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HEAD AND NECK CANCER

Cancer type

WHAT IS HEAD AND NECK CANCER

Head and neck cancer is a group of cancers that develop in areas like the mouth, throat, voice box (larynx), nose, sinuses, or salivary glands. These cancers usually start in the squamous cells, which are thin, flat cells lining the surfaces of these areas.

Common causes include smoking, heavy alcohol use, and infections like human papillomavirus (HPV) or Epstein-Barr virus (EBV). Poor oral hygiene, exposure to harmful substances (like asbestos or wood dust), or prior radiation exposure can also increase the risk.

Symptoms can vary but may include a lump in the neck, a sore in the mouth or throat that doesn’t heal, hoarseness, difficulty swallowing, ear pain, or persistent nasal congestion. Early detection and treatment—through surgery, radiation, or chemotherapy—can improve the chances of recovery.

Head and neck cancers are categorized based on the area where they start. Here are the main types:

TYPES OF HEAD AND NECK CANCER

There are different types of colon cancer based on where it starts and the type of cells involved. Here are the main types:

Oral Cavity Cancer
  • Affects the lips, tongue, gums, inner cheeks, roof of the mouth (hard palate), and the floor of the mouth under the tongue.
  • Symptoms: A sore in the mouth that doesn’t heal, difficulty chewing or speaking, or a lump.
Pharyngeal Cancer (Throat Cancer)
  • Nasopharyngeal Cancer: Starts in the upper throat behind the nose.
  • Oropharyngeal Cancer: Affects the middle throat, including the tonsils and base of the tongue. Often linked to HPV.
  • Hypopharyngeal Cancer: Affects the lower part of the throat, near the esophagus.
  • Symptoms: Persistent sore throat, difficulty swallowing, ear pain, or hoarseness.
 Laryngeal Cancer (Voice Box Cancer)
  • Affects the larynx, which contains the vocal cords.
  • Symptoms: Hoarseness, breathing problems, or a persistent cough.
Nasal Cavity and Paranasal Sinus Cancer
  • Starts in the nasal cavity (inside the nose) or the sinuses (air-filled spaces around the nose).
  • Symptoms: Nasal blockage, frequent nosebleeds, or facial swelling.
Salivary Gland Cancer
  • Affects the glands that produce saliva, such as those under the jaw, in front of the ears, or under the tongue.
  • Symptoms: A lump near the jaw, mouth, or neck; numbness in part of the face.
Thyroid Cancer (sometimes included in head and neck cancers)
  • Starts in the thyroid gland at the base of the neck.
  • Symptoms: A lump in the neck, changes in voice, or difficulty swallowing.

Key Point

Each type is treated differently, depending on the location, stage, and specific characteristics of the cancer.

CAUSES AND RISK FACTORS OF HEAD & NECK CANCER

Head and neck cancer occurs when abnormal cells grow uncontrollably in areas like the mouth, throat, nose, or sinuses. These cancers are often associated with specific causes and risk factors, which can be divided into modifiable (lifestyle-related) and non-modifiable factors.

Causes

Head and neck cancer typically starts when the DNA in cells of the affected area becomes damaged or mutated. This can happen due to environmental factors, infections, or inherited traits. Over time, these damaged cells multiply, forming tumors.

Risk Factors

Non-Modifiable Risk Factors (Cannot Be Changed)

  1. Age: Most cases occur in people over 50.
  2. Gender: Men are more likely than women to develop head and neck cancer.
  3. Genetic Predisposition: A family history of head and neck cancer may increase risk.
  4. Epstein-Barr Virus (EBV): Associated with nasopharyngeal cancer.
  5. Radiation Exposure: Previous radiation therapy to the head or neck area.

