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  • Dr Jeeve Kanagalingam ENT
  • Dr Jeeve Kanagalingam ENT
  • Dr Jeeve Kanagalingam ENT

Head and Neck Cancers

Head and Neck Cancers predominantly affect adults and are not the most common cancers in Singapore and Southeast Asia. In fact, the Singapore Cancer Registry of 2018 shows that only thyroid cancer made the top ten most common cancers in women (placed 8th, accounting for 3.9% of all female cancer cases in Singapore or 300 cases a year). In men, no head and neck cancer made the top ten by incidence but nose cancer was placed 8th by mortality (accounting for 3.3% of all cancer deaths in men or 100 deaths per year)

Head and neck cancers can cause significant morbidity as they can affect the ability to breathe, eat and talk.

The following are the common head and neck cancers that I manage:

  • Thyroid cancer
    Thyroid cancer is more common in women than in men. They often present with a painless swelling or nodule within the thyroid gland. The most common thyroid cancer is papillary thyroid cancer. The other varieties include follicular thyroid cancer, medullary thyroid cancer (MTC), anaplastic thyroid cancer and thyroid lymphoma
  • Salivary gland cancer
    Cancers can arise within the salivary gland of the head and neck. The main salivary glands are the parotid gland, the submandibular gland and the sublingual glands. Twenty percent of lumps in the parotid gland are cancerous as is 40% of lumps in the submandibular glands. One type of benign parotid lump – a pleomorphic adenoma – has a propensity to turn malignant if not removed
  • Cancers of the lymph nodes (Lymphoma)
    Cancer can arise within the lymph nodes of the head and neck. Lymphomas can be broadly divided into Hodgkin’s and Non-Hodgkin’s Lymphomas. Patient’s often present to ENT Specialists with swollen lymph nodes. The ENT Specialist will initially assess the patient for any evidence of a primary cancer elsewhere in the head and neck causing these enlarged lymph nodes. The nodes often require an excision biopsy to definitively diagnose and subtype the lymphoma
  • Cancers of the Tongue, Cancers of the Oral Cavity, Cancers of the Lip, Cancer of the Gum (Gingiva)
  • Cancers of the Soft Palate, Cancers of the Hard Palate
  • Cancers of the Nose, Cancer of the Paranasal Sinuses, Cancer of the Nasopharynx (Nasopharyngeal Cancer, or NPC)
  • Cancer of the Tonsil, Cancers of the Base of Tongue, Cancers of the Pharynx
  • Cancers of the Larynx, Glottic Carcinoma, Supraglottic Cancers
  • Cancers of the Hypopharynx

What are the risk factors for head and neck cancers?
There are many dietary and lifestyle factors that increase one’s risk of head and neck cancers. These include:

  • Smoking
    Tobacco – either chewed or smoked – increases the risk of several head and neck cancers including cancers of the voice box (laryngeal cancer) and oral cavity cancers
  • Alcohol
    Alcohol increased the risk of oral cavity, hypopharyngeal and laryngeal cancers. The dark spirits contribute greater risks that other types of alcoholic beverages
  • Viral Infections
    Infection with the Human Papilloma Virus (HPV) can cause tonsil and tongue base cancers or what is collectively termed oropharyngeal cancers. Vaccination against HPV can reduce the risk of cancer. The Epstein-Barr Virus (EBV) is related to nose cancer and also certain lymphomas
  • Genes
    Some cancers are more common within some families or ethnic groups. Nasopharyngeal Cancer (NPC) is more common amongst the Southern Chinese especially the Cantonese. Thyroid Cancer can have a familial tendency

The key aspects of optimizing outcomes in head and neck cancer are:


  • Early recognition of symptoms and rapid diagnosis. This ensures that cancer is diagnosed at an early stage when treatment outcomes are more favourable. I rely on state of the art high-definition endoscopes with narrow-band imaging to ensure early diagnosis is achieved
  • Accurate staging of disease. Modern methods of imaging, such as PET-MR, which is available in Mount Elizabeth Novena Hospital, ensures that the extent of disease is established precisely
  • Correct definitive management. Head and neck cancer can be treated with surgery, radiotherapy or chemotherapy. For advanced stage disease, we often employ a combination of treatments. It is important to select the correct ‘definitive’ treatment for each patient. This is best done when your Oncologist and Surgeon work in close collaboration. There are almost 40 oncologists at Mount Elizabeth Novena Hospital and Gleneagles Hospital which I partner with in the care of my patients. There are some of the best radiation machines in Singapore at these hospitals. Mt Elizabeth Novena Hospital has a Proton Therapy Unit
  • Good rehabilitation. Treatment for head and neck cancers is complex and may affect speech and swallowing. I work closely with speech therapists, dieticians and physiotherapists to ensure optimal rehabilitation of these functions

