Overview
Oral cavity cancer arises from the tissues inside the mouth, including the lips, tongue, floor of
mouth, gums, buccal mucosa, hard palate, and retromolar trigone. It is one of the most common
cancers in India due to the high prevalence of tobacco, betel nut, and smokeless tobacco
consumption.
Most oral cavity cancers are squamous cell carcinomas (SCC), which begin as precancerous
lesions that progress through dysplasia, carcinoma in situ, and invasive cancer. If detected
early, oral cancers are highly curable with excellent long-term outcomes.
At Coimbatore Cancer Clinic, our team of surgical and medical oncologists provides
comprehensive management of oral cancers, including advanced diagnostic evaluation, early
detection of precancerous lesions, tumor resection, neck dissection, microvascular
reconstruction, chemotherapy, immunotherapy, targeted therapy, and coordinated radiation
therapy based on NCCN 2025 guidelines.
Causes & Risk Factors
Major Risk Factors
1. Tobacco Use
○ Smokeless tobacco (gutkha, paan, zarda)
○ Cigarettes, bidis
○ Increases risk more than 50-fold for some subsites
2. Betel Nut (Areca Nut) Chewing
Causes submucous fibrosis, a precancerous condition.
3. Alcohol Consumption
Acts synergistically with tobacco.
4. Human Papillomavirus (HPV)
Mainly HPV-16; more relevant in oropharyngeal cancers.
5. Chronic Trauma
Sharp teeth, ill-fitting dentures.
6. Poor Oral Hygiene
Long-term irritation increases malignancy risk.
Other Risk Factors
● Poor nutrition
● Immunosuppression
● Family history
● Exposure to industrial chemicals
Precancerous Conditions
Precancers must be recognized early
1. Leukoplakia – white patches.
2. Erythroplakia – red patches (higher malignant potential).
3. Oral Submucous Fibrosis (OSMF) – caused by betel nut; severe risk.
4. Lichen Planus (erosive type).
Early biopsy and intervention can prevent progression to cancer.
Symptoms & Warning Signs
Early Symptoms
Often subtle and mistaken for ulcers.
● Non-healing mouth ulcer (>2 weeks)
● Persistent pain
● White or red patches
● Thickening or lump in mouth
Progressive Symptoms
● Difficulty chewing or swallowing
● Restricted mouth opening
● Change in voice or speech
● Unexplained bleeding
● Loose teeth
● Numbness in mouth
● Swelling in neck (lymph nodes)
Any ulcer lasting more than two weeks requires evaluation.
Diagnostic Evaluation
1. Clinical Examination
Detailed inspection and palpation of the oral cavity and neck.
2. Endoscopy
Fiberoptic endoscopy or oral examination under anesthesia.
3. Biopsy
● Incisional biopsy is gold standard
● Punch biopsy for small lesions
● Excisional biopsy for small precancers
4. Imaging Studies
● Contrast-enhanced CT scan of head & neck
● MRI neck – best for tongue/floor of mouth
● PET-CT – staging, nodal involvement, and metastasis
● Chest CT – assess lung spread
5. Dental Evaluation
Required before radiation therapy.
Staging (AJCC 8th Edition)
T Stage (Primary Tumor)
● T1: ≤2 cm
● T2: >2–4 cm
● T3: >4 cm
● T4a: Invades mandible/maxilla, deep muscles
● T4b: Skull base, pterygoid plates, encases carotid
N Stage (Lymph Nodes)
● N0: No nodes
● N1–N3: Increasing node size, number, and laterality
M Stage
● M0: No distant metastasis
● M1: Spread to lungs, bones, liver
Staging determines treatment intensity.
Treatment – Stage-wise (NCCN 2025)
Oral cavity cancers are best treated with surgery as the primary modality, followed by
radiation or chemoradiation based on pathology.
Stage 0 (Carcinoma in Situ)
● Wide local excision
● Laser excision for accessible sites
● Regular follow-up for recurrence
Stage I–II (Early Cancer)
Standard Treatment: Surgery
● Wide local excision with margins
● Elective neck dissection (levels I–III) even in N0 neck, as occult metastasis risk is high
Reconstruction Options
● Primary closure
● Local flaps
● Microvascular free-flap surgery (radial, ALT, fibula), especially for tongue/mandible defects
Adjuvant Treatment
Not needed unless:
● Margin positive
● Perineural invasion
● Lymphovascular invasion
Stage III–IV (Locally Advanced)
Recurrent or Metastatic Oral Cancer
Options include:
● Re-surgery for localized recurrence
● Re-irradiation in selected patients
● Systemic therapy:
Chemotherapy
● Platinum-based doublets
● Paclitaxel-based regimens
Immunotherapy (Approved by NCCN 2025)
● Pembrolizumab (PD-L1 positive, recurrent/metastatic)
● Nivolumab (second-line)
Targeted Therapy
● Cetuximab (EGFR inhibitor)
Palliative care focuses on symptom relief and quality of life.
Surgical Techniques in Detail
1. Glossectomy (Partial/Total)
For tongue cancers, with reconstruction to preserve speech and swallowing.
2. Marginal or Segmental Mandibulectomy
Depends on depth & bone invasion.
3. Maxillectomy
For palate or upper alveolus tumors.
4. Neck Dissection
● Selective (levels I–III)
● Modified radical
● Radical
5. Free-Flap Reconstruction
Performed by trained reconstructive surgeons for functional and aesthetic recovery.
Radiation Therapy
Radiation is used:
● After surgery for high-risk features
● As primary therapy for inoperable tumors
Techniques:
● IMRT (Intensity-Modulated Radiation Therapy)
● IGRT (Image-Guided Radiation Therapy)
● Brachytherapy (rarely)
Side effects:
● Dry mouth
● Mucositis
● Dental issues
● Skin reactions
We coordinate with advanced radiation centers for precise treatment.
Chemotherapy & Immunotherapy
Chemotherapy
Used:
● Concurrent with radiation
● In recurrent/metastatic settings
Common agents:
● Cisplatin
● Carboplatin
● 5-FU
● Taxanes
Immunotherapy
● Pembrolizumab
● Nivolumab
Superior in selected PD-L1 positive tumors.
Targeted Therapy
● Cetuximab (EGFR)
Useful for patients who cannot tolerate cisplatin.
Rehabilitation & Supportive Care
Rehabilitation & Supportive Care in Oral Cancer
Oral cancer affects speech, nutrition, and quality of life.
Patients benefit from:
● Speech and swallowing therapy
● Dietician support
● Pain control
<br
Prognosis
Depends on:
● Stage at diagnosis
● Tumor thickness
● Lymph node involvement
● Margin status
● Extracapsular spread
Early-stage disease has excellent cure rates.
Our Expertise at Coimbatore Cancer Clinic
● Expertise in early detection of precancerous lesions
● High-quality tumor resection with functional preservation
● Neck dissection by experienced surgical oncologists
● Microvascular reconstruction capability
● Coordination of IMRT and chemoradiation
● Evidence-based use of immunotherapy and targeted therapy
● Nutritional support, speech therapy, and survivorship planning
● Long-term personalized follow-up
When to Consult
Consult immediately if you have:
● A non-healing mouth ulcer
● Persistent pain or bleeding
● Difficulty chewing or swallowing
● White or red patches
● Mouth opening restriction
● Lump in the neck
Early detection saves lives.
FAQ
1. What causes oral cancer most often?
Tobacco and betel nut are the leading causes.
