accrue in patients with oral cancer. In addition, proton therapy is known to reduce the risk of having second cancer. This is especially important in the case of adolescents and young adults undergoing radiotherapy for oral cancers.

At APCC, proton therapy is administered using the latest pencil beam scanning technology on an IBA Proteus Plus. The sophisticated treatment unit comprises 2 gantries that can rotate around the patient and deliver proton therapy from multiple angles and a specialized treatment couch that is capable of moving and rotating to position the patient accurately for treatment. The treatment unit is equipped with various forms of imaging, X-rays, Cone beam CT and surface imaging to ensure accurate delivery of radiotherapy.

In addition to proton therapy, patients may receive treatment for oral cancer on the RadixactTomotherapy unit, using helical tomotherapy. This advanced image-guided radiotherapy technique is based on photons or X-rays, with a high degree of modulation to reduce dose to normal structures.

At APCC, all head neck proton and radiation treatments are carried out under the care of head neck specialized expert doctors who are supported by a team of medical physicists and radiotherapy technologists. At APCC, the treating team is supported by a group of services that help in the holistic management of head neck cancer patients.

Click Here to see more about APCC and its therapy.

[certainhologramobservation]

Diagnosis and Treatment for Larynx Cancer

The larynx is a part of the throat, between the base of the tongue and the trachea. The larynx contains the vocal cords, which vibrate and make the sound when air is directed against them. The sound echoes through the pharynx, mouth, and nose to make a person's voice.

There are three main parts of the larynx:

Supraglottis: The upper part of the larynx above the vocal cords, including the epiglottis.

Glottis: The middle part of the larynx is where the vocal cords are located.

Subglottis: The lower part of the larynx is between the vocal cords and the trachea (windpipe). Laryngeal cancer forms in the tissues of the larynx (area of the throat that contains the vocal cords). The larynx includes the supraglottis, glottis (vocal cords), and subglottis. Cancer may spread to nearby tissues or to the thyroid, trachea, or esophagus. It may also spread to the lymph nodes in the neck, the carotid artery, the upper part of the spinal column, the chest, and other parts of the body. Most laryngeal cancers form in squamous cells, the thin, flat cells lining the inside of the larynx.

Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Radiation therapy may work better in patients who have stopped smoking before beginning treatment. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. A blood test to check the thyroid hormone level in the body may be done before and after therapy to make sure the thyroid gland is working properly.

Surgery

Surgery (removing cancer in an operation) is a common treatment for all stages of laryngeal cancer. The following surgical procedures may be used:

LASER Cordectomy: Surgery to remove the vocal cords only.

Supraglottic laryngectomy: Surgery to remove the supraglottis only.

Hemilaryngectomy: Surgery to remove half of the larynx (voice box). A hemilaryngectomy saves the voice.

Partial laryngectomy: Surgery to remove part of the larynx (voice box). A partial laryngectomy helps keep the patient's ability to talk.

Total laryngectomy & Voice rehabilitation: Surgery to remove the whole larynx. During this operation, a hole is made in the front of the neck to allow the patient to breathe. and an artificial voice box is inserted which helps the patient to speak.

Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor in the larynx.

After the doctor removes all cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that cancer will come back, is called adjuvant therapy.

Click here to see more about APCC and its therapy.

[certainhologramobservation]

Salivary Gland Tumours

The role of radiotherapy in salivary gland tumors:

This is a diverse group of tumors that are primarily treated with surgery. The commonest site for a salivary gland tumor is the parotid gland; however submandibular gland tumors are more likely to be malignant.

There are many histopathological types of salivary gland cancer such as adenoid cystic carcinoma, mucoepidermoid carcinoma adenocarcinoma, carcinoma ex pleomorphic adenoma. Adenoid cystic carcinoma has some peculiar characteristics, which are mentioned on a separate page.