Modifiable Risk Factors (Can Be Changed)

  1. Tobacco Use:
    • Smoking cigarettes, cigars, or pipes is a leading cause.
    • Chewing tobacco or using snuff also raises the risk, especially for cancers of the mouth and throat.
  2. Alcohol Use:
    • Heavy drinking increases the risk, especially when combined with tobacco use.
  3. Human Papillomavirus (HPV):
    • Certain strains of HPV, particularly HPV-16, are linked to oropharyngeal cancers.
    • Often spread through sexual contact, including oral sex.
  4. Poor Oral Hygiene:
    • Increases the risk of oral cancers.
  5. Diet:
    • A diet low in fruits and vegetables is linked to a higher risk of head and neck cancers.
  6. Exposure to Harmful Substances:
    • Workplace exposure to substances like asbestos, wood dust, paint fumes, and chemicals can increase the risk.
  7. Betel Quid and Areca Nut Use:
    • Common in some cultures, chewing these substances significantly raises the risk of mouth and throat cancer.
  8. Weakened Immune System:
    • Conditions like HIV/AIDS or medications that suppress immunity can increase risk.
  9. Chronic Irritation:
    • Prolonged use of ill-fitting dentures or chronic irritation in the mouth or throat may contribute.

 

Emerging or Possible Risk Factors

Genetic Mutations: Mutations in certain genes (e.g., TP53) may predispose individuals to head and neck cancers.

Reflux Disease (GERD): Chronic acid reflux may contribute to throat cancer.

Night Shift Work: Disruption of circadian rhythms might have a small impact.

Key Takeaway

Tobacco and alcohol use are the leading causes of head and neck cancer, but other factors like infections (HPV, EBV), poor diet, and occupational exposures also play significant roles. Many risks can be reduced by lifestyle changes, regular screenings, and vaccinations (e.g., HPV vaccine).

The treatment of head and neck cancer depends on the type, location, stage, and overall health of the patient. It often involves a combination of therapies to remove or destroy the cancer while preserving function and appearance.

TREATMENT

Surgery
  • Used to remove the tumor and surrounding tissue.
  • Common types:
    • Tumor Removal: Removing the cancer and nearby lymph nodes if necessary.
    • Neck Dissection: Removing lymph nodes in the neck if cancer has spread.
    • Reconstructive Surgery: Restoring appearance and function after tumor removal (e.g., skin grafts or prosthetics).
  • Indications: Effective for localized cancers.
Radiation Therapy
  • Uses high-energy beams to destroy cancer cells.
  • Types:
    • External Beam Radiation Therapy (EBRT): Common for head and neck cancers.
    • Brachytherapy: Placing radioactive material near the tumor.
  • Often used after surgery to eliminate remaining cancer cells or as the primary treatment for early-stage cancers.
  • Side Effects: Skin irritation, dry mouth, difficulty swallowing, and fatigue.
Chemotherapy
  • Involves drugs that kill cancer cells or stop their growth.
  • Commonly combined with radiation therapy (chemoradiation) for advanced-stage cancers.
  • Used to shrink tumors before surgery or control cancer that has spread.
  • Side Effects: Nausea, hair loss, weakened immune system, and fatigue.
Targeted Therapy
  • Uses drugs that specifically target cancer cell proteins or genetic changes.
  • Example: Cetuximab, which targets the EGFR protein found in some head and neck cancers.
  • Often combined with radiation or chemotherapy.
  • Fewer side effects compared to chemotherapy.
Immunotherapy
  • Helps the immune system recognize and attack cancer cells.
  • Example: Immune Checkpoint Inhibitors like pembrolizumab and nivolumab.
  • Used for advanced or recurrent head and neck cancers.
  • Side Effects: Fatigue, rash, or inflammation in various organs.
Photodynamic Therapy (PDT)
  • Uses a light-sensitive drug and laser to destroy cancer cells.
  • Suitable for small, early-stage cancers.
Supportive and Palliative Care
  • Focused on managing symptoms and improving quality of life.
  • Includes pain management, nutritional support, speech therapy, and psychological support.
  • For advanced cases, palliative care ensures comfort and dignity.
Rehabilitation After Treatment

Speech and Swallowing Therapy: Helps restore normal speech and swallowing functions after surgery or radiation.

Physical Therapy: Maintains movement and strength, especially after neck dissection.

Nutritional Support: Managing eating difficulties with the help of a dietitian.

