This week is celebrated as head and neck cancer awareness week across the world to bring attention to the devastating impact of these cancers, with a focus on early detection and treatment. Despite these cancers accounting for a third of all new cancers in India annually, awareness remains low for several reasons. The anatomy of this region is complex even for medical practitioners to understand, and symptoms associated with these cancers can often be vague and non-specific. Our understanding of head and neck cancers is also riddled with misconceptions—like that they occur only in the elderly and are always associated with heavy tobacco and alcohol exposure—which hamper early evaluation, treatment, and cure. As a nation, treating these cancers remains a formidable challenge, with three-quarters of patients being diagnosed at an advanced stage, when the resources and expenditure required for treatment are considerable and survival modest. To combat this menace, it is imperative to try and understand this group of cancers better.
The most common head and neck cancers are those of the mouth, throat (the area behind the mouth but above the voice box), and voice box, with the majority of these (around 80-85%) being tobacco and/or alcohol related. The remaining patients may never have had tobacco or alcohol exposure and can belong to virtually any age group; it’s important to realise this. The symptoms of mouth cancer are a white or red patch on the tongue, roof of the mouth, gums, or cheek; an irregular growth or sore in the area; progressive difficulty opening the mouth; persistent bleeding gums; blood-tinged saliva; or loosening teeth. Throat cancers are associated with pain or difficulty swallowing, a lump in the throat, coughing, or a change in voice. Voicebox cancers can present with hoarseness or a change in voice quality, breathing difficulty, painful or difficulty swallowing, or a feeling of fullness in the throat. These cancers can spread to the lymph glands in the neck, which can feel like lumps. Any of these symptoms lasting more than two weeks needs urgent evaluation to rule out cancer.
Although these cancers affect the way that patients see themselves and interact with the world around them, there are effective treatments available with high cure rates. Surgery, radiotherapy, and chemotherapy, either as individual treatments in early-stage cancers or as a combination in advanced-stage cancers, afford high cure rates with significant preservation of functions like swallowing, speech, taste, and facial expression. The challenge in treating these cancers remains to be radical enough to cure vthese aggressive tumours while limiting the collateral damage to the surrounding tissues to prevent treatment-related complications and loss of function. Sophisticated surgical techniques and equipment allow for complete removal of extensive tumours and appropriate reconstruction of form and function, while newer generations of radiotherapy delivery ensure high-dose delivery of ionising radiation to the tumour and minimal scatter to the surrounding normal tissues. Systemic therapy allows for a more targeted approach to cancer treatment with a reduced impact on normal tissues and physiology.
With a wide variety of treatment options available, oncologists are now able to offer patients several appropriate therapies based on the type of cancer, stage, and the patient’s general health. As with other cancers, there is an expanding role for personalised medicine, where, based on more refined and detailed testing, a tailor-made treatment plan that is most likely to be effective and suitable is matched to a patient. Unlike in other cancers like those of the breast, colon, or lung, the molecular testing that helps us understand the ideal treatment for head and neck cancers is still being developed; considerable research is still needed to be able to predict treatment response and prevent treatment failures. However, given the large volume of patients and the diversity of patients seen in the country, we have a unique opportunity to generate high-quality research and data that is used to improve the way that the world treats head and neck cancer. India has made significant contributions in this sphere already, especially in the treatment of advanced cancers; patients who were previously considered incurable now receive treatment and go on to live long and meaningful lives.
Treatment of head and neck cancer is probably the best example of teamwork in medicine. In addition to a large group of cancer and non-cancer specialists directly involved in treatment, a diverse team of specialists is also needed for rehabilitation and recovery. Speech and swallowing therapists, dentists, physical therapists, and psychologists are all vital components of a head and neck oncology service that not only cures patients, but also relieves them of the burden and trauma of cancer and its sequelae, and allows them to rejoin society as self-sufficient, confident and productive individuals. Although large cancer centers have these teams in place, most cases of cancer aren’t treated in these setups; technological advancements offer us unique opportunities to de-centralize cancer care and rehabilitation so that physical proximity to infrastructure, equipment,
The author is Consultant and Head of Department, Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Centre, Bengaluru.