Radiotherapy is indicated in all patients suffering from adenoid cystic carcinoma and in others in histologies, if high-risk features are noted in the examination of the tissue removed surgically. Radiotherapy for salivary gland tumors is unilateral i.e., treatment is directed only to the affected side of the face and neck. Radiotherapy may also be used to treat inoperable lesions.

Proton therapy has a significant advantage in the treatment of this tumor in that the radiation dose received by the opposite side of the face and neck is substantially less, of the order of more than 80% reduction in dose. This result is less inflammation of the inner lining of the cheek, palate, tongue and less dose to the voice box. Salivary gland tumors often occur in young adolescents and adults and the reduction in the radiation being received by the opposite side has an additional advantage of decreasing the risk of developing radiation-induced cancer.

[certainhologramobservation]

Treatment for Lip and Oral Cavity Cancer

Lip and oral cavity cancer is a disease in which malignant (cancer) cells form in the lips or mouth. Tobacco and alcohol use can affect the risk of lip and oral cavity cancer.

Signs of lip and oral cavity cancer include a sore or lump on the lips or in the mouth.

Treatment options depend on the following:

The stage of cancer.

The size of the tumor and where it is in the lip or oral cavity.

whether the patient's appearance and ability to talk and eat can stay the same.

The patient's age and general health.

Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

External radiation therapy uses a machine outside the body to send radiation toward cancer.

Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy is used to treat lip and oral cavity cancer.

Radiation therapy may work better in patients who have stopped smoking before beginning treatment. It is also important for patients to have a dental exam before radiation therapy begins so that existing problems can be treated.

Chemotherapy

Chemo (typically combined with radiation therapy) may be used instead of surgery as the main treatment for some cancers. (This is called chemoradiation).

Chemo (combined with radiation therapy) may be given after surgery to try to kill any small deposits of cancer cells that may have been left behind. This is known as adjuvant chemotherapy.

Chemo (sometimes with radiation therapy) may be used to try to shrink some larger cancers before surgery. This is called neoadjuvant or induction chemotherapy. In some cases, this makes it possible to use less radical surgery and remove less tissue. This can lead to fewer serious side effects from surgery.

Chemo (with or without radiation therapy) can be used to treat cancers that are too large or have spread too far to be removed by surgery. The goal is to slow the growth of cancer for as long as possible and to help relieve any symptoms the cancer is causing.

Click here to see more about APCC and its therapy.

[certainhologramobservation]

Proton Therapy for Adenoid Cystic Carcinoma

Adenoid cystic carcinomas are slowly growing, locally aggressive cancers that arise in salivary glands. They have a tendency to spread along nerves and also to metastasize to the lungs. The common location for adenoid cystic cancers is in the major salivary glands, parotid and submandibular glands being the most common. However, they may also occur in other locations in the head-neck region including the palate, nose and paranasal sinuses.

The primary treatment of adenoid cystic carcinoma is surgery. Radiotherapy is administered in the postoperative setting and for inoperable lesions. Proton therapy has a special role, in that the outcomes of proton therapy are excellent in postoperative and inoperable patients.

Proton therapy

Apollo Proton Cancer Centre is equipped with facilities and expertise for both proton therapy as well as radiotherapy.

Proton therapy has a special role in the treatment of adenoid cystic cancer. This is because of multiple factors, which relate to the nature of the tumour, its interaction with proton therapy. In addition, since adenoid cystic cancers can travel along cranial nerves that arise in the brain, the target for radiotherapy/proton therapy is in proximity to the brain. Proton therapy ensures that the required dose can be administered adjacent to the brain, with less dose going to the brain. This results in better outcomes than other forms of radiotherapy, even in the treatment of inoperable patients.

Proton therapy, administered over 6-7 weeks helps reduce the dose to all neighbouring critical structures. This results in substantially decreasing the risk of early side effects and late consequences of treatment. During the period of treatment, less dose to critical structures equates with a reduction in the risk of blisters in the mouth and throat, less requirement of strong pain killers, less chance of weight loss, tube feeding, hospital admission or treatment interruption.

