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Head and Neck Cancer: Early Detection

Kerala Cancer Crusade and Cancer Literacy Mission and IRIA Preventive Radiology National Program conducted a Webinar Series on “Kerala Cancer Crusade and Cancer Literacy Mission” in association with IRIA Kerala, Swasthi Foundation and Community Oncology, Regional Cancer Centre, Journo Med. The fourth-day webinar discussed “Head and Neck Cancer: Early Detection and Prevention”. The event was held on 14th October 2022.

Dr Rijo Mathew, President of IRIA, Kerala spoke about the importance of Head and Neck Cancers after Lung Cancers. Considering the major statistical data, head and neck cancers are the major cancers that are illustrated in India. 

Smt. Shobha Koshy, Advisory Board Member, Swasthi Foundation spoke about the promotion of early detection of cancers and their prevention. It is a surprising fact that head and neck cancers won’t cover the areas of brain, thyroid and oesophagal cancers. Head and neck cancers specifically discuss throat, mouth and sinistral cancers. Head and neck cancers account for 6th position among the other cancers in the World and surprisingly one-third in India and 30% of all cases in India fall under this category. There are nearly 2,00,000 cases, out of which 40% are oral cancers. There are 77,000 cases in a year, which is the Highest in the World which served as a huge surprise. Most of the cases are gathered among people below 40 years which was a surprising shock. Because of loss of capital and suffering, people under 40 years are more vulnerable to cancer. 40% of the incidents arise due to tobacco chewing. Tobacco usage is considered a cultural practice in the Northern parts of India and if one observes the global scenario, the larger incidents of tobacco usage are observed in Southeast Asia i.e., southern parts of India. Both pros and cons of cancer need to be observed to a greater extent and if detected early, 70-90% of cancer cure is possible. In the case of oral cancer, sedentary life issues even result in diseases and people get addicted to substances like tobacco through either chewing or smoking. Then alcohol consumption and lack of oral hygiene are also crucial things. Even food habits play a major role. A lot of lifestyle modifications need to be made to get cured easily. Many of them deny the fact of having serious symptoms and won’t even approach for diagnosis. As per the NCR centre data, 70% of the population turns up late for diagnosis. Awareness certainly plays a major role. Preventive oncology here provides a better cure for cancers. The global conferences and awareness sessions are conducted to serve as a good platform for important stakeholders. There is a discussion, debate, and clarification of ambiguities or concerns among people which needs to be discussed and the solution must be revealed. It also helps to optimize the resources. As Dr Rijo Mathew said earlier, October month is “National Breast Cancer Awareness Month.” A  neash created for the high end of cancer. In these sessions, women’s health would be a major concern.  

Dr Santhosh Kumar pursued his Fellowship research from JIPMER, Pondicherry Head and Neck Surgery, Regional Oncology from Cancer Centre, Trivandrum. He was trained in laser surgery, in Germany. He is a multifaceted personality who did a professional course in Management from IIM, Kozhikode. He spoke about Head and Neck Cancer including the mucosa of the Urinary and Digestive Tract. From lips to oral cavity, pharynx, larynx, nose, PNS to larynx and hypopharynx. It also includes salivary glands, thyroid, parathyroid glands, bone, skin and soft tissues.

Significance of presenting Head and Neck Cancers

The 5th and the 6th most common cancers are head and neck cancers. In India, it contributes about ⅓ rd of the cancer burden. While in the US, it is less than 5%. Importance is given to the developmental stages of cancer treatment. The diagnostic facilities or the medical facilities have improved with the 5-year survival rate still around 50%. The main reason for the decreased survival rate is most Head and Neck cancers are diagnosed at the advanced stage. 70% present in either stage 3 or stage 4, then cervical cancer decreases. Cancer survival is usually spoken of in terms of 5 years of survival. Aggressive cancers are of 2-3 years of survival. Early cancer survival comes down to 20-40% of cancer. The average would come down to around 50% of cancer. 40-50% of people opt for a good prognosis. 

Most head and neck cancers are preventable. It describes the technology. Unlike GI malignancy or even lung malignancy, early detection is easy. The signs and symptoms can be detected by individuals if observed early. Head and neck cancers mainly affect the lower socio-economic groups and regarding presentation itself, there is a difference. A few cancers might also affect middle-income groups. Most morbidity of the cases is observed if the treatment is neglected or if the patient has undergone other treatment modalities, alternative treatments can be reduced to some extent. Also, a lack of awareness and afraid towards cancer treatments such as hair loss, chemotherapies etc. can lead to mortality in a few cases.  

Cancer-causing Factors

Tobacco: 40% of head and neck cancers are due to tobacco. There are 70 different carcinogens present in tobacco. Either people getting addicted to tobacco or smoking is the major cause of oral malignancy. 

Alcohol and Tobacco: Tobacco and Alcohol are termed as synergistic or addictive. It increases the cancer risk multiple times. It increases the carcinogenic potential. Alcohol serves as a good solvent. Alcohol decreases the activity of DNA repair enzymes, and it increases chromosomal damage. It impairs immunity by reducing the T cell number and decreases the mitogenic and macrophage activity. The first byproduct of alcohol is acetaldehyde and different levels of the population are observed with a deficiency of aldehyde dehydrogenase. The alcohol contains other non-alcoholic constituents especially indigenous. Alcohol directly causes local mucosal damage, which increases the absorption of carcinogens. Chronic alcohol is another cause of malnutrition. It upregulates the enzymes of the cytochrome 450 system leading to the activation of pro-carcinogens to carcinogens. 

