Head and neck cancers: an overview

By Cristiano Antonino On Oct 12, 2022

Head and neck cancers: what is known? More than half the population does not know what ‘head and neck cancers’ are, and only a few know that viruses, specifically the Human Papilloma Virus – HPV, can also cause them

Lack of information is often responsible for the frequent delay in the diagnosis and consequently in the treatment of this important group of cancer diseases.

Head and neck cancers are difficult to treat when diagnosed at an advanced stage or when the disease has spread to other organs.

What are head and neck cancers?

The term ‘head and neck tumours’ refers to cancer affecting the mouth, tongue, gums, pharynx, larynx, nose, sinuses and salivary glands.

The organ most frequently affected is the larynx, followed by the oral cavity and pharynx.

Within each individual organ, it is important to know the precise location of the tumour (e.g. the pharynx is divided into nasopharynx, oropharynx or hypopharynx) in order to understand the severity of the disease.

The definition of the most correct therapy is decided by a group of medical experts in different specialities, which include the ENT surgeon, the radiotherapist and the oncologist.

Head and neck cancers, epidemiological data

It is estimated that in Europe there are approximately 140,000 cases of head and neck cancer and over 65,000 deaths each year are linked to this disease 1;

In women, the incidence is rising, linked to an increase in cancers of the oral cavity and pharynx.

What are the main risk factors?

Tobacco use (cigarettes, cigars, pipes, chewing tobacco, snuff) – represents the largest and most important risk factor. It is estimated that 85% of all such cancers are tobacco-related;

Frequent high alcohol intake – follows smoking in importance. It alone appears to increase the risk 5-11 times.

The association between smoking and alcohol further increases the risk;
Marijuana;
Passive smoking, asbestos dust, chemicals of various kinds;
Diet low in vitamins A and B;
Poor and incorrect oral hygiene, especially in individuals wearing dentures;
Human papilloma virus (HPV) exposure – this infection is currently considered to be very important in the genesis of some of these diseases (especially those of the oropharynx and mouth). The same virus is responsible for cervical cancer, and the infection is believed to be spread through sexual intercourse;
Epstein Barr virus is associated with cancers of the nasopharynx.

The importance of early diagnosis

Recognising the symptoms and diagnosing head and neck cancers at an early stage offers patients a hope of cure in excess of 90%.

Whenever possible, these tumours are treated with surgery, but there is often a danger of demolitive and invasive operations, as the disease is diagnosed at an advanced stage in 9 out of 10 cases.

Early intervention, which offers a better chance of resorting to less invasive surgery, makes it possible to preserve the functionality of the part affected by the tumour.

What are the main diagnostic techniques for head and neck cancers?

Early diagnosis of these diseases is based on the recognition of initial symptoms and a thorough medical examination, such as an exploration of the oral cavity.

Subsequently, an exact diagnosis requires a biopsy and the use of instrumental investigations such as fibroscopy, an endoscopic examination during which it is often possible to visualise the tumour and its extension.

How can symptoms be recognised?

Head and neck tumours are slow-growing in their early stages, which means that initial symptoms may be mild and non-specific.

This can cause a delay in diagnosis.

Common symptoms of the disease, but which should not be alarming as they can also be found in more frequent and less serious diseases, are for example

ulcers in the mouth;
weakness, anorexia and weight loss from malnutrition due to difficulty swallowing;
emission of blood from the mouth or respiratory tract;
earache;
painful swallowing;
appearance of swelling in the neck region.

Symptomatology may also take on characteristics depending on the site of origin of the disease:

in tumours of the larynx there may initially be voice changes; later, swallowing becomes difficult and/or painful;
in tumours of the pharynx there may be a foreign body sensation or pain in the throat, difficulty swallowing, halitosis, nasal voice and excessive saliva production. Many may feel lumps on the neck (enlarged lymph nodes). If the tumour is localised at the base of the nose, other symptoms may be auditory disturbances such as hearing loss, buzzing, whistling, feeling of a plugged ear, repeated and recurrent episodes of otitis, profuse nasal discharge, nosebleeds. In advanced forms, headaches, loss of sense of smell, reduced vision and double vision may occur;
in tumours of the mouth, the initial symptoms are mild such as small painful blisters, ulcers or wounds that do not heal, difficulty in tongue movements to the inability to open the mouth in the more advanced forms;
in tumours of the paranasal sinuses, nasal obstruction, copious nasal discharge and nosebleeds often appear. Pain, altered facial sensitivity, visual disturbances and tongue deviation are all symptoms of advanced disease.

It is therefore important to recognise apparently non-specific symptoms, especially when present in individuals at risk for developing head and neck cancer.

In the presence of one or more of these symptoms that do not resolve in a short time, it is a good idea to consult your doctor or a specialist.

Multidisciplinarity

Often, patients receive a combination of different treatment modalities and therefore a multidisciplinary approach is essential.

A multidisciplinary approach means an approach involving several specialists such as the surgeon, oncologist and radiotherapist working together to achieve the best therapeutic outcome.

In head and neck cancer, the nutritionist, rehabilitator (speech therapist), pain therapist, dentist, psychologist and social worker 5 should also be part of this group of specialists.

It has been shown that the multidisciplinary approach has become an inescapable necessity, as it can contribute to increased survival and a significant improvement in the quality of life of head and neck cancer patients.

Head and neck cancers, therapies

In this neoplasm, there are several therapies that can be used individually or together.

Several factors influence the choice of the most appropriate therapy, including:

the location of the tumour
the extent of the tumour;
the rapidity with which it has spread;
the general health condition;
the aesthetic and functional results;
patient preference 5.

Treatment options include:

Surgery

Patients with localised pathology that has not spread may undergo tumour surgery. Surgery may be followed by radiotherapy.

Radiotherapy

Patients with locally advanced tumours that cannot be operated on may receive radiotherapy alone, radiotherapy in combination with a monoclonal antibody, or radiotherapy in combination with chemotherapy.

Radiotherapy in combination with monoclonal antibody is as effective as the combination of radiotherapy and chemotherapy, but is associated with less toxicity.

Chemotherapy

Chemotherapy can be used in patients undergoing surgery either before surgery – when the tumour is large or to reduce the size or number of metastases – or after surgery to prevent recurrence.

In advanced (metastatic) stages, chemotherapy is used in combination with a monoclonal antibody to reduce tumour mass, alleviate symptoms and pain, and prolong survival 6.

Targeted therapy

In recent years, a monoclonal antibody targeting the epidermal growth factor receptor has helped to improve the treatment of these diseases.

This monoclonal antibody specifically attaches itself to tumour cells and acts by interfering with those particular molecules that are necessary for tumour growth and proliferation.

In this way, it helps to reduce the size of the tumour, increasing life expectancy and bringing significant benefits to patients’ quality of life, as it reduces the impact of symptoms related to this disease.