2. Is oral cancer curable?
Yes—especially if detected early.
3. Will I need reconstruction after surgery?
Large defects require flap reconstruction to restore function.
4. Is radiation necessary for all patients?
No. Only for high-risk pathology.
5. Can immunotherapy help me?
Yes, in recurrent/metastatic tumors with specific markers.
Disclaimer
This page provides general information for patient awareness. Individual treatment decisions
should be made after consultation with qualified surgical and medical oncologists.
Oropharyngeal Cancer – Causes,
Symptoms, Diagnosis, Treatment & Latest
Advances (Including HPV-Positive Cancer)
Overview
Oropharyngeal cancer arises in the middle part of the throat: the base of tongue, tonsils, soft
palate, and pharyngeal walls. In recent years, oropharyngeal cancer has undergone a major
epidemiologic shift. While tobacco and alcohol were historically the main causes, today a
significant portion—especially cancers of the tonsil and base of tongue—are caused by Human
Papillomavirus (HPV), predominantly HPV-16.
HPV-positive oropharyngeal cancers form a biologically distinct disease entity. They respond
better to treatment, have superior survival rates, and occur in younger, non-smoking individuals.
HPV-negative cancers (tobacco-related) are more aggressive and require intensive therapy.
At Coimbatore Cancer Clinic, our surgical and medical oncologists provide comprehensive
management including endoscopic evaluation, biopsies, advanced imaging, minimally invasive
surgical options (including TORS where available), chemoradiation, immunotherapy, and
specialized rehabilitation following NCCN/ESMO 2025 guidelines.
Causes & Risk Factors
1. HPV Infection (Most Important Modern Risk Factor)
● HPV-16 accounts for most cases
● Transmitted through oral sexual contact
● Occurs in younger, healthier individuals
● Far better prognosis than tobacco-related cancers
2. Tobacco Use
● Cigarettes, gutkha, betel nut
● Major cause of HPV-negative cancers
3. Alcohol Consumption
● Has a synergistic effect with tobacco
4. Poor Oral Hygiene
5. Immunosuppression
● HIV infection
● Chronic steroid use
HPV-Positive vs HPV-Negative
Oropharyngeal Cancer
HPV status strongly influences prognosis and treatment decisions.
Symptoms & Warning Signs
Early Symptoms
● Persistent sore throat
● Difficulty swallowing
● Change in voice
● Unilateral throat pain
● Feeling of something stuck in throat
Progressive Symptoms
● Lump in the neck (most common presentation)
● Pain radiating to ear
● Difficulty opening mouth
● Weight loss
● Bleeding from mouth or throat
● Persistent bad breath
Neck swelling due to metastatic lymph nodes is often the earliest sign.
Diagnostic Evaluation
1. Clinical Examination
Inspection of mouth, tonsils, base of tongue, soft palate.
2. Fiberoptic Nasopharyngolaryngoscopy
Direct visual assessment of oropharynx.
3. Biopsy
● Direct biopsy under anesthesia
● Fine-needle aspiration (FNA) for neck nodes
4. HPV Testing
Essential for all oropharyngeal tumors. Performed via:
● p16 immunohistochemistry (IHC)
● HPV DNA/PCR
5. Imaging
● Contrast CT of neck
● MRI for base of tongue infiltration
● PET-CT for staging and detecting unknown primary tumors
6. Dental Assessment
Needed before radiation.
Staging (AJCC 8th Edition)
Staging
HPV-positive and HPV-negative cancers have separate staging systems.
HPV-Positive Staging Highlights
● Earlier stage grouping
● Better prognosis reflected in simplified staging
General TNM Overview
● T1–T4 based on size and invasion
● N1–N3 based on lymph node involvement
● M1 for distant metastasis
PET-CT helps identify nodal spread and distant disease.
Treatment – Stage-wise (NCCN 2025)
Treatment depends on HPV status, stage, tumor size, nodal disease, and patient fitness.
Early-Stage (T1–T2, N0–N1)
Option 1: Primary Surgery
● Transoral surgery (TOS)
● Transoral robotic surgery (TORS) for tonsil/base of tongue
● Neck dissection
Advantages:
● Tissue preservation
● Faster recovery
● Precise margin assessment
Option 2: Radiation Therapy Alone
Used for:
● Small tumors
● Patients unfit for surgery
Adjuvant Therapy
Given if pathology shows:
● Close/positive margins
● Extracapsular nodal extension
● Multiple lymph nodes
Intermediate/Locally Advanced (T2–T4 or N2–N3)
Concurrent Chemoradiation (Standard of Care)
● IMRT (radiation)
● Weekly cisplatin
Surgery
Reserved for:
● Selected early tumors
● Residual disease post-radiation
● Salvage therapy for recurrence
HPV-Positive Tumor Considerations
Research is exploring de-escalation (lower radiation dose) due to excellent prognosis, but only within clinical trial settings.
Advanced/Unresectable Disease
Chemoradiotherapy
● High-dose or weekly cisplatin
● IMRT for improved organ preservation
Induction Chemotherapy (selected cases)
● TPF regimen (Docetaxel + Cisplatin + 5-FU)
May shrink tumor prior to definitive chemoradiation.
Recurrent or Metastatic Oropharyngeal
Cancer
Options include:
1. Surgery
For localized recurrence.
2. Re-irradiation
Highly selective, using modern techniques.
3. Systemic Therapy
● Platinum-based regimens
● Cetuximab (EGFR inhibitor)
4. Immunotherapy (NCCN Recommended)
● Pembrolizumab (first-line for PD-L1 positive disease)
● Nivolumab (second-line)
Immunotherapy is a major breakthrough for metastatic disease.
Surgical Management in Detail
1. Transoral Robotic Surgery (TORS)
For:
● Tonsil cancers
● Base of tongue cancers
Advantages:
● Organ preservation
● Better swallowing outcomes
● Shorter hospital stay
2. Transoral Laser Microsurgery (TLM)
For small, accessible lesions.
3. Neck Dissection
● Selective or modified radical
● Address nodal spread
4. Open Surgery
Reserved for large or deeply invasive tumors
Radiation Therapy
IMRT (Intensity-Modulated Radiation Therapy)
Gold standard for:
● Organ preservation
● Sparing salivary glands
● Reducing toxicity
Side effects:
● Mucositis
● Dry mouth
● Difficulty swallowing
● Taste alteration
We coordinate with advanced radiation oncology centers.
Chemotherapy & Targeted Therapy
1. Concurrent Chemotherapy
Cisplatin is standard.
2. Cetuximab
Used for patients unable to tolerate cisplatin.
3. Immunotherapy (Checkpoint Inhibitors)
● Pembrolizumab (first-line metastatic)
● Nivolumab (second-line)
These improve long-term survival in selected patients.
HPV-Positive Oropharyngeal Cancer:
Special Considerations
Better Prognosis:
● Survival often exceeds 85–90 percent in early stages.
Younger Patient Population:
● Often present with neck mass rather than throat symptoms.
De-escalation Trials:
Exploring:
● Lower radiation doses
● Surgery-only approaches
● Reduced chemotherapy intensity
Not yet standard of care.
