HEAD AND NECK CANCER

HEAD AND NECK CANCER

Head and neck cancer is an umbrella term for several types of cancer that develop in structures in the head and neck region. These cancers can affect areas such as the mouth, throat (including the pharynx and larynx), salivary glands, tonsils, nose, sinuses, nasal cavity, thyroid, and other structures present in this area.

Head and neck cancer that affects the head and neck region encompasses a variety of tumor types that involve the mouth, throat, and other areas of the head and neck region. A prevalent symptom of these cases is persistent sore throat. To minimize the risk of these cancers, it is recommended to avoid tobacco use, moderate alcohol consumption and take preventive measures against HPV infection. Diagnosed at an early stage, these cancers are largely treatable and, in many cases, even preventable.

There are different types of head and neck cancer including squamous cell carcinoma, adenocarcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma and others. The main risk factor for most of these cancers is tobacco use (cigarettes, cigars, pipes) and excessive alcohol consumption. In addition, human papilloma virus (HPV) infection is also associated with certain types of head and neck cancer, particularly those that affect the throat and base of the tongue.

WHAT ARE THE TYPES OF HEAD AND NECK CANCER?

There are several types of cancer that can affect the head and neck region. These include:

• 1. Oral cancer: characterized by the appearance of tumors on the lips, tongue, gums, lining of the cheeks and lips, as well as in the upper and lower part of the mouth, including the region located behind the wisdom teeth.
• 2. Oropharyngeal cancer: refers to cancer that develops in the central part of the throat, known as the oropharynx. Tonsil cancer is the most common form of oropharyngeal cancer.
• 3. Hypopharyngeal Cancer: Occurs in the lower portion of the throat, known as the hypopharynx.
• 4. Cancer of the larynx: affects the voice box, called the larynx, which houses the vocal cords.
• 5. Nasopharyngeal cancer: arises in the upper part of the throat, known as the nasopharynx.
• 6. Salivary gland cancer: affects the salivary glands, responsible for producing saliva.
• 7. Cancer of the nasal cavity and sinuses: It occurs in the hollow area inside the nose, called the nasal cavity, or in the hollow spaces in the bones around the nose, known as the sinuses.

LIKELY TO DEVELOP HEAD AND NECK CANCER?

The risk of developing head and neck cancer varies depending on a number of factors. Men and individuals assigned male at birth (AMAB) are up to three times more likely to receive the diagnosis compared to females and individuals assigned female at birth (AFAB). In addition, age also plays an important role, with most cases being diagnosed after the age of 50.

There are certain factors that can increase the risk of developing cancer in this region, such as tobacco and alcohol use, as well as HPV infection. It is important to be aware of these factors and take preventive measures such as avoiding tobacco, limiting alcohol consumption and taking precautions to prevent HPV infection in order to reduce the chances of developing head and neck cancer.

SYMPTOMS OF HEAD AND NECK CANCER

The symptoms of head and neck cancer can vary, it is important to note that they can be mild and similar to less serious conditions such as a cold or sore throat. However, it is essential to be aware of other possible signs and symptoms, which include:

• Frequent headaches.
• Hoarseness or voice changes.
• Pain when chewing or swallowing.
• Pain in the upper teeth.
• Facial numbness or pain.
• Persistent neck pain.
• Difficulty breathing or speaking.
• Presence of a lump in the throat, mouth or neck.
• Persistent earache or infections.
• Nosebleeds, bloody saliva or phlegm.
• Presence of a sore in the mouth or tongue that does not heal.
• Notice a white or red patch on the gums, tongue, or inside the mouth.
• Swelling in the jaw, neck or side of the face, which may affect the fit of dentures.

If you identify any of these symptoms, it is essential to seek medical attention immediately. Although they can be related to less serious conditions, a thorough evaluation is necessary to obtain an accurate diagnosis.

