NASOPHARYNX
The nasopharynx is the part of the airway that lies behind the nose. Its tumours cause subtle symptoms like persistent blocked ear, minimal hearing loss, blocked nose, snoring and lightly stained sputum in the early stages, which is dismissed by patients and doctors alike as nothing more than a common cold. But, its first manifestation of disease is usually a neck mass, which needs to be thoroughly investigated with the help of endoscopy and biopsy. Its treatment is again non-surgical.
METASTASIS OF UNKNOWN ORIGIN (MUO)
This denotes a neck lump which is cancerous in nature, but it cannot be discovered from where the cancer has originated. The cancer may be too small to manifest, or it may have started in some hidden corner of the head neck area, the so called coffin-corners. It is the surgeon's job to discover its origin by all means possible, including endoscopies, imaging and biopsies. Sometimes additional markers may also be required before labelling the metastasis as truly unknown.
SKIN AND SCALP TUMOURS
Skin tumours arise in areas of sun exposed regions, like the face and scalp. Common among these are squamous cell carcinoma and basal cell carcinoma. Athough Indians are less prone to it than the western world, by virtue of our melanin-protected skin, it nevertheless is seen among people who have been exposed to the harsh UVrays of the sun for prolonged duration. Again, it is a preventable disease, by simply using umbrella, caps/hats and sunscreen. The diagnosis is clinical and by biopsy, and the treatment is surgical.
In contrast, melanoma skin cancers are more aggressive, and tend to spread fast. They have a poor prognosis. The treatment is surgical and immunological.
LYMPHOMAS
Lymphomas are tumours of the lymph nodes, and often present as a neck lump. The role of surgery is limited to performing a lymph node biopsy.
MALIGNANCY OF TEMPORAL BONE
Malignancy of the temporal bone is very rare. Its symptoms mimic that of ear infection ( chronic otitis media) like ear discharge, ear itching, pain, loss of hearing. It is usually suspected when the patient develops facial nerve palsy, and is diagnosed by biopsy. The treatment is surgical, but very few patients can undergo surgery because the cancer is too advanced at diagnosis, and hence, the overall prognosis is poor.
RARE TUMOURS OF HEAD NECK
There are many other varieties of tumours, each arising out of different cells which populate the head neck area. They are too extensive to enumerate, and need to be differentiated by a specialist.