Rehabilitation & Quality of Life
Treatment can affect:
● Speech
● Swallowing
● Nutrition
● Taste
Our supportive programs include:
● Swallow therapy
● Dietician guidance
● Pain management
● Dental care
● Psychological support
Our Expertise at Coimbatore Cancer Clinic
● Expertise in diagnosis and early detection
● Skill in TORS and minimally invasive transoral surgery (when applicable)
● Advanced neck dissection techniques
● Chemoradiation planning according to NCCN guidelines
● Immunotherapy and targeted therapy for advanced disease
● Long-term survivorship follow-up
● Rehabilitation for speech and swallowing
We focus on organ preservation and optimal functional outcomes.
When to Consult
● A persistent sore throat
● Difficulty swallowing
● Lump in the neck
● Pain radiating to the ear
● Change in voice
● Non-healing throat ulcer
Early diagnosis leads to significantly better outcomes.
FAQ
1. Is HPV-related oropharyngeal cancer a sexually transmitted disease?
HPV is transmitted sexually, but the cancer itself is not contagious.
2. Is prognosis better for HPV-positive cancers?
Yes. They respond better to treatment.
3. Will I need surgery?
It depends on the tumor site, stage, and HPV status.
4. Is immunotherapy effective?
Yes—especially in recurrent or metastatic disease.
5. Can oropharyngeal cancer be cured?
Yes, especially when detected early.
Disclaimer
This page provides general medical information for patient education. Individual treatment plans
should be made after consultation with qualified surgical and medical oncologists.
Hypopharyngeal Cancer – Causes,
Symptoms, Diagnosis, Treatment & Latest
Advances
Overview
Hypopharyngeal cancer arises in the lower part of the throat (hypopharynx), which includes the
pyriform sinuses, post-cricoid region, and posterior pharyngeal wall. Although it is less common
than oral or oropharyngeal cancers, hypopharyngeal cancer is one of the most aggressive
head and neck cancers due to its tendency to present late, high incidence of nodal metastasis,
and submucosal spread.
Because early symptoms are subtle, most patients present with advanced disease requiring
multimodality treatment. Despite this, survival outcomes have significantly improved with
advances in imaging, precision radiation (IMRT), organ-preserving chemoradiation, minimally
invasive surgical techniques, and immunotherapy.
At Coimbatore Cancer Clinic, our team of surgical and medical oncologists offers expert
evaluation, accurate staging, advanced surgical and nonsurgical treatment, and comprehensive
rehabilitation following NCCN and ESMO 2025 guidelines.
Causes & Risk Factors
1. Tobacco Use (Major Risk Factor)
● Cigarettes, bidis, gutkha, paan
● Strongly associated with all hypopharyngeal cancers
2. Alcohol Consumption
Acts synergistically with tobacco.
3. Poor Nutrition
Low intake of vitamins A and C, iron deficiency.
4. Genetic and Environmental Factors
5. HPV Infection
Less common than in oropharyngeal cancers, but possible.
6. Plummer–Vinson Syndrome
Associated with post-cricoid cancers.
Symptoms & Warning Signs
Early symptoms are often non-specific, leading to delayed diagnosis.
Common Symptoms
● Persistent sore throat
● Difficulty swallowing (dysphagia)
● Pain on swallowing (odynophagia)
● Referred ear pain
● Sensation of something stuck in throat
Advanced Symptoms
● Hoarseness
● Breathing difficulty
● Coughing while eating or drinking
● Significant unintentional weight loss
● Visible neck swelling (due to lymph node metastasis)
● Aspiration episodes
Neck nodes are present in more than 70 percent of cases at diagnosis.
Hypopharyngeal Subsites
1. Pyriform Sinus
Most common site (>60 percent).
2. Post-cricoid Region
3. Posterior Pharyngeal Wall
Each subsite may require different surgical approaches and reconstruction.
Diagnostic Evaluation
1. Clinical Examination
Inspection of oral cavity, oropharynx, larynx, and neck nodes.
2. Fiberoptic Endoscopy
Evaluates tumor extent, involvement of larynx, submucosal spread, and airway compromise.
3. Biopsy
● Direct laryngoscopy with guided biopsy under anesthesia
● FNA of neck nodes
4. Imaging
● Contrast-enhanced CT – initial staging
● MRI – superior for soft tissue invasion
● PET-CT – detects distant metastasis, second primaries, and unknown primaries
5. Airway Evaluation
Some patients may require tracheostomy if obstruction is suspected.
6. Esophageal Evaluation
Swallowing studies if aspiration is suspected.
Staging (AJCC 8th Edition)
T Staging
● T1: Tumor limited to one subsite
● T2: More than one subsite
● T3: Vocal cord fixation
● T4a: Invades thyroid cartilage/esophagus
● T4b: Prevertebral fascia, mediastinum, carotid artery encasement
N Staging
Based on number, size, and laterality of nodes.
M Staging
M1 indicates distant spread.
Treatment – Stage-wise (NCCN 2025)
Treatment is individualized and often requires a combination of surgery, radiation, and
chemotherapy.
Stage I–II (Early Tumors, Rare)
Only about 5–10 percent present early.
Early-stage laryngeal and hypopharyngeal cancers are uncommon (5–10% of cases). Treatment focuses on tumor control while preserving function.
Option 1: Organ-Preserving Chemoradiation
● IMRT (Intensity-Modulated Radiation Therapy) + weekly cisplatin
● Excellent functional outcomes for speech and swallowing
Option 2: Surgery
For small, accessible tumors:
● Endoscopic resection
● Partial pharyngectomy or laryngectomy
● Selective neck dissection
Adjuvant radiation may be required depending on pathology.
Stage III–IV (Most Common Presentation)
Option 1: Concurrent Chemoradiotherapy (Preferred for Organ
Preservation)
● IMRT: Highly conformal radiation
● Weekly or 3-weekly cisplatin
Suitable for:
● Good performance status
● Minimal cartilage invasion
● Desire for laryngeal/pharyngeal preservation
Option 2: Surgery (Primary Surgical Approach)
Indicated when:
● Tumor invades cartilage
● Large T4 disease
● Airway compromise
● Poor candidates for chemoradiation
Surgical procedures include:
● Total laryngopharyngectomy
● Partial pharyngectomy
● Circumferential pharyngolaryngectomy (for extensive disease)
Neck Dissection
● Modified radical or selective, depending on nodal disease
Reconstruction
Complex reconstruction required, including:
● Free flap (ALT, radial forearm)
● Jejunal free flap (circumferential defects)
● Regional flap for partial defects
Adjuvant Therapy
Given for:
● Positive margins
● Extracapsular extension
● Multiple lymph nodes
● T3/T4 tumors
Options:
● Radiation
● Concurrent chemoradiation
Unresectable Disease
T4b tumors or extensive carotid encasement.
Treatment:
● Chemoradiation
● Palliative chemotherapy
● Immunotherapy where appropriate
Recurrent or Metastatic Hypopharyngeal
Cancer
1. Salvage Surgery
For local recurrence when radiation was given earlier.
2. Re-irradiation
Highly selective with modern IMRT techniques.
3. Systemic Therapy
● Platinum-based chemotherapy
● Taxanes
● 5-FU
4. Immunotherapy
A major advancement for recurrent/metastatic disease:
● Pembrolizumab – first-line in PD-L1 positive disease
● Nivolumab – improves survival in platinum-refractory disease
Immunotherapy is now central to management in advanced disease.
Surgical Management – Detailed
1. Total Laryngopharyngectomy
Standard for extensive tumors.
2. Partial Pharyngectomy
For well-lateralized pyriform sinus tumors.
