Head and neck cancer: The lesser known facts | Health - Hindustan Times
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Head and neck cancer: The lesser known facts

ByZarafshan Shiraz, Delhi
May 08, 2023 08:13 PM IST

In India, most of the head and neck cancers are diagnosed in advanced stages hence, early detection is of paramount importance. Here's what to know

Globally, Head and Neck Cancer (HNC) are the seventh-most common cancer and developing countries such as India are witnessing a rise in its incidence as in India, Head and Neck Cancers are the second most common cancer especially, Lip and Oral Cavity Cancer. When we say cancer of the head and neck, we club cancers of head and neck area in quite a few anatomical subsites -- cancers of the lips, tongue, mouth, other parts in the pharynx i.e. (oropharynx, nasopharynx, hypopharynx), sinuses, nasal cavity, the salivary glands and the larynx (voice box) and the different HNC types may have similar natural course of history and their pattern of spread to adjacent sites and lymph nodes.

Head and neck cancer: The lesser known facts (Shutterstock)
Head and neck cancer: The lesser known facts (Shutterstock)

In an interview with HT Lifestyle, Dr Yash Mathur, Head Neck Surgical Oncologist at HCG Cancer Centre in Mumbai, shared, “Many subsites of the disease’s location makes several of its manifestations easily visible or palpable on clinical examination, allowing easier detection but symptoms which are not alarming are easily mistaken for less-damaging diseases and can mislead patients due to ignorance. In India, most of the head neck cancers are diagnosed in advanced stages and hence early detection is of paramount importance.”

According to him, due to scarcity of good and affordable medical facilities people ignore and often report their sign and symptoms late. Advising to seek medical attention for certain symptoms associated with HNC, he highlighted some of the prevalent symptoms, depending on the site of HNC -

  • Oral cancer: Unexplained swelling or growth in the jaw, numbness on the lip, loosening of teeth, red or white patch in the mouth, such as on the gums, the tongue or inside of the cheeks, that don’t heal for more than 15 days, progressive reduction of mouth opening, change in speech, unusual bleeding in the mouth or from the gums.
  • Throat/Pharynx cancer: A sore throat which refuses to heal even after 2 weeks, difficulty or pain in swallowing; pain in the neck , persistent cough that refuses to stop; pain or ringing in the ears; sudden trouble in hearing; a change of voice or a hoarse voice. Difficulty in swallowing along with pain in ear.
  • Nasopharynx cancer: Aggravated or blocked sinuses that refuse to heal; chronic sinus infections that resist antibiotics; persistent/multiple episodes of nosebleeds, frequent headaches, swelling or other trouble in the eyes, pain in the upper teeth.
  • Voicebox/Larynx cancer: Difficulty in breathing, a change of voice or a hoarse voice, pain in swallowing, ear pain. Persistent coughing after swallowing liquids.
  • Salivary gland cancer: Pain in the ear area, chin, below jawbone or neck which is persistent; a lump or swelling anywhere in the neck near jawbone, facial paralysis, drooping of saliva from corner of mouth on one side, inability to smile completely, inability to withhold air in mouth, partial closure of eye lid or radiating pain along the neck, in front of ear, behind the ear.

He revealed, “Gold standard for HNC is diagnosis by tissue biopsy, some under local and some even require general anesthesia. The extent of spread may be detected through imaging such as Pet scan or Contrast enhanced MRI, CT scan. Late diagnosis in HNC is often blamed on illiteracy, poverty but there is also the paucity of trained HNC oncologists and cancer diagnostic and treatment centers beyond the metros that make diagnosis and treatment tailored to the patient difficult. The head and neck houses vital, intricate and delicate parts that are crucial for our appearance, social interaction, speech and facial expression. HNC may wrought deformities, functional problems, affecting the quality of life of the patient.”

Dr Yash recommended that due to rapidly changing guidelines in field of oncology, once HNC deemed treatable, patient can be treated with surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy or combination of these therapies depending on the stage and structures involved. He said, “Apart from these factors the person’s age and overall health and other associated illness also determine the course of treatment. Pain management and palliative care are other ways of improving the patient’s quality of life when patient cannot be cured of cancer. While early detection helps achieve better treatment results, the etiology like tobacco and alcohol are major cause of having other associated illnesses of cardio respiratory, liver, neurological origin thus complicating cancer treatment plans.”

Advanced stage HNC may be difficult to manage but the onset can be prevented and Dr Yash Mathur insisted that many HNC in general and oral cancer are the most preventable cancers, which can be achieved through a concerted approach. He said, “HNC is a form of cancer which is largely driven by our lifestyle choices & addiction to betel nut-chewing, tobacco and alcohol consumption, maintaining poor oral hygiene. With lifestyle tweaks, it may be assumed that HNC can be prevented. In Indian sub continent, the world capital of HNC, focus should be on prevention or at least, early detection. It can start with tobacco consumers consulting their doctor and tobacco cessation experts for ways to quit or mitigate tobacco’s risks and maintaining a regular checkup plan. Mouth self examination should be practised by high rish individuals who have history of addiction and have quit the habit now. Vaccinations for prevention of HPV-led head and neck cancer reduces its incidence. Sensitizing people to the signs of HNC through health education and screening on a large scale.”

He emphasised, “Diets rich in green and yellow vegetables and fish have been known to provide protection against HNC. HNC, no matter its prevalence, manifests easily detectable signs and can be treated effectively, especially in its early stages. Reducing Incidence and mortality can be within reach if we act in a concerted way. Opting for a tobacco-free lifestyle, seeking medical attention for possible signs, regular screenings, reinforcing health literacy, building a robust affordable cancer care system with Head Neck oncologists, pathologists, surgeons and radiolgists can all go a long way in cutting down the care gap.”

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