Head and Neck Cancer

Overview

India accounts for almost 30% of all head and neck cancers globally. According to the GLOBOCAN 2022 India fact sheet, head and neck cancer is the most common cancer in men and the 4th most common cancer in women. It also has the second-highest cancer-related deaths attributed to it. The primary risk factors associated with head and neck cancer include tobacco use, alcohol consumption, human papillomavirus (HPV) infection (for oropharyngeal cancer), and Epstein-Barr virus (EBV) infection (for nasopharyngeal cancer). The high prevalence of head and neck cancers in India is strongly linked to high tobacco consumption rates, which include smoking and chewing. This higher incidence and mortality are due to lack of social or community awareness, inadequate screening programs, late-stage presentation, delay in diagnosis due to socio-economic factors, and inaccessibility or poor adherence to evidence-based standard treatment guidelines. Almost 60 to 80% of head and neck cancer cases in India present in advanced stages. The most frequent type of head and neck cancer in India is head and neck squamous cell carcinoma (HNSCC). India accounts for almost 30% of all head and neck cancers globally. According to the GLOBOCAN 2022 India fact sheet, head and neck cancer is the most common cancer in men and the 4th most common cancer in women. It also has the second-highest cancer-related deaths attributed to it. The primary risk factors associated with head and neck cancer include tobacco use, alcohol consumption, human papillomavirus (HPV) infection (for oropharyngeal cancer), and Epstein-Barr virus (EBV) infection (for nasopharyngeal cancer). The high prevalence of head and neck cancers in India is strongly linked to high tobacco consumption rates, which include smoking and chewing. This higher incidence and mortality are due to lack of social or community awareness, inadequate screening programs, late-stage presentation, delay in diagnosis due to socio-economic factors, and inaccessibility or poor adherence to evidence-based standard treatment guidelines. Almost 60 to 80% of head and neck cancer cases in India present in advanced stages. The most frequent type of head and neck cancer in India is head and neck squamous cell carcinoma (HNSCC).

Clinical Presentation

When HNSCC is small in size and in early stages, a person is usually asymptomatic. But with increasing size and advancing stages, one or more symptoms may develop. Some of the common symptoms of HNSCC advised by head and neck cancer specialists to look out for are:

Treatment From a Head And Neck Cancer Specialist

The management of HNSCC depends on the stage and location of the cancer. Therapy options offered by a head and neck cancer specialist include:

• Surgery – for early-stage, localized cancers and includes removal of the mass and lymph nodes.
• Radiation therapy – Your head and neck cancer specialist uses high-energy X-rays or other types of radiation like protons to kill cancer cells. It can be post-surgery or for pain relief in stage 4 cancers with painful bone metastasis or for hemostatic purposes for bleeding cancers. Highly conformal RT techniques, such as intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT), are the standard of care now, as they have shown reduced morbidity.
• Chemotherapy – it uses medicines that kill cancer cells. It can be given before surgery to shrink the cancer and make it easier to remove. It can be given after surgery, depending on the stage with radiation, to prevent the growth or spread of the cancer. It is also given in stage 4 cancers where surgery and radiation are not considered.
• Targeted therapy – As the name suggests, targeted medicines attack only specific types of cancer cells, like cetuximab and nimotuzumab.
• Head and neck cancer immunotherapy – Head and neck cancer immunotherapy aids the immune system in recognizing and attacking cancer cells.

Choosing the right therapy is crucial for improving the response rates and overall survival of the patient. However, there is no one therapy that fits for all cases. Combined modality approaches are required in HNSCC for long-term disease control. Which therapies are to be chosen and in which combination is decided by the head and neck cancer specialist depending on the patient’s stage, anatomic site of cancer, comorbidities like diabetes, hypertension, heart problems, etc., and type of head and neck cancer.

Follow Up Care With a Head And Neck Cancer Specialist

After your head and neck cancer specialist completes therapy in early-stage cancers, long-term follow-up is required to detect recurrences and second primary cancers and to look for late toxicities of chemotherapy and radiation. It is important to watch for symptoms that could signal the return of cancer—hoarseness of voice, pain, swallowing difficulty, bleeding, and enlarged neck nodes. Speech and swallowing rehabilitation are essential for restoring the function and quality of life following both surgery and radiation therapy. A CECT or MRI is required to be done by the head and neck cancer specialist every 3 months in the first 2 - 4 years of therapy. Approximately 80 to 90 percent of all recurrences occur during this time frame; the risk of a second HNSCC is higher than the recurrence risk for most patients after three years, especially those with exposure to tobacco and alcohol. Hence, it is critical to encourage and educate head and neck cancer survivors about smoking or tobacco chewing cessation and limiting alcohol consumption. Exercise and physical activity in head and neck cancer survivors have been associated with improved quality of life, and they are encouraged. Long-term complications of therapy include worsening of dental health; dry mouth; sticky saliva; persistent need to drink water or fluids while eating, swallowing, and speaking; difficulty eating and speaking; lockjaw; chronic pain; compromise in hearing; dizziness (especially in those who received radiation to the neck); and neck stiffness. Psychosocial issues like difficulty in sexual function, body image issues (due to facial disfigurement, loss or change of organ function, fear of recurrence and death), depression, anxiety, increased suicidal thoughts, and employment difficulties should also be discussed with the treating physician and caretaker relatives.