3. Neck Dissection
● Levels II–IV
● Bilateral if central or post-cricoid tumors
4. Microvascular Reconstruction
● Radial forearm flap
● ALT flap
● Jejunal free flap for circumferential defects
5. Airway Management
Planned tracheostomy may be necessary.
Radiation Therapy
IMRT
Preferred technique for:
● Sparing salivary glands
● Reducing swallowing dysfunction
● Preserving laryngeal function
Side effects:
● Mucositis
● Dry mouth
● Aspiration
● Taste loss
● Skin burns
Meticulous planning and supportive care are essential.
Chemotherapy & Immunotherapy
1. Concurrent Chemotherapy (Standard)
● Cisplatin weekly or every 3 weeks
2. Induction Chemotherapy (Selected Cases)
● TPF regimen (Docetaxel, Cisplatin, 5-FU) to shrink bulky tumors
3. Immunotherapy
Highly effective in recurrent/metastatic disease:
● Pembrolizumab
● Nivolumab
4. Targeted Therapy
● Cetuximab (EGFR inhibitor) for cisplatin-unfit patients
Rehabilitation & Supportive Care
Hypopharyngeal cancer treatment affects:
● Voice
● Swallowing
● Nutrition
● Airway function
Essential supportive services:
● Speech & swallowing therapy
● Dietary counseling
● Pain management
● Psychological support
● Stoma care training for laryngectomy patients
Long-term follow-up for recurrence and second primary cancers is crucial.
Prognosis
Prognostic Factors
● Stage at diagnosis
● Nodal spread (most important)
● Tumor thickness
● Cartilage invasion
● HPV status (rarely positive)
Although aggressive, survival outcomes improve significantly with timely multimodality treatment.
Our Expertise at Coimbatore Cancer Clinic
● Expertise in early detection of hypopharyngeal lesions
● Skilled in complex laryngopharyngectomy and reconstruction
● Precision IMRT planning coordination
● Evidence-based chemotherapy and immunotherapy
● Multidisciplinary approach with nutrition, speech therapy, and rehabilitation
● Long-term surveillance for recurrence and second primaries
Our goal is organ preservation when possible, and optimal functional recovery when surgery is
necessary.
When to Consult
Seek medical advice if you experience:
● Difficulty or pain while swallowing
● Persistent throat discomfort
● Ear pain with no ear disease
● Change in voice
● Weight loss without reason
● Neck swelling
Early consultation leads to better outcomes.
Frequently Asked Questions (FAQs)
1. Is hypopharyngeal cancer curable?
Yes, especially when detected early and treated appropriately.
2. Will I lose my voice after treatment?
Not always. Organ-preserving chemoradiation is often effective.
3. What is the role of surgery?
Surgery is crucial for advanced or cartilage-invasive tumors.
4. Are feeding tubes needed?
Sometimes during chemoradiation; temporary in most cases.
5. Can immunotherapy help?
Yes. Immunotherapy is effective in recurrent/metastatic disease.
Disclaimer
This page provides general medical information for patient education. Individual treatment
decisions must be made after consultation with qualified surgical and medical oncologists.
Laryngeal Cancer – Causes, Symptoms,
Diagnosis, Treatment & Latest Advances
Overview
Laryngeal cancer arises in the voice box (larynx), a structure crucial for speech, breathing, and
protecting the airway during swallowing. It is one of the most common head and neck cancers
and is strongly associated with tobacco and alcohol use. The larynx is divided into three
regions:
1. Glottis (vocal cords)
2. Supraglottis (above vocal cords)
3. Subglottis (below vocal cords)
Glottic cancers have the best prognosis because early voice changes lead to early detection,
while supraglottic cancers often present late due to subtle symptoms.
Advances in organ-preserving chemoradiation, transoral laser microsurgery, minimally invasive
surgical approaches, and precision radiation (IMRT) have significantly improved outcomes and
functional recovery.
At Coimbatore Cancer Clinic, our surgical and medical oncologists deliver comprehensive
care based on NCCN and ESMO 2025 guidelines, including advanced diagnostics,
voice-preserving treatment strategies, targeted therapies, immunotherapy, and rehabilitation.
Causes & Risk Factors
1. Tobacco Use (Major Risk Factor)
● Cigarettes, bidis, smokeless tobacco
● Strongly linked to all laryngeal cancers
2. Alcohol Consumption
Synergistic effect with tobacco
3. HPV Infection
Less common in laryngeal cancer compared to oropharyngeal cancer
4. Occupational Exposure
Asbestos, wood dust, industrial chemicals
5. Family History & Genetics
Family clusters occasionally seen
6. Reflux Disease
Chronic laryngopharyngeal reflux may contribute
Symptoms & Warning Signs
Glottic (Vocal Cord) Tumors
● Persistent hoarseness (>2 weeks)
● Voice changes
● Vocal fatigue
Supraglottic Tumors
● Difficulty swallowing
● Lump in the neck
● Sore throat
● Ear pain
Subglottic Tumors
● Breathing difficulty
● Persistent cough
● Noisy breathing (stridor)
Advanced Stage Symptoms
● Airway obstruction
● Weight loss
● Neck nodes
● Persistent throat pain
Hoarseness lasting more than two weeks should always be evaluated.
Diagnostic Evaluation
1. Clinical Examination
Inspection of mouth, throat, and neck.
2. Fiberoptic Laryngoscopy
Visualizes:
● Vocal cord movement
● Tumor extent
● Airway compromise
3. Direct Laryngoscopy Under Anaesthesia
For biopsy, detailed mapping, and assessment.
4. Biopsy
Histopathology confirms diagnosis.
5. Imaging
● Contrast CT neck: initial staging
● MRI: detailed soft tissue involvement
● PET-CT: staging, distant spread, second primary cancer
6. Voice Evaluation
Baseline voice assessment before treatment.
Staging (AJCC 8th Edition)
T Staging
Depends on:
● Tumor size
● Vocal cord mobility
● Invasion of adjacent structures
N Staging
● Lymph node spread—more common in supraglottic cancers.
M Staging
Distant metastasis.
Treatment – Stage-wise (NCCN 2025)
Treatment depends on location (glottic vs supraglottic), stage, voice considerations, and patient
health.
Early-Stage (Stage I–II)
Option 1: Single-Modality Radiation Therapy
● IMRT
● High cure rates
● Excellent voice preservation
Option 2: Transoral Laser Microsurgery (TLM) / Conservative Surgery
● Suitable for early glottic tumors
● Comparable cure rates
● Faster recovery
● No external scars
Neck Treatment
Early glottic cancers rarely need neck dissection.
Supraglottic tumors often require elective neck treatment (radiation or surgery).
Locally Advanced (Stage III–IV)
Treatment Options
Option 1: Organ-Preserving Chemoradiation (Preferred)
● IMRT + cisplatin
● Preserves natural voice in many patients
Especially effective for:
● T3 lesions
● Selected T4a without cartilage destruction
Option 2: Primary Surgery
Indicated when:
● Cartilage invasion
● Airway obstruction
● Non-functional larynx
● Poor candidates for chemoradiation
Surgical options:
1. Partial laryngectomy (supraglottic, vertical, or supracricoid)
2. Total laryngectomy (for advanced disease)
Neck dissection is performed when nodes are involved.
