Head and Neck Cancer

Head and neck cancers are cancers that begin in the tissues and organs of the head and neck. As per GLOBOCAN 2020, 2,52,772 cases per annum in India (melanoma of skin and lymphoma excluded) are head and neck cancers.

Incidence of tobacco use is more in men compared to women as per Global Adult Tobacco Survey (GATS) data. Hence, tobacco related cancers like mouth cancer, throat cancer, and food pipe cancer are common in men compared to women. However, certain cancers like thyroid are commonly found in women.

Causes:

Causes of head and neck cancer are primarily related to use of tobacco and excess alcohol. In addition, there is a new entity called HPV (Human Papilloma Virus) virus cancers that are affecting the oropharynx (tonsil & base tongue). It is primarily seen in the western countries but increasing in our country as well. Risk of HPV infection increases due to unsafe sex, having multiple sexual partners, and oral sex.

Symptoms:

1. Growth/ patch/ color change in mouth
2. swelling neck
3. hoarseness in voice
4. Difficulty in swallowing/ pain when swallowing
5. Bleeding or blockage in nostril (nose) usually on one side
6. Swelling face/ loosening of teeth

Pain is usually not seen in early stage disease.

Early detection:

Awareness of the warning signs is essential for early detection:

1. White/ red patch in mouth

2. Presence of any of the above symptoms

In cases when the person is a tobacco user with symptoms and person presenting with symptoms for more than four weeks, diagnosis should be done immediately.

Diagnosis:

Clinical evaluation is the key. Tissue diagnosis in the form of needle biopsy snack (FNAC) or biopsy is a must before starting any treatment for head and neck cancer.

Imaging tests like PET-CT scan, CT scan, and MRI can be suggested based on the scenario for staging and treatment modality planning.

Treatment:

There are three main modalities of treating head and neck cancer:

1. Surgery
2. Radiation therapy
3. Chemotherapy

Early stage disease can be treated by single modality therapy, either surgery or radiotherapy. Advanced stage disease (stage III & IV) can be treated by combined modality treatment. Surgery and radiotherapy are curable whereas chemotherapy cannot be cured and usually helps surgery or radiotherapy. Recently, a form of chemotherapy called immunotherapy has been introduced for cancer treatment.

Prevention:

Prevention can be primary or secondary.

Primary prevention is by awareness on harmful effects of tobacco use.

Secondary prevention can be by:

• Tobacco cessation or de-addiction programs
• Healthy lifestyle
• HPV cancers prevention by safe sex practices

Inputs by Dr. Anil D’ Cruz, Head and Neck Oncosurgeon, Director- Oncology Services, Apollo Cancer Centres Navi Mumbai