Follow-Up Care
  • Regular check-ups are essential to monitor for recurrence or late side effects.
  • Imaging tests, blood tests, and endoscopic exams may be required.

Personalized Treatment

Treatment plans are tailored to each patient, considering their medical history, preferences, and the specific cancer characteristics. Early detection often allows for more effective and less aggressive treatments.

PREVENTION OF HEAD AND NECK CANCER

Preventing head and neck cancers involves addressing modifiable risk factors and adopting healthy lifestyle choices. Key preventive measures include:

Avoid Tobacco Products
  • Smoking: Cigarette, cigar, and pipe smoking are major risk factors. Quitting smoking significantly reduces the risk of developing head and neck cancers.
  • Smokeless Tobacco: Using chewing tobacco or snuff also increases cancer risk. Avoiding these products is crucial.
Limit Alcohol Consumption
  • Heavy and frequent alcohol use elevates the risk of head and neck cancers. Moderating alcohol intake or abstaining altogether can lower this risk.
 Maintain Good Oral Hygiene

Regular brushing, flossing, and dental check-ups help prevent infections and conditions that could lead to cancer. Poor oral hygiene has been linked to an increased risk of head and neck cancers. 

Get Vaccinated Against HPV

The human papillomavirus (HPV) is associated with certain head and neck cancers, particularly oropharyngeal cancer. Vaccination against HPV can significantly reduce this risk. 

Practice Safe Sexual Behaviors

Engaging in safe sex practices reduces the risk of HPV transmission, thereby lowering the chance of HPV-related head and neck cancers.

 Protect Against Prolonged Sun Exposure

Extended exposure to ultraviolet (UV) light increases the risk of lip and skin cancers in the head and neck region. Using sunscreen, wearing protective clothing, and avoiding tanning beds can help mitigate this risk.

Eat a Balanced Diet

Consuming a diet rich in fruits and vegetables provides essential vitamins and antioxidants that may protect against cancer. Limiting processed and salty foods is also advisable.

Avoid Exposure to Carcinogenic Substances

Occupational exposure to substances like asbestos, wood dust, and certain chemicals can increase cancer risk. Using protective equipment and following safety guidelines in the workplace are important preventive steps.

Regular Medical and Dental Check-Ups

Routine examinations can detect precancerous conditions or early-stage cancers, improving the chances of successful treatment.

By implementing these preventive strategies, individuals can significantly reduce their risk of developing head and neck cancers.

NEWER ADVANCEMENTS/ RESEARCHES

Recent advancements in head and neck cancer research have led to significant improvements in diagnosis, treatment, and patient outcomes. Key developments include:

 Immunotherapy and Targeted Therapies
  • Cetuximab vs. Durvalumab: A study comparing cetuximab and durvalumab found that cetuximab outperformed durvalumab in treating head and neck cancers, with a higher probability of patients being alive and disease-free at two years. 
  • HPV Vaccination: Research indicates that HPV vaccines, initially designed to prevent cervical cancer, also reduce cancer risks in men, including head and neck cancers. 
Artificial Intelligence (AI) in Diagnosis and Treatment

AI technologies, such as deep learning and natural language processing, are enhancing diagnostic accuracy and personalizing treatment strategies for head and neck cancer. These advancements aid in early detection, biomarker discovery, and treatment planning. 

Early Detection Methods

Diagnostic Lollipops: Scientists are developing non-invasive “flavored lollipops” that can diagnose mouth cancer before symptoms appear, offering a quicker and less painful alternative to traditional methods. 

Microbiome Research

Studies have discovered that certain oral bacteria, like Fusobacterium, can kill up to 99% of specific cancer cells, particularly in head and neck cancers. This finding could lead to new treatment approaches.

 Lifestyle Factors

Research emphasizes the importance of oral hygiene, revealing that neglecting dental care can increase the risk of head and neck cancer by up to 50%. Regular brushing and flossing are crucial preventive measures. 

These advancements reflect a multidisciplinary approach to combating head and neck cancer, integrating immunotherapy, AI, early detection techniques, microbiome research, and lifestyle modifications to improve patient outcomes.