At APCC, proton therapy is administered using the latest pencil beam scanning technology on an IBA Proteus Plus. The sophisticated treatment unit comprises 2 gantries that can rotate around the patient and deliver proton therapy from multiple angles and a specialised treatment couch that is capable of moving and rotating to position the patient accurately for treatment. The treatment unit is equipped with various forms of imaging, X-rays, Cone beam CT and surface imaging to ensure accurate delivery of radiotherapy.

In addition to proton therapy, patients may receive treatment for adenoid cystic cancers on the RadixactTomotherapy unit, using helical tomotherapy. This advanced image-guided radiotherapy technique is based on photons or X-rays, with a high degree of modulation to reduce dose to normal structures.

At APCC, all head neck proton and radiation treatments are carried out under the care of head neck specialised expert doctors who are supported by a team of medical physicists and radiotherapy technologists. At APCC, the treating team is supported by a group of services that help in the holistic management of head neck cancer patients.

[certainhologramobservation]

Diagnosis and Treatments for Thyroid Cancer

Thyroid cancer forms in the tissues of the thyroid gland, which is located in the front of the throat, below the cartilage known as Adam’s apple. Though thyroid cancer is not considered a type of head and neck cancer, it is typically treated by an otolaryngology-trained oncologist who also treats malignancies of the mouth, nose, tonsils, sinuses, salivary glands, and lymph nodes of the neck. Symptoms of thyroid cancer may include neck pain, voice changes, breathing difficulties, coughing, or trouble swallowing.

The thyroid gland produces several important hormones, including the thyroid hormone, which is involved in controlling body temperature, weight, energy level, and heart rate. The thyroid gland also produces calcitonin, which helps the body use calcium.

Surgery

Types of surgeries may be used to treat thyroid cancer:

HEMITHYROIDECTOMY:

For small, well-differentiated tumors that have not spread beyond the thyroid gland, a lobectomy may sometimes be performed. In this type of thyroid cancer surgery, the lobe containing the cancer is removed, leaving the other healthy lobe behind. This may reduce the need to take thyroid hormone treatment after surgery since a functioning part of the thyroid remains.

TOTAL Thyroidectomy:

In this procedure, most or all of the thyroid gland is removed by surgery (total, near-total, or subtotal thyroidectomy). This type of surgery for thyroid cancer is used for most patients. However, because very little or no functioning thyroid tissue is left behind, patients will need to take daily thyroid hormone replacement pills afterward.

Lymph node removal:

When the surgeon suspects that the thyroid cancer cells have spread to nearby lymph nodes, they will remove the enlarged or suspicious nodes in order to remove as much cancer as possible. This thyroid cancer surgical procedure is usually performed at the same time as the surgery on the primary tumor.

Radioactive iodine treatment/nuclear medicine treatment.

Radiation Therapy

External beam radiation therapy (EBRT):

It directs the radiation from outside the body to cancerous tissues inside the body. It is a cancer treatment option that uses doses of radiation to destroy cancerous cells and shrink tumors. Examples of EBRT include 3D conformal radiation therapy, IMRT, IGRT, TomoTherapy®, and stereotactic radiosurgery.

Intensity-modulated radiation therapy (IMRT):

Uses advanced software to plan a precise dose of radiation, based on tumor size, shape, and location. A computer-controlled device called a linear accelerator delivers radiation in sculpted doses that match the 3D geometrical shape of the tumor, including concave and complex shapes. If you have previously had radiation therapy for thyroid cancer and are experiencing recurrent tumors in the treated area, IMRT may be an option for you. Compared to standard radiotherapy, IMRT allows our radiation oncologists to use higher radiation doses than traditional therapies would allow in these areas. At the same time, IMRT helps to spare more of the surrounding healthy tissue from harmful doses of radiation.

TomoTherapy:

Combines a form of intensity-modulated radiation therapy (IMRT), with the accuracy of computed tomography (CT) scanning technology, in one machine. With this technology, we deliver more precise radiation to match complex tumor shapes while avoiding sensitive structures. Using built-in CT scanning to confirm the shape and position of the tumor before each treatment, TomoTherapy may reduce radiation exposure to healthy tissues and organs.