My training

I trained in several central and west London hospitals and was fortunate to have mentors in head and neck cancer surgery who were world famous surgeons and excellent teachers. They were Professor Tony Cheesman at Charing Cross Hospital who sparked my interest in head and neck, and anterior skull base surgery. Professor David Howard at the Royal National Throat Nose and Ear Hospital who introduced transoral laser microsurgery to the United Kingdom, and from whom I learnt many techniques in this field. As the Senior Registrar at the Royal Marsden Hospital, I worked with Mr Peter Rhys-Evans and Mr Peter Clarke who were excellent oncological surgeons. The Royal Marsden is the oldest cancer hospital in the world and boasts some of the finest surgeons in the UK. It was here that I met the visiting Professor William B Coman of the Princess Alexandra Hospital in Brisbane, Australia. His unit treats the largest number of head and neck cancers in Australasia and I subsequently became his fellow in 2007. At the Princess Alexandra, I further developed my knowledge and skills in treating oral cavity and laryngopharyngeal cancers.

During my tenure as Consultant and Chief of the Head and Neck Cancer Service at Tan Tock Seng Hospital (TTSH), I had the opportunity to further my training in robotic surgery. I completed advance training in transoral robotic surgery (TORS) and robotic thyroidectomy at Severance Hospital in Seoul, South Korea. I also undertook basic and advanced training in ultrasound of the neck and thyroid with the American College of Surgeons in San Francisco in 2010 and Boston in 2017. I initiated the head and neck ultrasound service within the Department of ENT in TTSH. I routinely use in-office ultrasound for the comprehensive assessment and monitoring of the neck in all my head and neck cancer patients.


Head Neck Cancers

Head Neck Cancers

Head Neck Cancers

Head Neck Cancers

Nose (Nasopharyngeal) Cancer

Nose cancer is common in Southeast Asia. Singapore has one of the highest incidence of nose cancer in the world. People from South China (particularly the Cantonese) have a high incidence of this tumour. A diet rich in nitrosamines (which is present in salted and preserved foods) and infection early in life by the Epstein-Barr Virus (EBV) contribute to this cancer.

One of the problems with nose cancer is that the tumour causes few symptoms in the early stages of disease. When advanced, it causes nasal congestion, nose bleeds, neck lumps, deafness and double vision. The survival outcome from this cancer is best when diagnosed and treated at an early stage. Early diagnosis is therefore important. The best method for screening for nose cancer is to perform flexible nasal endoscopy of the nose and nasopharynx. Narrow band imaging is sometime helpful in identifying early lesions and blood tests for cancers markers are useful too particularly in relatives of patients with nose cancer.

Head and Neck Cancers

Oral cavity cancer

Cancers of the oral cavity include tongue cancer, cancers of the floor of mouth and gum. These cancers are often due to chronic irritation of the lining of the mouth. Hence, smoking, alcohol consumption, chewing betel nut, sharp teeth and conditions such as lichen planus and Fanconi's Anaemia may all cause oral cavity cancers.
Head and Neck Cancers
Head and Neck Cancers

Larynx cancer

Cancer of the larynx is intimately related to smokers. Smoking one pack of cigarettes a day increases your risk of larynx cancer by seven fold. Larynx cancer fortunately presents early as it causes hoarseness. Cancers of the larynx when large may cause airway obstruction and noisy breathing (called stridor).

Early stage cancer of the larynx may be treated by surgical removal. This can be achieved effectively with the use of Carbon Dioxide (CO2) laser. The voice quality, although poor to begin with, is equivalent to that achieved with radiotherapy. For advanced stage cancers, radiotherapy with chemotherapy is often used except in extensive disease where it is necessary to remove the larynx. This is an operation called laryngectomy (see my lecture handouts)

Head and Neck Cancers

Operations for Head and Neck Cancer

Surgery to remove cancers of the head and neck are technically challenging. The anatomy of the head and neck is extremely complex. These are some of the common operations I undertake:

  • Hemithyroidectomy and Total Thyroidectomy
  • Superficial Parotidectomy and Total Parotidectomy
  • Excision of the Submandibular Gland
  • Hemiglossectomy and Partial Glossectomy
  • Segmental Mandibulectomy and Hemimandibulectomy
  • Mandibulotomy
  • Radical Tonsillectomy
  • Laryngectomy
  • Laryngopharyngectomy
  • Transoral Laser Microsurgery
  • Nasopharyngectomy
  • Selective Neck Dissection
  • Modified Radical Neck Dissection