RISK FACTORS FOR HEAD AND NECK CANCER

Head and neck cancer is more common in men and individuals designated male at birth (AMAB) over age 50. In addition to sex and age, there are several risk factors associated with this type of cancer. Some of these factors vary depending on the specific type of cancer. Let's see:

• 1. Tobacco: Tobacco use is the leading cause of head and neck cancer, being linked to approximately 70% to 80% of cases. This includes smoking cigarettes, cigars or pipes, as well as using chewing tobacco, snuff or tobacco.
• 2. Excessive alcohol consumption: Excessive alcohol consumption is also a significant risk factor. The Centers for Disease Control and Prevention (CDC) recommends that men and AMAB individuals consume no more than two drinks per day, while women and AFAB individuals should consume no more than one drink per day.
• 3. Human Papillomavirus (HPV) Infection: The incidence of HPV-related head and neck cancers is increasing, particularly among younger adults. It is estimated that up to 75% of oropharyngeal cancers are associated with HPV infection.
• 4. Epstein-Barr Virus (EBV): While EBV is best known for being associated with mononucleosis, it is also linked to cancer risk. Research suggests that EBV infection can lead to the development of nasopharyngeal cancer.
• 5. Weakened Immune System: A weakened immune system makes the body more vulnerable to cancer. HIV infection and recent major surgery, such as organ or bone marrow transplants, are associated with an increased risk of head and neck cancer.
• 6. Exposure to substances in the work environment: Certain occupations can expose individuals to substances related to head and neck cancer, such as asbestos, pesticides, wood dust, paint fumes, among others.
• 7. Radiation Exposure: Radiation treatment for malignant or benign tumors may increase the risk of salivary gland cancer, although the risk is low.
• 8. Diet: Excessive consumption of salt-cured foods such as salted meat and fish can increase the risk of nasopharyngeal cancer.
• 9. Genetic predisposition: Certain genes can increase the risk of head and neck cancer. For example, people with Fanconi anemia inherit genes that increase their predisposition to certain types of cancer, including head and neck cancer.

HOW ARE HEAD AND NECK CANCER STAGED?

Head and neck cancer staging is a way to assess the extent of the disease and determine the stage it is in. The most commonly used staging system for head and neck cancers is the TNM system, which takes into account three main aspects:

• 1. Primary tumor (T): Refers to the size and extent of the primary tumor. It can range from T0 (no evidence of primary tumor) to T4 (tumor of large size or that has spread to adjacent structures).
• 2. Regional lymph nodes (N): Indicates whether the cancer has spread to lymph nodes near the affected area. It can range from N0 (no lymph nodes affected) to N3 (multiple lymph nodes affected or distant lymph nodes).
• 3. Distant metastases (M): Refers to the presence of metastases in other parts of the body. It can be categorized as M0 (no metastases detected) or M1 (presence of metastases).

Based on this information, it is possible to stage the head and neck cancer using a combination of the T, N, and M categories. The stages are numbered 0 through IV, with stage 0 corresponding to precancerous lesions and stage IV indicates advanced disease with metastases.

HOW IS HEAD AND NECK CANCER TREATED?

Treatment of head and neck cancer depends on several factors, such as the type and stage of cancer, location of the tumor, the patient's general health, and individual preferences. Generally, the treatment of head and neck cancer involves a combination of therapeutic modalities, which may include:

• 1. Surgery: Surgery is often performed to remove the primary tumor and, if necessary, may also involve removing affected lymph nodes. Depending on the location and extent of the cancer, surgery may involve removing part or all of the affected organ.
• 2. Radiotherapy: Radiotherapy uses high-energy radiation beams to destroy cancer cells. It may be given before surgery (neoadjuvant radiotherapy) to shrink the tumor, during surgery (intraoperative radiotherapy) or after surgery (adjuvant radiotherapy) to eliminate remaining cancer cells.
• 3. Chemotherapy: Chemotherapy involves using drugs that attack cancer cells throughout the body. It can be given in combination with radiotherapy (chemoradiotherapy) to improve the effectiveness of the treatment, or it can be used as palliative treatment in advanced or metastatic cases.
• 4. Targeted therapy: Targeted therapy uses drugs that specifically target certain genetic changes or proteins in cancer cells. These drugs can be used in combination with other treatments or as a sole therapy in selected cases.
• 5. Immunotherapy: Immunotherapy stimulates the patient's immune system to recognize and fight cancer cells. It can be given as monotherapy or in combination with other treatments.

In addition to these modalities, other treatments, such as internal radiation therapy (brachytherapy), photodynamic therapy, and proton therapy, can be used in specific cases.

It is important to highlight that the treatment plan is individualized and should be discussed with a specialized medical team, including oncologists, surgeons and radiotherapists. The aim is to find the most appropriate therapeutic approach for each patient, taking into account the stage of the cancer, location, individual needs and possible side effects.