Head and Neck Cancers – The ‘Life-style’ Cancers

Cancers which occur in the region of the head and neck (excluding the brain) are together termed as Head and Neck Cancers. Over 80% of these cancers arise from the inner epithelial lining of the upper aero-digestive tract (the upper part of the food and air passages). They include oral cancers (cancers of the mouth and tongue), throat cancers (cancers of the larynx and pharynx) and sinus cancers. These cancers are generally related to habits and life-style, specifically, the use of tobacco and alcohol and thus may be termed as ‘life-style’ cancers.

Causes of Head and Neck Cancer:

Over two thirds of head and neck cancers are related to the use of tobacco. Both epidemiologic and experimental studies have clearly shown that chronic exposure to tobacco in any form induces changes in the cells that lead to the development of cancer.  While smokers have a higher risk of lung and throat cancer, those who chew tobacco run an increased risk of cancer of the mouth, throat and food passages. The brunt of the tobacco is borne by the throat and lungs in smokers and the oral cavity in tobacco chewers. The tobacco chewer’s oral cancer is universally referred to as the ‘Indian oral cancer’ in view of its typical location in the furrow between the cheek and the lower gum – the location where the tobacco or pan masala is usually kept.

Warning signs of head and neck cancer:

1. Ulcer or growth in the tongue or mouth
2. Persistant change in voice or difficulty in swallowing
3. Abnormal lump or swelling in the head and neck region
4. Blood in sputum or saliva
5. A mole or wart which increases in size or starts itching or bleeding

Treatment for Head and Neck Cancer:

Head and Neck cancers are highly curable with proper treatment. The main modalities of treatment are Surgery, Radiation therapy and Chemotherapy in isolation or in combination depending on the site and stage of the cancer.

Surgery is the main modality of treatment for oral cancers and some advanced cancers of the larynx and pharynx as well as cancers of the thyroid and salivary glands. Advances in surgical techniques for oral cancer and refinements in reconstructive methods have made major surgery for these cancers safe, effective as well as cosmetically and functionally acceptable.  

Radiation therapy is mainly used for early and intermediate stage aero-digestive tract cancers (other than oral cancers) as well as advanced cancers which are not surgically operable. Technological advances in the delivery and planning of radiation therapy with techniques such as IMRT, IGRT etc. have made radiation treatment for head and neck cancer precise with minimal side-effects and high cure rates.

Chemotherapy in primarily used in lymphomas and in combination with radiotherapy in advanced aero-digestive cancers of the head and neck. It is also sometimes used before surgery to reduce the size of the tumor and make it more manageable during surgery.

Prevention and life-style changes:

Changes in life-style and avoidance of tobacco and drinking habits can prevent most head and neck cancers. Screening of high risk population by regular oral and throat examination can detect early cancers where treatment strategies are most effective.

 Many commercial preparations (Nicotine skin patches, nicotine impregnated chewing gum, etc) are available in the market to help smokers to get rid of smoking. 

The Government has only recently woken up to the reality of the health hazards of the various tobacco products.  While restrictions on smoking in public places and a ban on advertising of all tobacco products have been in existence since 2003, it has done precious little to stop the menace of tobacco chewing. Subsequent to this law, a modest reduction in the sale of cigarettes and other smoking products was negated by a significant increase in the sale and consumption of chewed tobacco. A pictorial warning depicting oral cancer on all tobacco products (including chewed) was made mandatory from June 2010.  Time will tell whether this results in any significant reduction in the incidence of head and neck cancers in the country.

Article by:
Dr.Umanath Nayak,
Consultant Head and Neck Oncologist,
Apollo Cancer Hospital, Hyderabad

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