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Mortality from head and neck cancers is very high. For 5,5 thousand cases diagnosed annually as much as 3,8 percent ends in the patient’s death. What are head and neck cancers? Where do they come from? For MedTvoiLokona, Dr. Dorota Kiprian – oncologist, deputy head and chief radiotherapist of the Head and Neck Cancer Clinic in Warsaw, explains.
- Many types of neoplasms can develop in the head and neck area, including the most common cancer of the larynx among Poles
- The lifestyle is largely responsible for these cancers. However, viral neoplasms are also becoming more common
- These most often affect young people who do not smoke or consume alcohol
- More information can be found on the Onet homepage
What are head and neck cancers? Which of them is the most common among Poles?
Tumors of the head and neck region affect virtually every organ that is located in this area, but excluding the brain. The central nervous system is excluded from this classification. These are neoplasms located in the pharynx, nasopharynx, oropharynx, lower pharynx, larynx, salivary glands, maxillary and ethmoid sinuses, outer, middle and inner ear, thyroid gland, as well as the skin of the head and neck. So it is a very broad category.
In Poland, the most common cancer of the head and neck region is laryngeal cancer. Oropharyngeal cancer has also been increasing recently, but laryngeal cancer remains in the lead. Its incidence does not change from 10 to 15 years and ranges from 5,5%. up to 6 percent It’s about 5. 500 cases a year, but also, unfortunately, many deaths. Patients with laryngeal cancer go to doctors at a too late stage, so out of these 5,5 thousand cases per year 3,5 – 3,8 thousand ends in death.
The rest of the text is below the video.
Where do head and neck cancers come from? Do they have any common denominator?
At the top of the list of factors leading to cancer in the head and neck area is smoking, or actually cigarette smoke, and drinking strong alcohol. We also often see the formation of neoplasms in the places where the mucosa was irritated, e.g. through poorly selected prostheses. This most often applies to people over 60 years of age, who have not drunk or smoked very often, and yet have tongue cancer, cancer of the floor of the mouth or gum cancer, most often the lower ones.
Recently, the number of diagnosed jaw cancers at the site of badly inserted implants has also been increasing. In Poland, they began to be inserted in the late 90s and early XNUMXst century, and today we are collecting a harvest of poorly selected or poorly cleaned implants.
We are also seeing an increase in the incidence of oropharyngeal cancer, i.e. of the tonsils, palate, base of the tongue, of viral origin. HPV is responsible for them. The same one that causes cervical cancer in women. In both men and women, it can lead to the development of head and neck cancers. That is why I am an ardent supporter of HPV vaccination. Not only girls, but also boys. In the case of HPV-dependent cancers, we have a different patient profile. These are young people, over 30, who live healthy, take care of themselves, do not smoke or drink strong alcohol. It happens that I immediately see that the patient who comes to me has HPV-dependent cancer, because he is a young man who did not work on cancer with his lifestyle.
What is the prognosis for these young patients?
Fortunately, these are cancers with a better prognosis – they undergo combined chemoradiotherapy treatment. The patient’s response to treatment is good, much better than in the rest of the group of patients. Therefore, such neoplasms constitute a separate disease entity. Most often, these are small primary changes, but often metastasize rapidly to regional lymph nodes.
What are the symptoms of HPV-dependent tumors? When should these young patients see a doctor?
Certainly when they feel an obstruction in their throat for more than three weeks and this condition persists. This is a sign that something is wrong. Also, any changes in the topography of the neck or enlarged lymph nodes that last longer than three weeks. In such a situation, we should see a doctor. The doctor can prescribe an antibiotic and tell us it’s inflammatory. If the nodes do not shrink after the medication, I recommend having an ultrasound scan. It is a simple, painless examination which, if performed by a good radiologist, will allow you to check for suspicious changes. If it turns out that it is, then the entire diagnostic algorithm will be turned on.
At the beginning of our conversation, you said that patients with head and neck tumors, those that are not HPV-dependent, see their doctor too late. In their case, what should be a signal that they need to be tested? Are these the same symptoms?