Due to Viruses (HPV, EBV, HIV): Cancers of the head and neck is increasing due to the human papillomavirus (HPV) nowadays. HPV is documented evidence of oropharyngeal carcinoma. In the USA, 75% of oropharyngeal malignancies are due to HPV. It may be due to sexual habits including multiple sexual partners or participating in oral sex. HPV is recently for the cervix primarily. HPV-related oropharyngeal cancers have a better prognosis. That’s the reason, the de-escalation treatment is also prescribed. During a biopsy, a routine check-up of HPV must be conducted. CA nasopharynx is more prevalent in Hongkong, China and the Northeast. In India, it is mainly due to the Ebstein-Barr virus, and the prevalence of HIV is decreasing. HIV Virus also leads to several malignancies. 

Usage of Immunosuppression Drugs: Any immunosuppression drugs can cause cancers. Chronic immunosuppressants can cause malignancy and malnutrition. Most transplantation patients receiving immunosuppressants for longer duration are cancer sufferers. Chronic immunosuppressants are another cause of malignancy.  

Malnutrition and Dietary Factors: So many deficiencies can cause malnutrition, but increased obesity, increased calorie, and increased protein intake can also cause malignancy. It is usually more common among Head and Neck cancer cases. Even Oxygen free radicals and nitrogen free radicals are abundant in other metabolic conditions which leads to head and neck cancers and other malignancies. Radiation provided must be extraterrestrial radiation during cancer treatments. Chronic irritation and trauma due to dentures can also cause head and neck cancers, and oral cancers. 

Genetic and Familial Factors: Many people are associated with tobacco-associated susceptibility to HNSCC.
If the first-degree family member has got a malignancy. They got an increase in malignancy of 2-14-fold. There is a chance of malignancy if there are using tobacco. There can be other conditions like genetic factors such as Xeroderma pigmentosum, Fanconi anaemia, Ataxia telangiectasia, Li-Fraumeni syndrome, and Hereditary non-polyposis colorectal cancer. In these conditions, there is an increase in potential. 

Occupational Risk Factors
There are several occupational risk factors which lead to cancer. Some of the occupational workers who get affected by cancer are:

Woodworkers have an increase in nose and paranasal malignancies.
Formaldehyde workers
Alcohol manufacturing workers
Leatherworkers
Workers from Nickel refiners
Radium dial painters
Paint and printing industry workers
Textile workers
Chromium and Abestos industry workers
Workers from the Rubber fumes industry
Sulphuric acid metal workers
Plastic and car mechanics
Coal and stone dust workers
Naphthalene industry workers 

Facts and Statistics

Over 9,00,000 cases every year and 4,00,000 deaths occur annually. Oral cancer is more prevalent in the Indian subcontinent. Ca Nasopharynx is more prevalent in Hong Kong.
The male, female ratio varies between 2:1 and 15:1. The cases of head and neck cancer are increasing in females nowadays. Especially, it is associated with non-alcohol and non-tobacco-associated head and neck cancers. The highest incidence of head and neck cancers is observed in males in Somme, France (43.1/ 1,00,000). In females, it is in Bangalore (11.2/ 1,00,000). The lowest incidence cases were observed in males in Quito, Ecuador (2.4/ 1,00,000. In females, it is observed in Kanawha, Korea (0.05/ 1,00,000). 

  • Many head and neck cancers start as premalignant lesions. Leukoplakia is one condition where white lesions appear in the oral cavity. Leukoplakia, another condition suddenly appears as diffuse, and it can be excited earlier. 
  • Erythroplakia has much more increased potential. Submucous fibrosis is mainly due to tobacco. It has got the maximum malignant potential.
    Lichen Planus, Keratosis is a condition of having white patches.
  •  Oral cancers are usually seen in the larynx which results in voice modifications. Either biopsy is required and regular endoscopy examination is suggested.

    Pre-malignant Lesions

    To observe the pre-malignant lesions, laser excision is preferred. Even a biopsy is preferred to observe the suspicious areas.

    Symptoms

    A few symptoms of cancer include:

    Non-healing ulcer
    Swelling
    Pain
    Loosening of teeth
    Ill-Fitting dentures
    Change in voice
    Difficulty in swallowing
    FB sensation in the throat
    Nasal obstruction/ mass
    Chronic epistaxis
    Serous otitis media
    Cervical lymph node enlargement
    CN Palsy

    Even in the early and advanced stages of tongue cancers, early detection helps in proper diagnosis. Usually the salivary gland, and mucosa cover malignancies, in such cases a biopsy is performed. The biopsy can yield only mucosa, but efficacy can diagnose it.

    Evaluation

    First tissue diagnosis is required if one is suspecting regarding a malignancy. Staging can be done with imaging depending on the clinical stage of the disease. One can go for an ultrasound neck, CT, MRI or even a PET scan in later stages. Endoscopic evaluation is also available for all head and neck malignancies. Synchronous are common with head and neck cancers. All 40% of cancers are usually due to tobacco. There are multiple pre-malignancies for cancer-prone areas. Endoscopic evaluation is much required. 

Conclusion 

A lot of Head and neck cancers remain incurable as there is no awareness of head and neck cancers. If the cancer detection camp is being conducted, there can be awareness and a lot of cancer cases can come into the limelight. It is observed in most cases, some people don’t approach for evaluation. After 2000, cancer treatment changed a lot. 70-80% of cancers are potentially curable. The only thing is cancers need to be detected at an early stage. Most people are afraid of cancer before the 2000 century. Chemotherapy is followed which involves different medications. Kerala Cancer Crusade aims to identify people with high cancer risk and the high-risk groups are identified among the population. With the help of the doctor community, clinical and the para clinical community, cancer can be reduced to a major extent. Thus, a crucial role of the Kerala Cancer Crusade in eradicating cancer to major extent. 


 

 

 

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