Reconstruction & Speech Options
Post-laryngectomy speech rehabilitation includes:
● Tracheoesophageal prosthesis (TEP)
● Electrolarynx
● Esophageal speech
Unresectable Disease
Includes:
● Carotid encasement
● Prevertebral fascia involvement
● Extensive extralaryngeal spread
Treatment:
● Chemoradiation
● Immunotherapy for metastatic/unresectable cases
● Palliative care as needed
Recurrent or Metastatic Laryngeal Cancer
1. Salvage Surgery
Total laryngectomy is recommended for persistent or recurrent disease after radiation.
2. Re-irradiation
Highly selective using IMRT or proton therapy.
3. Systemic Therapy
● Platinum-based chemotherapy
● Cetuximab (EGFR inhibitor)
4. Immunotherapy
Approved for recurrent/metastatic cases:
● Pembrolizumab (first-line for PD-L1 positive tumors)
● Nivolumab (second-line)
These therapies significantly improve survival.
Surgical Management – Detailed
1. Transoral Laser Microsurgery (TLM)
Best for early glottic cancers.
2. Partial Laryngectomy
Preserves some voice function:
● Supraglottic laryngectomy
● Vertical partial laryngectomy
● Supracricoid laryngectomy
3. Total Laryngectomy
Required for:
● T4a tumors
● Non-functional larynx
● Failed chemoradiation
4. Neck Dissection
Selective or modified radical depending on nodal disease.
5. Airway Management
Tracheostomy may be required for airway compromise.
Radiation Therapy
IMRT
Gold standard due to:
● Improved tumor control
● Reduced toxicity
● Better salivary gland sparing
Side effects:
● Dry mouth
● Difficulty swallowing
● Skin irritation
● Voice changes
Brachytherapy
Used selectively for early glottic disease.
Chemotherapy & Immunotherapy
Chemotherapy
Primarily used:
● Concurrent with radiation
● For metastatic disease
Common agents:
● Cisplatin
● Carboplatin
● Taxanes
Immunotherapy
A major advancement:
● Pembrolizumab
● Nivolumab
Used in recurrent/metastatic cases.
Targeted Therapy
● Cetuximab (EGFR inhibitor)
Useful for patients unfit for cisplatin.
Rehabilitation & Quality of Life
Laryngeal cancer affects:
● Voice
● Swallowing
● Breathing
● Social interactions
Essential supportive services:
● Speech and voice therapy
● Dietician support
● Stoma care training for laryngectomy patients
● Psychological counseling
● Smoking cessation support
Long-term follow-up detects recurrence, second primaries, and functional issues.
Prognosis
Depends on:
● Stage at diagnosis
● Tumor location
● Vocal cord mobility
● Nodal involvement
● Response to treatment
Early glottic cancers have excellent cure rates (>90 percent).
Our Expertise at Coimbatore Cancer Clinic
● Expertise in early diagnosis and fiberoptic evaluation
● Advanced minimally invasive surgical options (TLM)
● Skilled in partial and total laryngectomy
● Precision IMRT coordination
● Evidence-based chemotherapy and immunotherapy
● Comprehensive voice rehabilitation and stoma care
● Long-term follow-up and survivorship planning
We focus on organ preservation whenever possible and provide optimal functional outcomes.
When to Consult
Seek medical evaluation if you experience:
● Hoarseness lasting more than 2 weeks
● Difficulty swallowing
● Persistent sore throat
● Noisy breathing
● Neck lumps
● Voice fatigue
● Breathing difficulty
Early diagnosis leads to the best outcomes.
Frequently Asked Questions (FAQs)
1. Is laryngeal cancer curable?
Yes—especially when diagnosed early.
2. Will I lose my voice?
Many patients can preserve voice with early treatment or organ-sparing therapy.
3. What is the best treatment?
Depends on stage; early cases may use surgery or radiation alone.
4. Can immunotherapy help?
Yes—particularly for recurrent/metastatic disease.
5. Is smoking the main cause?
Yes. Quitting smoking drastically reduces risk.
Disclaimer
This page provides general information for patient education. Individual treatment plans must be
made after consultation with qualified surgical and medical oncologists.
Nasopharyngeal Cancer – Causes,
Symptoms, Diagnosis, Treatment & Latest
Advances
Overview
Nasopharyngeal cancer (NPC) arises in the nasopharynx—the upper part of the throat located
behind the nose and above the soft palate. This region contains the opening of the Eustachian
tubes and rich lymphoid tissue. NPC is biologically distinct from other head and neck cancers
due to its strong association with Epstein–Barr Virus (EBV), unique epidemiology, and
exquisite sensitivity to radiation and chemotherapy.
NPC is most common in Southeast Asia but also occurs in India, especially in the Northeast. It
often presents late because early symptoms mimic sinus or ear infections. However, modern
therapy offers excellent control, especially for the EBV-positive non-keratinizing subtype.
At Coimbatore Cancer Clinic, our surgical and medical oncologists provide comprehensive
evaluation, radiation-based treatment, precision chemoradiation, EBV viral load–based
monitoring, and advanced systemic therapy following NCCN and ESMO 2025 guidelines.
Causes & Risk Factors
1. Epstein–Barr Virus (EBV)
Most important risk factor. Chronic EBV infection leads to malignant transformation.
2. Genetic Susceptibility
Family history increases risk.
3. Lifestyle & Environmental Factors
● High consumption of smoked/salted foods
● Nitrosamines in preserved foods
● Tobacco and alcohol (less important compared to other head & neck cancers)
4. Occupational Exposure
Dust, smoke, solvents.
5. Geography & Ethnicity
Higher incidence in:
● Northeast India
● Southern China
● Southeast Asia
Symptoms & Warning Signs
NPC often presents with non-specific symptoms.
Ear-Related Symptoms (Common)
● Persistent unilateral ear fullness
● Hearing loss
● Tinnitus
● Recurrent middle ear infections
*Due to blockage of the Eustachian tube.*
Nasal Symptoms
● Nasal obstruction
● Blood-stained nasal discharge
● Persistent nasal congestion
Neck Swelling
● Painless enlarged lymph nodes
● Often bilateral
Throat Symptoms
● Sore throat
● Difficulty swallowing
● Foreign-body sensation
Neurological Symptoms (Advanced)
● Facial numbness
● Headaches
● Double vision (cranial nerve involvement)
Any persistent nasal/ear symptoms with neck swelling should prompt evaluation.
Diagnostic Evaluation
1. Nasal Endoscopy
Flexible nasopharyngoscopy is essential to visualize:
● Tumor
● Eustachian tube involvement
● Posterior nasopharyngeal wall
2. Biopsy
Direct biopsy under local or general anesthesia.
3. EBV Testing
● EBV DNA viral load (diagnosis & monitoring)
● EBV serology
4. Imaging
● MRI of nasopharynx & skull base (preferred): Excellent for soft tissue, nerve involvement, skull base invasion.
● CT scan for bone involvement.
● PET-CT for staging, metastasis, and detection of occult disease.
5. Hearing Evaluation
Baseline assessment before radiation.
Staging (AJCC 8th Edition)
T Staging
Based on invasion of:
● Nasal cavity
● Parapharyngeal space
● Skull base
● Cranial nerves
N Staging
NPC commonly spreads to lymph nodes, especially in the neck
M Staging
Distant spread (lungs, bones, liver).
Treatment – Stage-wise (NCCN 2025)
NPC is one of the few head and neck cancers where radiation is the primary treatment, not
surgery.
Stage I
Radiation Alone
IMRT directed at:
● Primary tumor
● Bilateral neck nodes
High cure rates.