My Head and Neck Research

  1. Patient and oncologist perceptions regarding symptoms and impact on quality-of-life of oral mucositis in cancer treatment: results from the Awareness Drives Oral Mucositis PercepTion (ADOPT) study. Kanagalingam J, Wahid MIA, Lin JC, Cupino NA, Liu E, Kang JH, Bazarbashi S, Bender Moreira N, Arumugam H, Mueller S, Moon H. Support Care Cancer. 2018 Jul;26(7):2191-2200. doi: 10.1007/s00520-018-4050-3. Epub 2018 Jan 31. PMID: 29387994
  2. Extended endonasal approach versus maxillary swing approach to the parapharyngeal space. Roger V, Patron V, Moreau S, Kanagalingam J, Babin E, Hitier M. Head Neck. 2018 Jun;40(6):1120-1130. doi: 10.1002/hed.25092. Epub 2018 Jan 31. PMID: 29385316
  3. Povidone-iodine for the management of oral mucositis during cancer therapy. Kanagalingam J, Chopra A, Hong MH, Ibrahim W, Villalon A, Lin JC. Oncol Rev. 2017 Sep 15;11(2):341. doi: 10.4081/oncol.2017.341. eCollection 2017 Jun 14. PMID: 28959380
  4. Oral Neurothekeoma of the Right Buccal Mucosa. Tham AC, Chilagondanahalli NL, Bundele MM, Kanagalingam J. Case Rep Otolaryngol. 2016;2016:4709753. doi: 10.1155/2016/4709753. Epub 2016 Sep 8. PMID: 27672465
  5. Subglottic Extramedullary Plasmacytoma With Light Chain Multiple Myeloma Masquerading as Adult-Onset Asthma. Gan YJ, Chopra A, Kanagalingam J. J Voice. 2014 Feb 1. pii: S0892-1997(13)00229-4.doi: 10.1016/j.jvoice.2013.10.016. [Epub ahead of print]
  6. Soon SR, Kanagalingam J, Johari S, Yuen HW. Head and neck cancers masquerading as deep neck abscesses. Singapore Med J. 2012 Dec;53(12):840-2. PubMed PMID: 23268159.
  7. Nicoll F, Kanagalingam J, Coman WB. ECG electrode for tracheostome closure following decannulation. Ann R CollSurg Engl. 2009 Sep;91(6):517. Erratum in: Ann R CollSurg Engl. 2010 Jul;92(5):410. Comam, W B [corrected to Coman, W B]. PubMed PMID: 20238462; PubMed Central PMCID: PMC2966210.
  8. Kazi R, Kanagalingam J, Venkitaraman R, Prasad V, Clarke P, Nutting CM, Rhys-Evans P, Harrington KJ. Electroglottographic and perceptual evaluation of tracheoesophageal speech. J Voice. 2009 Mar;23(2):247-54. Epub 2007 May 9. PubMed PMID: 17490856.
  9. Kazi RA, Prasad VM, Kanagalingam J, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Assessment of the formant frequencies in normal and laryngectomized individuals using linear predictive coding. J Voice. 2007 Nov;21(6):661-8. Epub 2006 Sep 28. PubMed PMID: 17010569.
  10. Kazi R, Prasad VM, Kanagalingam J, Georgalas C, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Analysis of formant frequencies in patients with oral or oropharyngeal cancers treated by glossectomy. Int J Lang CommunDisord. 2007 Sep-Oct;42(5):521-32. PubMed PMID: 17729144.
  11. Kazi R, De Cordova J, Kanagalingam J, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Quality of life following total laryngectomy: assessment using the UW-QOL scale. ORL J OtorhinolaryngolRelat Spec. 2007;69(2):100-6. Epub 2006 Dec 5. PubMed PMID: 17148941.
  12. Kazi R, Kanagalingam J, Al-Mutairy A, Nutting CM, Clarke P, Rhys-Evans PH, Harrington KJ. Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer.ClinOtolaryngol. 2006 Feb;31(1):83. PubMed PMID: 16441818.
  13. Tatla T, Kanagalingam J, Majithia A, Clarke PM. Upper neck spinal accessory nerve identification during neck dissection. J Laryngol Otol. 2005 Nov;119(11):906-8. PubMed PMID: 16354345.
  14. Georgalas C, Kanagalingam J, Gallimore A, O'Flynn P. Follicular dendritic cell sarcoma arising from the hypopharynx. J Laryngol Otol. 2004 Apr;118(4):317-8. PubMed PMID: 15117477.
  15. Kanagalingam J, Medcalf M, Courtauld E, Clarke PM. Rhabdomyosarcoma of the adult nasopharynx. ORL J OtorhinolaryngolRelat Spec. 2002 May-Jun;64(3):233-6. PubMed PMID: 12037394.