What Are Head and Neck Cancers?
Most HNCs arise from squamous cells lining the upper aerodigestive tract. Common sites include the lips, tongue, gums, cheeks, throat, larynx, and sinuses. While thyroid and salivary gland cancers are sometimes grouped under HNCs, they differ biologically.
Major Risk Factors:
• Tobacco use (smoking and smokeless forms like gutka and paan)
• Alcohol consumption
• Human papillomavirus (HPV) infection
• Poor oral hygiene
• Chronic irritation (e.g., ill-fitting dentures)
• Nutritional deficiencies
In India, smokeless tobacco and areca nut consumption are key contributors, especially in rural populations.
Common Symptoms:
• Non-healing ulcers or sores
• Lumps in the neck
• Bleeding from mouth or nose
• Difficulty swallowing or speaking
• Hoarseness or unexplained weight loss
Unfortunately, over 60–70% of patients present at advanced stages, reducing survival rates. Early screening and awareness are crucial.
Oral Cancer: India’s Major Concern
Oral cancer is the most prevalent HNC in India, accounting for nearly one-third of global cases. It is especially common among men aged 40–60, though younger individuals are increasingly affected.
Key Warning Signs:
• Persistent white or red patches
• Non-healing ulcers lasting more than two weeks
• Loose teeth without cause
• Difficulty chewing or moving the tongue
• Neck swelling (lymph node involvement)
Many people mistake early symptoms for dental issues, delaying diagnosis.
Prevention:
Oral cancer is largely preventable. Avoiding tobacco and alcohol can reduce risk by up to 80%. Maintaining oral hygiene, eating a balanced diet, and undergoing regular dental check-ups are essential. Community screening programs in high-risk populations have shown promising results.
Diagnosis of Oral Cancer
Diagnosis begins with a clinical examination by a specialist, followed by a biopsy to confirm malignancy. Imaging techniques such as CT, MRI, and PET-CT help determine the extent of disease and staging (TNM system), which guides treatment planning.
Treatment Options for Oral Cancer
Treatment is multidisciplinary and depends on the stage and patient condition.
1. Surgery
Surgery remains the cornerstone for most cases. It involves removal of the tumor with adequate margins along with affected lymph nodes. Advanced cases may require removal of parts of the jaw, tongue, or cheek. Modern reconstructive techniques, especially microvascular free flaps, help restore appearance and function effectively.
2. Radiation Therapy
Radiotherapy is used after surgery in high-risk cases or as a primary treatment in inoperable tumors. Techniques like IMRT allow precise targeting, minimizing damage to healthy tissues.
3. Chemotherapy
Often used alongside radiation (chemoradiation), especially in advanced disease. It may also be given before surgery to shrink tumors.
4. Emerging Therapies
Targeted therapy (e.g., cetuximab) and immunotherapy (e.g., pembrolizumab) are increasingly used for recurrent or metastatic cancers, offering improved survival and quality of life. Recent trials have also shown promising results with immunotherapy when used in borderline cases prior to surgery and along with radiation.
Rehabilitation
Post-treatment care includes speech therapy, swallowing rehabilitation, dental prosthetics, and nutritional support to restore quality of life in a multidisciplinary fashion and this is very important for proper rehabilitation post treatment .
Outcomes: ( in terms of survival at 3-5 years after treatment )
• Early-stage survival: 80–90%
• Advanced-stage survival: 40–60%
Thyroid Cancer: A Growing Concern
Thyroid cancer is increasing in India and is more common in women. Most cases are papillary or follicular types with excellent prognosis.
Symptoms:
• Painless neck lump
• Voice changes
• Difficulty swallowing
Diagnosis & Treatment:
Diagnosis involves ultrasound of neck and guided fine-needle aspiration biopsy. Treatment typically includes surgery (thyroidectomy) followed by radioactive iodine therapy. Long-term thyroid hormone replacement is required.
Prognosis:
Survival rates exceed 90% for most differentiated thyroid cancers.
Laryngeal Cancer: Protecting Voice and Life
Laryngeal cancer affects the voice box and is strongly associated with smoking and alcohol use.
Early Signs:
• Persistent hoarseness (lasting more than two weeks)
Advanced Symptoms:
• Difficulty breathing or swallowing
• Neck swelling
Treatment:
• Early-stage: Radiation or laser surgery (voice-preserving)
• Advanced-stage: Chemoradiation or total laryngectomy
Even after removal of the voice box, patients can regain speech through prosthetic devices or electrolarynx systems.
Prognosis:
Early-stage survival exceeds 80%, with good outcomes when treated appropriately.
Conclusion: Early Action Saves Lives
Head and neck cancers, particularly oral cancer, are highly preventable and treatable when detected early. India’s high burden is driven by tobacco use and delayed diagnosis, highlighting the need for greater awareness and screening.
Advances in surgery, radiation, and systemic therapies have significantly improved outcomes, allowing many patients to return to normal life. However, prevention remains the most effective strategy.
If you notice any persistent symptoms, seek medical advice promptly. Quitting tobacco, limiting alcohol, maintaining oral hygiene, and adopting a healthy lifestyle can drastically reduce risk.
Authored by Dr Harsh Dhar (Head Neck OncoSurgeon).
(Dr Dhar along with his Colleagues Dr Sourav Datta and Dr Kinshuk Chatterjee comprise one of the top most Head Neck Departments in a premier hospital in Kolkata. To know more about the team and services, visit www.kolkataheadneckoncology.com)