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Diagnosis and Treatment for Larynx Cancer

The larynx is a part of the throat, between the base of the tongue and the trachea. The larynx contains the vocal cords, which vibrate and make the sound when air is directed against them. The sound echoes through the pharynx, mouth, and nose to make a person's voice.

There are three main parts of the larynx:

Supraglottis: The upper part of the larynx above the vocal cords, including the epiglottis.

Glottis: The middle part of the larynx is where the vocal cords are located.

Subglottis: The lower part of the larynx is between the vocal cords and the trachea (windpipe). Laryngeal cancer forms in the tissues of the larynx (area of the throat that contains the vocal cords). The larynx includes the supraglottis, glottis (vocal cords), and subglottis. Cancer may spread to nearby tissues or to the thyroid, trachea, or esophagus. It may also spread to the lymph nodes in the neck, the carotid artery, the upper part of the spinal column, the chest, and other parts of the body. Most laryngeal cancers form in squamous cells, the thin, flat cells lining the inside of the larynx.

Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Radiation therapy may work better in patients who have stopped smoking before beginning treatment. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. A blood test to check the thyroid hormone level in the body may be done before and after therapy to make sure the thyroid gland is working properly.

Surgery

Surgery (removing cancer in an operation) is a common treatment for all stages of laryngeal cancer. The following surgical procedures may be used:

LASER Cordectomy: Surgery to remove the vocal cords only.

Supraglottic laryngectomy: Surgery to remove the supraglottis only.

Hemilaryngectomy: Surgery to remove half of the larynx (voice box). A hemilaryngectomy saves the voice.

Partial laryngectomy: Surgery to remove part of the larynx (voice box). A partial laryngectomy helps keep the patient's ability to talk.

Total laryngectomy & Voice rehabilitation: Surgery to remove the whole larynx. During this operation, a hole is made in the front of the neck to allow the patient to breathe. and an artificial voice box is inserted which helps the patient to speak.

Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor in the larynx.

After the doctor removes all cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that cancer will come back, is called adjuvant therapy.

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Treatment for Oral Cancer

Treatment choice depends on the following 3 factors:

the general health of the patient

site and size of the cancer

whether cancer has spread to other parts of the body or not

Surgery

This includes the following:

Resection

Neck dissection

Reconstruction

Resection:

This involves the removal of the entire tumor with a cuff of surrounding healthy tissue to obtain negative margins.

Neck Dissection:

This involves the removal of lymph nodes from the neck which may be involved by cancer.

Reconstruction:

Many times, cancer surgery may involve the removal of jawbones, skin, tongue, and surrounding tissues. These missing structures will be replaced via reconstructive surgery to restore form and function.

Proton Therapy

Apollo Proton Cancer Centre is equipped with facilities and expertise for both Proton therapy as well as radiotherapy.

Radiotherapy and proton therapy are usually administered after surgery in patients with cancer of the tongue, cheek, or gums. In this situation, the role of proton therapy/radiotherapy is to prevent cancer cells from re-growing, thus improving the chance of the patient remaining disease-free.

Cells that form the lining of the oral cavity are shed daily. When exposed to radiation, they are not replenished at the usual rate, thus resulting in raw areas in the lining of the mouth, i.e. cheeks, lips, palate. Since this region is very richly endowed with nerve endings these raw areas are painful. Radiotherapy can result in inflammation of the cheek lining, thick saliva, weight loss, swallowing difficulties. Modern radiotherapy techniques aim to reduce these side effects of radiotherapy.

Proton therapy, administered over 6-7 weeks helps reduce the dose to all neighboring critical structures. This results in substantially decreasing the risk of early side effects and late consequences of treatment. During the period of treatment, less dose to critical structures equates with a reduction in the risk of blisters in the mouth and throat, less requirement of strong pain killers, less chance of weight loss, tube feeding, hospital admission, or treatment interruption.

