About 90% of head and neck cancers are squamous cell carcinomas[i] that originate in mucosal lining[ii].Head and neck cancers refer to different types of invasive cancer cells, most common of which are:
- Nasopharyngeal Cancer: Nasopharyngeal is the upper part of the throat behind the nose.
- Nasal Cavity and Paranasal Sinus Cancer: The nasal cavity refers to the space behind the nose through which air passes to the throat. The paranasal sinuses refer to the groups of four paired air-filled spaces surrounding the nasal cavity.
- Oral and Oropharyngeal Cancer: The oral cavity includes the tongue, the floor of mouth, hard palate, buccal mucosa and alveolar ridges. The oropharynx refers to the base of tongue, tonsils, and soft palate.
- Laryngeal Cancer: The larynx, more commonly known as the voice box.
- Hypopharyngeal Cancer: The pharynx, more commonly known as the throat.
- Salivary Gland Cancer: Salivary glands are responsible for the discharge of fluid secretion most noteworthy saliva.
Head and neck cancers are very aggressive. Patients are at a high risk of developing other cancers. They are highly curable if detected early.
A number of other cancers exist in the same area. Head and neck cancers, such as brain tumor and eye cancer do not classify to be part of the head and neck cancers.
Head and Neck Cancers treatment Programs:
Cancer treatment in Cuba follows the standard treatment for cancer by using surgery, radiation, and chemotherapy in combination with immunotherapy. The treatment program is dependent on the type of cancer as well as the stage it is in and finally patient’s overall health.
- Initial evaluation and preparation.
- Pre-application medical checkup.
- Cyclophosphamide 200mg
- Nimotuzumab (CIMAher EGF) 24 pairs of vials for 6 weeks treatment.
- The induction phase lasts six weeks corresponding to the application of 24 pairs of vials (4 vials x 6 vaccine applications), Cyclophosphamide and saline solutions.
- The first dose will be given in Cuban health centers. Follow-up doses can be continued the in Cuba or in the patient’s home country.
Glossectomy medical program:
Glossectomy is a surgery of the tongue performed to remove all, half or parts of the tongue in order to treat malignant growth on the tongue.
- Total glossectomy: removal of all of the tongue
- Semi glossectomy: removal of half of the tongue
- Partial glossectomy: removal of parts of the tongue.
- Trans maxillary Glossectomy with neck dissection: When cancer in the oral cavity spreads to the lymph nodes in the neck, as a result removal of the nodes through surgery may become a necessary procedure to control the spread of cancerous tissue. Radical neck dissection, put in practice since 1906, is a major yet simple and well-designed surgery and is usually performed at the same time as the surgery for the removal of the main tumor. Depending on the original cancer size and how much it has spread, neck dissection surgery can be one of the following:
-Partial neck dissection: very few lymph nodes are removed.
-Modified neck dissection: more lymph nodes on the neck are removed
in addition to possibility of the removal of other structures such as some muscles, nerves and veins.
-Radical neck dissection: the most amount of lymph nodes and more muscles, nerves and veins are removed.
Larynx Medical Programs:
Laryngectomy is a surgery for the removal of the larynx, commonly known as the voice box, and possibly the detachment of the airway from the mouth, nose and esophagus. Laryngectomy is used to control the spread of tumors or cancerous tissue.
Depending on the original cancer size and how much it has spread, neck dissection surgery can be one of the following:
- Partial Laryngectomy
- Subtotal Laryngectomy Horizontal
- Total Laryngectomy
- Radical neck dissection with total laryngectomy
- Selective neck emptying with laryngectomy
Maxillary Medical Programs:
Maxillary cancer is very rare being most common in Asia and Africa, especially Japan and South Africa. The preferred method of treatment is usually the trans maxillary approach since it is less intrusive, less destructive and also more cosmetically appealing. This approach gives a better surgical exposure allowing for tumor resection with minimal blood loss. Vascularized flaps provide and maintain blood supply in the area.
Trans maxillary approach offered in the maxillary program could be one of the following:
- Micro-vascularized flap
- Vascularized flap
- Trans maxillary resection and reconstruction with vascularized flap
Miscellaneous Medical Programs for Head and Neck:
Exeresis of Neck Tumour Program:
removal of tumors in the neck is an inpatient operation. Administration of local or general anesthesia is subject to the age of the patient as well as the location of the neck mass.
Parotid Medical Programs:
The location of Parotid glands as the largest and most important salivary glands is in front of each ear. A parotidectomy is a surgical procedure for the removal of the gland due to the development of tumors. About 80% of tumors are benign. Cuba performs the following parotidectomy procedures. Please note that preservation of the facial nerve determines the specific selected surgery.
- Subtotal parotidectomy: A superficial lobectomy in which dessects less than a full facial nerve.
- Total parotidectomy: It removes the deep portion of the gland.
Radical Neck Dissection Medical Programs:
- Radical Neck Dissection: a major yet simple and straightforward surgery needed due to cancer spreading to the lymph nodes in the neck.
- Functional neck dissection: functional neck dissection preserves the spinal accessory nerve, internal jugular vein and sternocleidomastoid muscle.
Craniofacial Resections Medical Programs:
Craniofacial resection refers to a group of operations involving the skull and the middle of the face. It is the standard treatment for the removal of tumors affecting the anterior skull base. This is done through an incision along the side of the nose to the forehead also from one ear to the other over the head. Alternatively through the skull giving better exposure to the tumours and a better chance of removing it with as little amount of damage to the brain, nerves and other major systems in and around the area. Cuba offers the following options:
- Middle fossa dissection
- Middle fossa dissection and reconstruction with vascularized flap
- Anterior fossa dissection
- Anterior fossa dissection and microvascular flap reconstruction
Thyroid Medical Programs:
The location of the thyroid, a small gland made up of two connected lobes is in the front of the neck below the larynx. Furthermore it is most of all responsible for controlling body functions such as body temperature, metabolism, heart rate and also blood pressure. Thyroid cancer develops since some cells change and become cancerous. In general, thyroid cancer is slow in developing therefore least deadly of the head and neck cancers and as a result the most curable of all cancers. Cuba offers the following procedures :
- Hemi thyroidectomy: standard surgical procedure for the removal of one of the thyroid lobes. The procedure is very safe with little risk of damage.
- Thyroidectomy with radical dissection: a common surgical procedure for the removal of part or all the gland. Radical dissection is performed if there are lymph node metastases.
[i] Squamous cell are found in the tissue that forms the thin layer of the skin as well as the lining of the digestive and respiratory tracts.
[ii] The layer of moist tissue.