Stage II
Concurrent Chemoradiation
● IMRT + weekly or 3-weekly cisplatin
● Followed by adjuvant chemotherapy in selected cases
Stage III–IV (Locally Advanced)
Standard Treatment: Concurrent Chemoradiotherapy (CRT)
● IMRT is essential for precision
● Cisplatin during radiation improves survival
● Adjuvant chemotherapy (cisplatin + 5-FU) may be added in selected high-risk patients
Induction Chemotherapy (Increasingly Used)
TPF regimen:
● Docetaxel
● Cisplatin
● 5-FU
Benefits:
● Shrinks bulky tumors
● Reduces distant metastasis risk
Followed by CRT.
Recurrent or Persistent NPC
1. Surgery
Reserved for:
● Neck recurrence
● Local recurrence accessible via endoscopic nasopharyngectomy
2. Re-irradiation
● Using IMRT or stereotactic radiotherapy (carefully selected cases)
3. Systemic Therapy
Options include:
● Platinum-based chemotherapy
● Gemcitabine + cisplatin (preferred first-line metastatic regimen)
● Capecitabine (effective oral option)
4. Immunotherapy
Approved for recurrent/metastatic NPC:
● Pembrolizumab
● Nivolumab
Particularly effective in PD-L1 positive disease
Surgical Management – Limited Role
Surgery is not first-line for NPC because:
● Tumors are deep and difficult to access
● Radiation/chemotherapy are highly effective
Situations Where Surgery Is Used
1. Neck dissection – persistent nodal disease after CRT
2. Endoscopic nasopharyngectomy – small local recurrences
3. Skull base surgery – highly selected cases
Performed only by experienced surgical oncologists and skull-base teams.
Radiation Therapy
IMRT (Intensity-Modulated Radiation Therapy)
Gold standard:
● High precision
● Spares parotid glands
● Reduces side effects
Side Effects
● Dry mouth
● Difficulty swallowing
● Hearing loss
● Skin reactions
● Fatigue
● Neck stiffness
Long-term monitoring is required.
Chemotherapy & Immunotherapy
Concurrent Chemotherapy
● Cisplatin (standard)
● Carboplatin if cisplatin intolerant
Induction Chemotherapy
● TPF regimen (Docetaxel + Cisplatin + 5-FU)
● Gemcitabine + Cisplatin (modern alternative)
Immunotherapy
Major breakthrough in advanced NPC:
● Pembrolizumab
● Nivolumab
Can be used alone or with chemotherapy.
Targeted Therapy
Investigational but promising:
● Anti-angiogenic agents
● EBV-targeted therapies
EBV DNA Monitoring
EBV DNA levels are used for:
● Diagnosis
● Predicting prognosis
● Monitoring treatment response
● Detecting relapse early
A rapidly falling EBV DNA level indicates excellent response.
Rehabilitation & Long-Term Care
NPC treatment affects:
● Hearing
● Swallowing
● Salivary function
● Nutrition
● Quality of life
Essential supportive services:
● Dietician support
● Physiotherapy
● Hearing rehabilitation
● Psychological support
Long-term follow-up improves outcomes.
Prognosis
Depends on:
● Stage at diagnosis
● EBV DNA level
● Cranial nerve involvement
● Nodal spread
● Response to treatment
Early and intermediate-stage NPC has excellent outcomes.
Our Expertise at Coimbatore Cancer Clinic
● Multidisciplinary team specializing in nasopharyngeal tumors
● Expertise in endoscopic evaluation and accurate staging
● Precision IMRT planning via leading radiation partners
● Evidence-based chemoradiation protocols
● Advanced systemic therapy (gemcitabine-based, immunotherapy)
● EBV DNA–based monitoring
● Comprehensive supportive care and survivorship programs
We aim for optimal cure rates while preserving function and quality of life.
When to Consult
Seek evaluation if you have:
● Persistent nasal blockage
● Blood-stained mucus
● Unexplained hearing loss
● Ear fullness
● Neck swelling
● Frequent headaches
● Facial numbness
These symptoms should not be ignored.
Frequently Asked Questions (FAQs)
1. Is nasopharyngeal cancer related to EBV?
Yes. EBV is a major risk factor.
2. Is surgery required?
No. Radiation or chemoradiation is the mainstay.
3. Is NPC curable?
Yes—especially when detected early.
4. Will I lose my hearing?
Temporary hearing effects may occur; long-term effects depend on treatment.
5. Can immunotherapy help?
Yes. It is effective in recurrent/metastatic NPC.
Disclaimer
This page provides general information for patient education. Individual treatment plans must be
made after consultation with qualified surgical and medical oncologists.
Salivary Gland Cancers – Causes,
Symptoms, Diagnosis, Treatment & Latest
Advances
Overview
Salivary gland cancers are rare tumors that arise in the major salivary glands (parotid,
submandibular, sublingual) or the numerous minor salivary glands lining the mouth, oropharynx,
nasal cavity, and sinuses. Though uncommon, they are among the most diverse cancers, with
more than 20 different histologic subtypes, each with distinct behavior, treatment needs, and
outcomes.
The parotid gland accounts for nearly 70 percent of cases. Most parotid tumors are benign, but
malignancies require expert surgical management due to the proximity to the facial nerve and
the need for precise margins and reconstruction.
At Coimbatore Cancer Clinic, our surgical and medical oncologists specialize in
comprehensive management of salivary gland cancers, including advanced imaging,
fine-needle aspiration, expert parotid and neck surgery, facial nerve preservation or
reconstruction, radiation therapy coordination, targeted therapy, and immunotherapy based on
NCCN/ESMO 2025 guidelines.
Types of Salivary Gland Tumors
Salivary gland cancers are classified based on cell type.
Common Malignant Types:
1. Mucoepidermoid carcinoma
2. Adenoid cystic carcinoma (ACC)
3. Acinic cell carcinoma
4. Adenocarcinoma (NOS)
5. Salivary duct carcinoma
6. Carcinoma ex pleomorphic adenoma
7. Myoepithelial carcinoma
8. Polymorphous adenocarcinoma (minor glands)
Each type has unique prognosis and treatment implications.
Causes & Risk Factors
1. Radiation Exposure
Therapeutic radiation to the head and neck increases lifetime risk.
2. Genetic Mutations
Specific gene rearrangements (e.g., MYB-NFIB in adenoid cystic carcinoma).
3. Viral Infections
● EBV: associated with lymphoepithelial carcinoma
● HIV: associated with certain lymphomas of salivary glands
4. Occupational Exposure
Rubber manufacturing, asbestos, nickel, and woodworking.
5. Smoking
Linked to Warthin tumor (benign) but less with cancers.
Symptoms & Warning Signs
Common Symptoms
● Lump or swelling near jaw, neck, or mouth
● Pain or discomfort in the cheek or jaw
● Facial nerve weakness or paralysis
● Difficulty chewing or swallowing
● Persistent dry mouth
● Ulcer or mass in the mouth (minor salivary glands)
Concerning Signs
● Rapidly growing mass
● Facial asymmetry
● Numbness
● Fixation to skin or deeper tissues
● Ulceration
Any persistent swelling in the jaw or neck area should be evaluated.
Diagnostic Evaluation
1. Clinical Examination
● Palpation of glands
● Facial nerve function assessment
● Neck lymph node evaluation
2. Imaging
● Ultrasound (initial for parotid)
● MRI (best for soft tissue and facial nerve relation)
● CT scan (bony involvement)
● PET-CT (high-grade tumors or suspected metastasis)
3. Fine-Needle Aspiration Cytology (FNAC)
● Accurate for distinguishing benign vs malignant
● Guides surgical planning
4. Core Biopsy
Used selectively for deep or high-grade tumors.
