Overview

Head and Neck Cancer

Cancers of the head and neck are generally taken to mean those of the larynx (voice box), tongue, the mouth, the lips and saliva glands, and the pharynx (throat).

These are relatively common in developing countries where smoking and alcohol abuse are problems, since they are closely associated with both smoking and alcohol use.

They can be devastating cancers, since treatment often results in deformity, and, if of the larynx, loss of the voice. To make matters worse, they are difficult to see and are often not picked up until they are well advanced.

Who gets head and neck cancers?

Head and neck cancers mainly affect those of low socioeconomic status who are heavy users of tobacco and alcohol.

They represent 5% of all malignancies and are the fourth most common cancers in men. The mouth is the most common site, followed by the larynx and the pharynx. Head and neck cancers are usually squamous cell cancers.

What causes head and neck cancers?

The main risk factor is tobacco and alcohol use; for alcohol generally spirits rather than wine and beer. This relationship is consistent and has been found in studies throughout the world. The association is strengthened by the fact that stopping smoking reduces the risk of getting one of these cancers.

The increased risk of head and neck cancers among alcoholics has also been seen in a number of studies world-wide.

There are also possible environmental influences such as exposure to the human papilloma viruses (HPV) and the Epstein-Barr Virus (EBV), which may promote head and neck cancer. There is increasing evidence that viruses play a role in cancer of the nose.

The fact that young adults, and those who have never smoked, sometimes get head and neck cancers suggests that there may be a genetic predisposition. Mutations in tumour suppressor genes havebeen found in these people.

What are the symptoms of head and neck cancers?

The symptoms of head and neck cancers vary depending on how advanced they are and the stage of the disease, particularly whether or not there has been any spread.

Since disease which is caught early is more likely to be cured than that detected late, it is important to be aware of the early signs of one of these cancers. Cancers of the mouth can first present as non-healingulcers, swelling, spasm of the jaw muscles and pain.

Pain in one ear only is not uncommon, and can be referred from other areas of the head and neck, so is an important symptom in someone who has smoked for many years.

Cancers of the nose and sinuses present with discharge from the nose and persistent congestion. Because the nose and the ears are closely linked, these cancers may also sometimes first be picked up along with an ear infection, and problems with balance.

Large tumors of this area can affect nerves in the head and neck and cause facial pain, double-vision and other neurological problems.Cancers of the upper part of the throat and soft palate are often silent and so present late. Symptoms may include sore throat, jaw spasm, pain in the ears, spitting up blood and pain and difficulty on swallowing.

Cancer of the larynx is, fortunately, the only one of these cancers to show early symptoms. These are hoarseness and difficulty breathing.

Any of the above symptoms in someone who is a heavy drinker or smoker must be taken very seriously, and they should be examined by a specialist in ear-nose-and-throat problems.

How are head and neck cancers treated?

As with all other cancers treatment depends on the stage of the disease, that is, how far advanced it is when first diagnosed. Generally, early tumors can be treated with surgery or radiation therapy alone. Advanced tumors often require chemotherapy along with surgeryand radiation therapy.

Modern techniques can now provide excellent control of the tumor, both at their point of origin and if they have spread. So, quality of life of those with these tumors has improved. However, overall survival has not changed much, probably because these tumors spread easily.

Radiation can be used on its own for early cancers, or as part of combined therapy with surgery and chemotherapy for advanced cancers.The advantages of radiotherapy are that it can prevent disfiguring surgeryand it is effective for early tumors. The disadvantages are that it causesdental problems, swelling of the tissues of the mouth, damage to the boneof the face and jaw, and cannot be used again should the cancer re-occur. The side effects are dry mouth, loss of taste and skin changes.

Surgery is an effective technique on its own in early cancers and is often used in combination with radiotherapy in more advanced tumors. The advantages of surgery are that it effectively removes the cancer with few side effects in early tumors and allows a relatively quick recovery. It also allows assessment of the lymph nodes and tissue around the tumor, which is helpful in telling whether the cancer has spread. The disadvantages are potential disfigurement, loss of function and surgical complications.

Chemotherapy is not widely used in head and neck cancers and it's role is not well defined. It is being used more often since cancers are now more easily removed from their point of origin, but patients are then getting re-occurence at distant sites. The idea behind chemotherapy is to prevent these distant occurences.

Its potential is still being investigated. Where are we now?

The overall five year survival rates for head and neck cancers vary according to where they are and the stage at which they are detected. Sites with a good prognosis include the lip and the glottis (part of the larynx),with survival rates of 80 to 85%.

Cancers of the soft palate, base of the tongue and the nose and sinuses unfortunately generally only have survival rates of between 20 and 40%.

All patients with head and neck cancers need frequent follow up since the possibility of re-occurence is high. Treatment of this type of cancer has advancedenormously in the past few years and the surgery is not nearly as disfiguring as itused to be. However, prevention is still the best form of treatment.Do not smoke and keep your alcohol intake at moderate levels.