When it comes to laryngeal cancer, especially in smokers, chronic hoarseness, pain and a problem with swallowing should be noted. Especially if they are ailments that persist. In the case of cancer of the maxillary sinuses or nasopharynx, such a signal is the persistent ailments that we usually do not pay attention to. A stuffy nose or headaches that come and go, but also limited hearing. These may be the first symptoms of maxillary sinus cancer. And remember that at an early stage they are not visible from the outside. They slowly grow in the mouth. Besides – lymph nodes. If they are enlarged and persist after antibiotics, this should alarm us and encourage in-depth diagnostics. Lymph nodes may shrink after medication is administered, but will still be felt if it is cancerous.
In the case of breast cancer or cervical cancer, we have simple screening tests, thanks to which the changes can be detected at an early stage (breast ultrasound or cytology). Do we have similar options in the case of head and neck cancers? Are there any tests that we can do cyclically?
We have a head and neck cancer prevention program financed by the Ministry of Health. People who notice three symptoms, e.g. hoarseness, cough or enlarged lymph nodes for at least three weeks, may undergo a preventive examination. These are often people at risk: that is, smoke cigarettes and have other unhealthy habits. Then we go to the ENT specialist. But such a routine review, the so-called screening, as in the case of breast cancer, we do not have. Even among smokers or people who drink a lot of alcohol, and therefore are at risk, there are no such routine tests that would be recommended, for example, once a year.
Screening is a study that concerns the entire population, i.e. healthy, asymptomatic people. In the case of head and neck cancers, preventive examinations concern people at risk who are concerned about their symptoms. These people can report to one of the centers participating in this program and gain easier access to the tests that need to be performed.
Since screening is out of the question, we are left with prevention. What should we do to avoid head and neck cancers?
Primary prevention is a change in the way of life. First of all, it is about these two key factors, i.e. exposure to tobacco smoke and strong alcohol, or the abuse of weaker, because wine can be dangerous if drunk in large amounts. Especially if there is a coincidence, i.e. a combination of drinking and smoking. In this situation, the risk of cancer of the larynx, tongue and floor of the mouth increases to 50-70 percent.
So the most important thing is education. Cigarette smoke is really bad. It causes cancer not only of the lung, but also of the larynx, pharynx, breast and many other locations. The smoke causes irritation and chronic inflammation of the entire mucosa of the throat. Remember that smokers are nicotine addicts and need help as such. When someone wants to quit smoking and cannot cope with it on their own, GPs or specialists should refer the person to a smoking cessation clinic. These are centers open to everyone. There, the patient will receive help in the form of psychotherapy or pharmacotherapy.
And even if psychotherapy and pharmacotherapy turn out to be ineffective and the patient continues to smoke afterwards? Then what?
Then there is one more method, registered in the United States and in some European countries. This is called substitution therapy or smoking cessation bridge therapy. It is associated with the use of nicotine delivery systems, mainly the so-called tobacco heaters. There is nicotine in them, but no smoke or tar. It is nicotine that causes addiction, but smoke and tar are the main factors in the development of diseases, and they are the promoters of cancer.
It has been found that if there are patients who are unable to get used to smoking and do not respond to pharmacotherapy, it is advisable to recommend tobacco heating to them, which may help them to wean themselves gradually and more gently from the addiction and reduce its negative health effects. Research shows that the content of group 1 carcinogens, i.e. human carcinogens, in an aerosol from some of these heaters is lower by an average of 95 percent. compared to cigarette smoke. Of course, we are only talking about a situation in which the former smoker completely switches to this type of product – and not that, for example, he uses a heater and smokes cigarettes at the same time. Of course, you need to be fully aware that the so-called the gold standard that perfectly reduces health risks is quitting smoking. Both the smoking patient and the doctor should always strive to this standard together.
What else can we do to reduce our risk of head and neck cancer?
A very important element of anti-cancer prophylaxis is proper oral hygiene, i.e. thorough teeth brushing. It is an important element of protection against cancers of the mouth and gums. And let’s also remember about HPV. It is part of the prevention of oropharyngeal cancers. I know that these neoplasms have a better prognosis, but our treatment is not indifferent to the body. Leaves traces. Instead of undergoing treatment, it is much better to simply get the HPV vaccine, which I strongly encourage you to do. In addition, do not drink hot teas, do not overdo it with spicy spices and smoked dishes, and focus on more physical activity.