Jose discovered that his hoarseness was not due to a cold or flu. Though he quit cigarette smoking, he still smoked three to four cigars a week. When the hoarseness persisted for more than a month, he visited an otolaryngologist. During an endoscopy, the doctor noticed white spots on his left vocal cord and expressed suspicion that it could be cancer and a confirmatory biopsy was required. More than a week later, he was diagnosed with stage I squamous cell carcinoma.
Jose’s story is but one among several that prove that seemingly harmless symptoms can indicate serious conditions like head and neck cancer. Ignoring such symptoms may lead to a late diagnosis with advanced cancer, and as a result, the five-year survival rate of such advanced cancers remains extremely poor due to late diagnosis, recurrence metastasis, resistance to therapies, and loss of life. Thus, the importance of early diagnosis cannot be overemphasized, while the cancer is still in a curable stage.
Understanding the symptoms
Head and neck cancer refers to a set of heterogeneous cancers that develop in the (squamous cells) surface lining of the tissues in the head and neck (e.g.,nasal cavity, sinuses, nasopharynx, lips, oral cavity, hypopharynx, (throat) oropharynx, larynx (voice box) salivary glands, and thyroid gland.
Several risk factors contribute to the development of head and neck cancer. These include tobacco use, in any form (smoking or chewing tobacco) alcohol consumption, poor oral hygiene, advancing age, exposure to ultraviolet light, excessive intake of salt-cured fish and meat, and insufficient consumption of fruits and vegetables. A notable risk factor is infection with human papillomavirus (HPV), particularly the HPV16 and HPV18 strains. Interestingly, patients with HPV-related oropharynx cancers tend to have a better prognosis and respond more favorably to treatment, often requiring less intensive therapy, compared to their tobacco induced counterparts.
Symptoms of head and neck cancer can vary widely but commonly include mouth ulcers, sore throat, blood in the phlegm, hoarseness of voice, weight loss, and difficulty swallowing or a lump in the neck. A frequently overlooked symptom is a persistent sore throat, often mistaken for a common cold or flu. If a sore throat does not respond to conventional treatments and persists over an extended period, particularly when accompanied by difficulty swallowing, hoarseness, or unexplained weight loss, it may signal a more serious condition such as an underlying cancer.
Treatment modalities
Over the years, the treatment of head and neck cancer has evolved significantly, often involving multiple modalities, resulting in becoming more precise and less prone to complications or sequelae of treatment. The primary treatment modalities include surgery, radiotherapy, or systemic therapy, which may include chemotherapy, targeted therapies or immunotherapy. Each of these treatment modalities have a specific role and indications, offering unique advantages. Minimally invasive surgical techniques have gained prominence, due to reduced morbidity from open operations while maintaining equal efficacy. However, they are applicable in selected circumstances. These advanced surgical methods not only reduce the risk of complications but also help avoid surgical scars and result in shorter hospital stays.
Depending on the specific type of cancer, a range of radiation therapies are employed, including intensity-modulated radiation therapy (IMRT), proton therapy, image-guided intensity-modulated radiation therapy (IG-IMRT), stereotactic body radiotherapy, and adaptive radiotherapy. These methods can be used alone, after surgery, or in combination with other systemic treatments. Designed to minimise side effects, these advanced approaches effectively protect surrounding healthy tissues from damage.
Despite its challenges, the landscape of head and neck cancer treatment is rapidly evolving, bringing renewed hope and enhanced survival rates. Modern advancements, ranging from minimally invasive surgeries to precise radiation therapies and cutting-edge immunotherapies, represent powerful tools in combating this disease. However, their effectiveness hinges on early diagnosis and timely intervention, which relies on patients’ ability to recognise warning signs, such as a persistent sore throat. Therefore, raising awareness, promoting early detection, and regular check-ups is crucial in saving more lives, and improving quality of life.
(The author is head and neck surgeon at Memorial Sloan Kettering Cancer Center, New York, USA)
Dr Jatin P Shah