Head and Neck Cancer

Functions of the Head and Neck and Issues Related to Head and Neck Cancer

The head and neck region comprises critical anatomical structures, including the mouth, pharynx, larynx, nasal cavities and sinuses, salivary glands, and lymph nodes. These structures play essential roles in breathing, speaking, swallowing, hearing, and the complex movements of the face. Tumors in these regions — including cancers of the mouth, larynx, thyroid, and salivary glands — can severely impair vital functions such as respiration and phonation.

Damage or cancer in the head and neck area can also lead to profound emotional and psychological distress, as well as complications like chronic pain, facial disfigurement, obstructed airways, stroke, and even death.

Understanding Head and Neck Cancer

Most head and neck cancers begin in the moist squamous cells that line these regions. These cancers are collectively known as squamous cell carcinomas (SCC). Common causes include tobacco use, excessive alcohol consumption, and Human Papillomavirus (HPV) infection. Among these, HPV-related squamous cell carcinoma has emerged as a major concern due to its ability to spread along major nerves and blood vessels.

Although certain head and neck cancers may produce early warning signs, many remain hidden until advanced stages. Increasing public awareness and education about HPV-related cancers is essential to reducing associated morbidity and mortality.

Classification of Head and Neck Tumors

Head and neck tumors are classified based on the anatomical site of origin:

• Oral Cavity: Includes lips, tongue, gums, and inner lining of the mouth.
• Pharynx: Divided into nasopharynx, oropharynx, and hypopharynx.
• Larynx (Voice Box): Responsible for speech and breathing.
• Nasal Cavity and Paranasal Sinuses: Involved in respiration and filtration of air.
• Salivary Glands: Produce saliva for digestion and oral health.

The most aggressive and common subtype is squamous cell carcinoma (SCC). Other rare yet serious types include melanoma, adenocarcinoma, lymphoma, and sarcoma.

Secondary (Metastatic) Head and Neck Cancers

These cancers originate from other body sites — such as the breast, lungs, or gastrointestinal tract — and spread to the head and neck via the lymphatic system.

Causes and Risk Factors

• Use of tobacco in any form, including smoking and chewing.
• Chronic alcohol consumption.
• Infection with HPV subtype 16.
• Infection with Epstein–Barr Virus (EBV), linked to nasopharyngeal carcinoma.
• Poor oral hygiene and neglected dental health.
• Occupational exposure to wood dust, asbestos, and industrial chemicals.
• Genetic or familial predispositions and chronic inflammatory conditions.

Symptoms of Head and Neck Cancer

• Chronic ear infections or ear pain (otitis media).
• Persistent sore throat and fever.
• Difficulty swallowing, hoarseness, or changes in speech.
• Unexplained weight loss and general weakness.
• Facial or neck swelling, lumps, and chronic sinus congestion.
• Nosebleeds (epistaxis) and persistent nasal discharge.
• Facial numbness or paralysis.
• Restricted jaw movement and difficulty opening the mouth.
• Asymmetrical facial changes or swelling in the supraclavicular region.

These symptoms may progress silently, often leading to delayed diagnosis and treatment.

Diagnosis and Clinical Evaluation

Accurate diagnosis requires a multidisciplinary approach, beginning with a thorough patient history and examination by an ENT or oncologist. Common diagnostic methods include:

• Clinical Examination: Inspection of the mouth, throat, nose, neck, and lymph nodes.
• Imaging: CT scans, MRI, and ultrasound for evaluating tumor size and spread.
• Endoscopic Evaluation: Nasopharyngoscopy and laryngoscopy to visualize internal lesions.
• Fine Needle Aspiration (FNA) or Biopsy: Confirms malignancy and type.
• TNM Staging System: Determines cancer stage and guides treatment planning.

Treatment Approaches for Head and Neck Cancer

A. Surgical Procedures

• Tumor Excision: Complete removal of the primary tumor with surrounding healthy tissue.
• Neck Dissection: Removal of lymph nodes to prevent cancer spread.
• Reconstructive Surgery: Restores facial aesthetics and functionality after excision.

B. Radiation Therapy

External Beam Radiation Therapy (EBRT) and Intensity-Modulated Radiation Therapy (IMRT) are used to precisely target cancer cells while minimizing damage to surrounding tissues. Common side effects include sore throat, dry mouth, and skin irritation.

C. Systemic Chemotherapy

Drugs such as cisplatin, carboplatin, and 5-fluorouracil are commonly used in combination with radiotherapy. Side effects may include fatigue, nausea, mucositis, and immunosuppression.

Emerging and Advanced Treatments

• Cryosurgical Ablation: Destroys tumor tissue using extreme cold; can also stimulate immune response post-surgery.
• Microvascular Interventional Chemotherapy: Delivers chemotherapy directly to the tumor’s blood supply, improving efficacy and reducing systemic toxicity.
• Targeted Drug Therapy: Agents like Cetuximab and Pembrolizumab are used in advanced or metastatic cases for more precise and less toxic treatment.
• Targeted Radiation (Brachytherapy / Radioembolization): Uses implanted radioactive seeds for localized cancers, with 3D imaging for precise dose delivery.
• Stem Cell and Immunotherapy: Treatments using Nivolumab and Pembrolizumab show durable responses; CAR-T cell therapies are under investigation.

Prevention and Public Health Measures

• Avoid all forms of tobacco and alcohol.
• Promote HPV vaccination to reduce risk.
• Maintain good dental hygiene and schedule regular dental checkups.
• Use protective gear for occupational hazards like dust and chemicals.
• Encourage lifestyle changes that strengthen immunity and lower cancer risk.

Conclusion

The impact of advanced head and neck cancer is profound, with a five-year survival rate ranging from 30% to 40%. Outcomes are influenced by factors such as HPV status, early detection, and modern treatment modalities like surgery, radiation, and immunotherapy.

Because these tumors affect essential functions like breathing, swallowing, and speech, the importance of awareness, early diagnosis, and advanced treatment cannot be overstated. Ongoing research, education, and innovation in stealth surgical and immunotherapeutic techniques are vital to improving survival and quality of life for patients.