5. Histopathology & Molecular Tests
Confirm type and guide prognosis (e.g., MYB gene in adenoid cystic carcinoma).
Staging (AJCC 8th Edition)
T Staging
Based on size and invasion:
● T1: ≤2 cm
● T2: 2–4 cm
● T3: >4 cm or extraparenchymal extension
● T4a: Skin, mandible, ear canal involvement
● T4b: Skull base or pterygoid plate involvement
N Staging
Nodal spread common in high-grade tumors.
M Staging
Distant metastasis to lung, bone, liver.
Treatment – Stage-wise (NCCN 2025)
Treatment is individualized based on tumor location, grade, stage, and facial nerve involvement.
Major Salivary Glands (Parotid & Submandibular)
1. Surgery (Primary Treatment for Most Cases)
Parotidectomy
● Superficial parotidectomy for lateral tumors
● Total conservative parotidectomy for deep lobe tumors
● Radical parotidectomy if facial nerve is involved by cancer
Submandibular Gland Cancer
● Complete gland excision with negative margins
● Selective neck dissection if high-grade or clinically node-positive
2. Facial Nerve Management
● Preservation whenever possible
● Nerve grafting (sural nerve) if resection needed
● Static/dynamic facial reanimation in case of facial nerve sacrifice
3. Neck Dissection
Indicated for:
● High-grade tumors
● Tumors >4 cm
● Clinical nodal disease
● Certain subtypes (ACC less likely; salivary duct carcinoma more likely)
4. Reconstruction
● Local flaps for contour defects
● Free flaps for large resections
Minor Salivary Gland Tumors
Often arise in:
● Hard palate
● Buccal mucosa
● Base of tongue
● Nasopharynx
Treatment
● Wide local excision
● Neck dissection if high-risk features
● Postoperative radiotherapy for high-grade tumors
Radiation Therapy
Indications
● Close or positive surgical margins
● High-grade histology
● Perineural invasion (common in adenoid cystic carcinoma)
● Lymph node involvement
● T3/T4 tumors
Technique
● (IMRT)
● Adjuvant post-surgery or definitive in rare unresectable cases
ACC Special Note
(ACC) has a strong tendency for perineural spread; radiation therapy significantly reduces recurrence risk.
Chemotherapy & Systemic Therapy
Chemotherapy is not very effective for most salivary gland cancers but is used in advanced disease.
1. Chemotherapy
Used in high-grade or metastatic cancers:
● Cisplatin + 5-FU
● Taxane-based regimens
2. Targeted Therapy
Useful for selected subtypes:
● HER2-targeted therapy for salivary duct carcinoma
● Androgen deprivation therapy (ADT) for androgen receptor–positive tumors
● c-Kit inhibitors (ACC – limited role)
3. Immunotherapy
Growing role in metastatic disease:
● Pembrolizumab
● Nivolumab
Especially beneficial in PD-L1 positive tumors
Special Considerations by Tumor Type
Adenoid Cystic Carcinoma (ACC)
● Tends to spread along nerves
● Late distant metastasis, especially to lungs
● Standard treatment: Surgery + Radiation
● Requires long-term follow-up
Mucoepidermoid Carcinoma
● Low-grade: excellent outcomes
● High-grade: aggressive; treated with Surgery + Radiation
Salivary Duct Carcinoma
● HER2-positive in many cases
● Treated similarly to breast cancer with targeted therapy
Acinic Cell Carcinoma
● Usually low-grade
● Surgery often curative
Recurrent or Metastatic Disease
Management depends on:
● Tumor subtype
● Extent of spread
● Functional status
Treatment options:
● Surgery for isolated recurrence
● Re-irradiation (carefully selected)
● Systemic therapy (chemotherapy, targeted therapy, immunotherapy)
● Palliative radiation for symptom control
Rehabilitation & Quality of Life
Salivary gland cancer surgery affects:
● Facial symmetry
● Mouth opening
● Swallowing
● Speech
● Shoulder function (if spinal accessory nerve affected)
Supportive care includes:
● Facial physiotherapy
● Speech therapy
● Dietician support
● Psychological counseling
● Pain management
Prognosis
Depends on:
● Tumor subtype
● Stage at diagnosis
● Margin statusv
● Lymph node involvement
● Perineural invasion
Low-grade cancers have excellent outcomes; high-grade types require close follow-up.
Our Expertise at Coimbatore Cancer Clinic
● Expert parotid and salivary gland surgery
● Facial nerve preservation and reanimation techniques
● Advanced neck dissection skills
● Precision IMRT coordination
● Targeted therapy and immunotherapy for select tumorsv
● Molecular profiling for personalized treatment
● Comprehensive rehabilitation and long-term follow-up
We aim for complete tumor removal with maximal functional preservation.
When to Consult
Seek medical evaluation if you notice:
● A new swelling in front of or below the ear
● Facial weakness
● Jaw pain
● Numbness in the face
● Ulcer or lump in the mouth
● Persistent dry mouth or discomfort
Early diagnosis greatly improves outcomes.
Frequently Asked Questions (FAQs)
1. Are most parotid tumors cancerous?
No. Most are benign, but evaluation is essential.
2. Is surgery always required?
Most malignant tumors require surgery.
3. What happens if the facial nerve is involved?
Surgeons attempt preservation; if sacrifice is needed, reconstruction is performed.
4. Is radiation necessary after surgery?
Yes, for high-risk pathology.
5. Can salivary gland cancer spread?
Yes. High-grade tumors may spread to lungs or lymph nodes.
Disclaimer
This page provides general medical information for patient education. Individual treatment plans
should be made after consultation with qualified surgical and medical oncologists.
Paranasal Sinus & Nasal Cavity Cancers –
Causes, Symptoms, Diagnosis, Treatment
& Latest Advances
Overview
Paranasal sinus and nasal cavity cancers are rare malignancies that arise from the mucosal
lining of the maxillary, ethmoid, frontal, and sphenoid sinuses, or from the nasal cavity itself.
Because these spaces are deep, symptoms are subtle and often misdiagnosed as chronic
sinusitis or benign nasal growths, resulting in late-stage diagnosis.
These tumors require a highly specialized multidisciplinary approach involving surgical
oncology, medical oncology, advanced skull base surgery, endoscopic techniques, and precision
radiation therapy.
At Coimbatore Cancer Clinic, our team of surgical and medical oncologists offers
comprehensive evaluation and treatment based on NCCN and ESMO 2025 guidelines,
including complex surgical resections, endoscopic skull base surgery (when applicable),
advanced reconstruction, chemoradiation, and immunotherapy for advanced disease.
Types of Paranasal Sinus & Nasal Cavity
Cancers
More than a dozen histologic types exist. Common malignant types include:
1. Squamous Cell Carcinoma (Most Common)
Arises from mucosal epithelium.
2. Adenocarcinoma
Associated with woodworking and occupational exposure.
3. Adenoid Cystic Carcinoma (ACC)
Known for perineural invasion and slow but persistent spread.
4. Sinonasal Undifferentiated Carcinoma (SNUC)
Highly aggressive, requires multimodality therapy.
5. Esthesioneuroblastoma (Olfactory Neuroblastoma)
Arises from olfactory epithelium near cribriform plate.
