The cancer we ignore

The cancer we ignore

While breast, lung and cervical cancers get a fair share of discussion, one group of cancers—oral, head and neck cancers—finds very little space. Yet the numbers are huge, particularly in India.

According to a 2013 article, Head And Neck Cancer Burden in India, published in the International Journal of Head And Neck Surgery, 57.5% of global head and neck cancers occur in Asia. Head and neck cancers in the subcontinent account for 30% of all cancers and 60-80% of patients are diagnosed at the advanced stage, compared to 40% in developed countries, according to the article. “According to the Indian Council of Medical Research, about 200,000-250,000 new head and neck cancer patients are diagnosed each year,” says Praveen Bansal, director, medical oncology, Asian Institute of Medical Sciences, Faridabad.

What is it?

According to J.B. Sharma, senior consultant, medical oncology, Action Cancer Hospital, New Delhi: “Head and neck cancer are tumours that occur in the head and neck region, usually in areas that include the oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, thyroid, and salivary glands.” Oral cancer, laryngeal cancer, nasal cavity and paranasal sinus cancers, nasopharyngeal cancer or pharyngeal cancer, hypopharyngeal cancer, salivary gland cancer and thyroid cancer are the most common, says Radheshyam Naik, head, medical oncology and stem cell transplantation, HealthCare Global centre, Bangalore. “In India, cancer of the mouth and tongue are more common than head and neck cancers. Moreover, it has been observed that males are affected more than females,” adds Dr Sharma.

The causes:

"About 200,000-250,000 new head and neck cancer cases are diagnosed each year, according to the Indian Council of Medical Research "

A 32-year-old marketing executive based in Gurgaon, working with a beer company, used to smoke and drink occasionally. He developed an ulcer on his tongue; he ignored it, thinking it would heal on its own. It didn’t, and he eventually visited a doctor. It turned out he had cancer of the tongue and had to be operated upon. “He is now undergoing radiation and chemotherapy cycles to eradicate the cancer completely,” says Dr Sharma.

“Tobacco is the most known risk factor for the development of head and neck cancer. In addition, tobacco and alcohol consumption appear to have a synergistic effect. Human papillomavirus (HPV), a sexually transmitted virus, infection also has been established as a causative agent for head and neck cancers,” says Dr Sharma, citing the case of an Delhi-based human resource professional in a multinational company who developed throat pain and was having difficulty in swallowing. Her family doctor first treated her for a sore throat, but when the problem continued to get worse, a biopsy was conducted. She had tongue cancer. She was a non-smoker and the probable cause was pinned to an HPV infection.

“Some other causes of head and neck cancer include exposure to radiation, chewing of betel nut, deficiency of certain vitamins, periodontal (gum) disease, and occupational exposures (to wood dust, synthetic fibres, asbestos, etc.),” says Dr Sharma. “Poor oral hygiene is also a known cause,” adds Dr Bansal.

A study reported in August in the journal Cancer Prevention Research suggested that those with teeth and gums in poor condition might be more susceptible to an oral virus that can cause certain mouth and throat cancers. A research team from the University of Texas Health Science Center in Houston, US, studied more than 3,400 adults and found that those with poor (to fair) oral health were more likely to have an oral infection with HPV, which could sometimes lead to cancer. In fact, the US-based Centers for Disease Control and Prevention reports that worldwide, about 60% of oropharyngeal cancers—cancers of the throat, tonsils and the base of the tongue—are related to HPV.

Diagnosis and treatment:

“Diagnosis of head and neck malignancy normally includes clinical examination, fine needle aspiration/core biopsy of any neck masses, followed by further examination under anaesthetic with additional biopsies if needed. Examination of a sample of tissue under the microscope is always necessary to confirm a diagnosis of cancer,” says Dr Naik. “Endoscopy, CT (computed tomography) scan, PET (positron emission tomography) scan are some other tests which are useful in diagnosis of head and neck cancer,” he adds.

The treatment depends upon the location of the tumour, the stage of cancer and the patient’s overall health. Dr Sharma lists the treatment options: surgery to remove the cancerous cells completely, chemotherapy, where a group of medicines are prescribed to kill cancer cells throughout the body, and radiation therapy, which involves using high-energy rays to kill cancer cells. “The most encouraging advance in the treatment of head and neck cancer is the development of new monoclonal antibodies (cetuximab and nimotuzumab). The introduction of targeted therapies has made a tremendous impact on increasing survival and response rates, and sparing patients the significant toxicities that accompany chemo-radiation,” adds Dr Naik.

Stop it from coming back:

“Besides the terrifying numbers, another reason these cancers can be dangerous is that these are frequently aggressive in their biologic behaviour and patients with these types of cancer often develop a second primary tumour (usually in the head and neck, oesophagus or lungs),” says Dr Naik.

The chance of a second primary cancer is higher in people who smoke and drink alcohol. “After treatment, a regular check-up is essential to see if the cancer comes back. Follow-up tests can include exams, blood tests and imaging tests. Patients are counselled to look for any possible signs of tumour recurrence and post follow-up also includes screening for treatment-related complications (for example, hypothyroidism) and counselling for quitting smoking,” adds Dr Sharma.