In the long run, patients undergoing proton therapy for tonsil/base tongue cancer have been noted to be able to have a much better chance of resuming their normal life. The same benefit is likely to accrue in patients with oral cancer. In addition, proton therapy is known to reduce the risk of having second cancer. This is especially important in the case of adolescents and young adults undergoing radiotherapy for oral cancers.

At APCC, proton therapy is administered using the latest pencil beam scanning technology on an IBA Proteus Plus. The sophisticated treatment unit comprises 2 gantries that can rotate around the patient and deliver proton therapy from multiple angles and a specialized treatment couch that is capable of moving and rotating to position the patient accurately for treatment. The treatment unit is equipped with various forms of imaging, X-rays, Cone beam CT and surface imaging to ensure accurate delivery of radiotherapy.

In addition to proton therapy, patients may receive treatment for oral cancer on the RadixactTomotherapy unit, using helical tomotherapy. This advanced image-guided radiotherapy technique is based on photons or X-rays, with a high degree of modulation to reduce dose to normal structures.

At APCC, all head neck proton and radiation treatments are carried out under the care of head neck specialized expert doctors who are supported by a team of medical physicists and radiotherapy technologists. At APCC, the treating team is supported by a group of services that help in the holistic management of head neck cancer patients.

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Treatment for Oropharynx Cancer

The primary treatment of cancer of the oropharynx i.e tonsil or base tongue cancer, that is confined to the local site and neck is radiotherapy. Chemotherapy is administered along with radiation for most patients except those with very early stage radiation. Selected patients with early-stage tonsillar cancer may undergo Trans Oral Robotic Surgery (TORS) instead of radiotherapy.

Apollo Proton Cancer Centre is equipped with facilities and expertise for both proton therapy as well as photon radiotherapy.

The normal organs that are close to the tonsil and base tongue are the salivary glands, the lining of the cheek and throat, the voice box (larynx)the muscles associated with swallowing, and the spinal cord. In certain situations, treatment may also be required adjacent to the inner ear.

Proton therapy, administered over 6-7 weeks helps reduce the dose to all neighboring critical structures. This results in substantially decreasing the risk of early side effects and late consequences of treatment. During the period of treatment, less dose to critical structures equates with a reduction in the risk of blisters in the mouth and throat, less requirement of strong pain killers, less chance of weight loss, tube feeding, hospital admission, or treatment interruption. There are a number of retrospective studies that have noted this; our experience at APCC has been similar.

At APCC, proton therapy is administered using the latest pencil beam scanning technology on an IBA Proteus Plus. The sophisticated treatment unit comprises 2 gantries that can rotate around the patient and deliver proton therapy from multiple angles and a specialized treatment couch that is capable of moving and rotating to position the patient accurately for treatment. The treatment unit is equipped with various forms of imaging, X-rays, Cone beam CT and surface imaging to ensure accurate delivery of radiotherapy.

Surgery

Commonly throat cancer is used for a group of cancers affecting the oropharynx (back of the mouth) and hypopharynx (upper end of the food pipe), this includes tonsil cancers and base of tongue cancers.

Traditional surgical approaches to these cancers affect the critical function of speech and swallowing.

HPV (Virus) is being increasingly associated as a causative agent for throat (tonsil) cancer, and these HPV-associated cancers have a better outcome resulting in better long-time survival.

At APCC we discuss these cancer cases in a Multi-disciplinary team approach and provide a comprehensive treatment plan (Radiation (Proton/Photon) / surgery (transoral robotic)) along with a focus on functional rehabilitation (speech and swallowing).

Transoral Robotic Surgery

Transoral Robotic Surgery involves the removal of cancers affecting the back of the mouth and throat using a surgical robot. The Robotic arms are controlled by the surgeon in a master (surgeon) slave (robot) engagement.

The robotic system provides high definition magnified vision to the inaccessible areas where the human hand cannot reach comfortably, resulting in a quicker and easy recovery following cancer surgery.