6. Melanoma of Nasal Cavity
7. Sarcomas (Rhabdomyosarcoma, Osteosarcoma)
8. Lymphomas
Different histologies require customized treatment plans.
Causes & Risk Factors
1. Occupational Exposure
Major risk factor for adenocarcinoma:
● Wood dust
● Leather tanning
● Nickel and chromium exposure
● Textile and chemical industries
2. Tobacco & Alcohol
Increases the risk of squamous cell carcinoma
3. Viral Infections
● HPV (some sinonasal carcinomas)
● EBV (rarely)
4. Chronic Sinus Inflammation
5. Genetic Mutations
Specific gene rearrangements in ACC, SNUC
Symptoms & Warning Signs
Symptoms often mimic chronic sinusitis, leading to delayed diagnosis.
Nasal Symptoms
● Nasal obstruction (often one-sided)
● Persistent nasal discharge
● Blood-stained mucus
● Recurrent nosebleeds
Facial Symptoms
● Facial swelling or numbness
● Pain over cheeks or forehead
● Loss of smell
Eye Symptoms (Orbital Involvement)
● Double vision
● Bulging of eye (proptosis)
● Reduced vision
● Excess tearing
Oral/Dental Symptoms
● Loose teeth
● Palate bulge
● Numbness in upper jaw
Neurological Symptoms (Skull Base Invasion)
● Headache
● Facial nerve dysfunction
● Vision problems
Any unilateral nasal obstruction or bleeding persisting beyond a few weeks requires evaluation.
Diagnostic Evaluation
1. Nasal Endoscopy
Key examination. Helps visualize:
● Tumor location
● Extent
● Bleeding source
2. Biopsy
Performed endoscopically. Histopathology determines tumor type.
3. Imaging
Comprehensive imaging is essential:
● CT Scan (preferred for bone invasion)
● MRI (preferred for soft tissue, orbit, intracranial extension)
● PET-CT (for staging, metastasis, second primary)
4. Dental & Ophthalmologic Evaluation
Required if maxilla or orbit are involved
Staging (AJCC 8th Edition)
Staging is based on:
● Tumor location
● Extent of bone destruction
● Orbit/skull base involvement
● Nodal spread
● Distant metastasis
Most patients present with advanced T3 or T4 tumors.
Treatment – Stage-wise (NCCN 2025)
Treatment requires a multimodality approach involving surgery, radiation, and systemic
therapy, depending on tumor type.
Surgery (Primary Treatment for Most Localized Tumors)
Endoscopic Skull Base Surgery
Suitable for:
● Early tumors
● Selected sinonasal carcinomas
● Esthesioneuroblastoma (Kadish A/B)
Advantages:
● Minimal external scars
● Faster recovery
● Better visualization
Open Surgery
Indicated for:
● Extensive bone invasion
● Orbital involvement
● Skull base or facial soft tissue invasion
Procedures include:
● Total/maxillary sinus resection
● Partial/total maxillectomy
● Craniofacial resection
● Orbit-sparing or orbital exenteration (in severe cases)
Neck Dissection
Performed for:
● High-grade tumors
● Clinically node-positive disease
● Certain histologies (SNUC, SCC)
Reconstruction
● Local flaps
● Free flaps (ALT, radial forearm)
● Orbital/facial prosthesis if required
Radiation Therapy
Radiation is essential for most tumors except very small low-grade lesions.
Indications
● Postoperative for high-risk features
● Unresectable tumors
● Positive or close margins
● Perineural invasion (common in adenoid cystic carcinoma)
● Advanced disease
Technique
● IMRT (Intensity-Modulated Radiation Therapy) for precise targeting
● Reduces toxicity
● Protects critical structures (orbit, optic nerves, brainstem)
Proton Therapy
Used in selected cases internationally; not widely available.
Chemotherapy & Systemic Therapy
Chemotherapy is used in:
● Unresectable tumors
● Locally advanced disease (induction chemotherapy)
● Recurrent/metastatic disease
Common Regimens:
● Platinum-based chemotherapy
● Taxane + platinum
● TPF (docetaxel, cisplatin, 5-FU) for aggressive histologies
Targeted Therapy
For specific tumor types:
● HER2-targeted therapy for salivary duct carcinomas
● EGFR inhibitors (Cetuximab) in selected SCC
● KIT inhibitors in ACC (limited benefit but used in advanced disease)
Immunotherapy
Promising role in recurrent/metastatic tumors:
● Pembrolizumab
● Nivolumab
Especially in PD-L1 positive disease
Special Considerations by Tumor Type
Adenoid Cystic Carcinoma (ACC)
● Strong perineural invasion
● Tendency for late distant spread
● Surgery + radiation is standard
● Requires long-term monitoring (10+ years)
Esthesioneuroblastoma
● Treated with surgery + radiation
● Some require chemotherapy
● Staged using Kadish system
Sinonasal Undifferentiated Carcinoma (SNUC)
● Very aggressive
● Requires induction chemotherapy + chemoradiation ± surgery
Adenocarcinoma
● Strong link with occupational exposure
● Surgery + radiation recommended
Recurrent or Metastatic Disease
Management Options
● Salvage surgery (if resectable)
● Re-irradiation (in selected cases)
● Systemic therapy:
○ Chemotherapy
○ Targeted therapy
○ Immunotherapy
● Palliative radiation for symptom relief
Rehabilitation & Quality of Life
Treatment can affect:
● Vision
● Facial symmetry
● Speech
● Chewing
● Swallowing
● Sense of smell
Patients benefit from:
● Physiotherapy
● Speech/swallow therapy
● Ocular rehabilitation
● Maxillofacial prosthodontics
● Psychological counseling
Long-term follow-up is essential.
Prognosis
Depends on:
● Tumor type
● Stage at diagnosis
● Margin status
● Skull base or orbital involvement
● Nodal/distant metastasis
Early and low-grade tumors have excellent survival; advanced and high-grade tumors require
aggressive multimodality therapy.
Our Expertise at Coimbatore Cancer Clinic
● Comprehensive assessment with advanced imaging
● Expertise in endoscopic and open skull base surgery
● Skilled maxillectomy and reconstruction techniques
● Precision IMRT coordination
● Chemotherapy, immunotherapy & targeted therapy for advanced disease
● Long-term follow-up for recurrence and metastasis
● Multidisciplinary rehabilitation and supportive care
We aim for complete tumor control while preserving function and appearance.
When to Consult
Seek evaluation if you notice:
● Persistent unilateral nasal blockage
● Blood-stained nasal discharge
● Facial swelling or numbness
● Eye symptoms (double vision, bulging)
● Loose upper teeth
● Lump in the neck
● Recurrent sinus infections unresponsive to treatment
Early diagnosis improves outcomes dramatically
Frequently Asked Questions (FAQs)
1. Are sinus tumors always cancerous?
No. Many are benign, but evaluation is essential.
2. Is surgery always needed?
Surgery is the mainstay for most tumors, except a few that respond to chemoradiation.
3. Can the eye be preserved?
Yes, in many cases. Orbital exenteration is required only when the eye is severely invaded.
4. Is radiation required after surgery?
Often yes, especially for high-grade or advanced tumors.
5. Can immunotherapy help?
Yes, especially in recurrent or metastatic disease.
Disclaimer
This page provides general medical information for patient education. Individual treatment plans
must be made after consultation with qualified surgical and medical oncologists.
