Head and neck cancers impact 66,000 people in the US annually (4% of all cancers) and 14,600 people die from it, the majority of whom are men. April is head and neck cancer awareness month, and it is important to shed light on key information about preventing and treating this cancer.
“I learned that the treatment of head and neck cancer involves the dual challenge of determining the therapy that offers not only the best oncologic outcome but also the best functional outcome,” Dr. Cristina Rodriguez, a medical oncologist at Seattle Cancer Care Alliance and associate professor of medicine at the University of Washington, explains. “The anatomic location of head and neck cancers makes maintaining the ability to speak, eat, swallow, breathe and see a very important component of therapy.”
Typically, head and neck cancers are diagnosed at a locally advanced stage. Patients have palpable lumps in their neck, difficulty swallowing and speaking, persistent mouth sores, and bleeding.
“Sometimes, patients will have pain in their mouth and think it’s just a loose tooth or a toothache, and then their dentist may find there’s really a tumor back there,” Dr. Lawrence Feldman, a medical oncologist and professor of medicine at the University of Illinois, Chicago, shares.
There are two subsets of head and neck cancer diagnoses. The first consists of patients with prolonged tobacco and alcohol use who present with concurrent health concerns related to their lifestyle, which creates challenges in identifying an appropriate therapy. The second subset includes patients who were exposed to human papillomavirus (HPV) and are typically younger with fewer concurrent medical problems. These patients typically do not need aggressive treatments, endure reduced toxicities, and have a better prognosis.
“We want to give [patients] the best chance of being cured, but if they come in really bad shape to begin with, it’s not as easy,” Dr. Feldman said. “We cannot give them the strongest therapy we might want to because they may not be willing to tolerate it for very long.”
To obtain treatment, patients typically visit a head and neck specialist first who determines if the person qualifies for surgery. Frequently, patients will undergo surgery. After the surgery, medical oncologists and radiation oncologists can provide radiation and/or chemotherapy to kill the remaining cancer cells. If the quality-of-life impact from upfront surgery is too severe, physicians will provide chemotherapy and/or radiation before surgery is done.
However, these treatments do not come without side effects. Patients commonly have dry mouth because less saliva is produced, and this can lead to cavities and teeth loss. Radiation can lead to bone loss that can be quite painful. Currently, immunotherapy, drugs that engage the body’s immune cells to attack cancer, is a promising alternative that is effective and better tolerated than chemotherapy and radiation.
It’s important to remember that head and neck cancers are largely preventable by avoiding smoking, excess alcohol, and vaccinating against HPV. Notably, head and neck cancers disproportionately impact ethnic minorities and socioeconomically disadvantaged populations.
“My hope is that through the current social discourse on equity, momentum is gained to remove barriers to prevention and health care access in these disadvantaged groups through collaboration between the scientific community and health policymakers,” Dr. Rodriguez shares.
The Binaytara Foundation aims to improve healthcare in resource-poor communities and improve cancer care worldwide by educating healthcare providers and community members, advocating for better access to care, and innovating program models and services that improve access to cancer care. Binaytara Foundation’s charitable projects include a bone marrow transplant center in Nepal, hospice and palliative care programs in Nepal and India, and the establishment of a cancer hospital in Southern Nepal. For more information on our projects, visit binayfoundation.org.