Head and Neck Cancers Treatment | What are they? Risk of Head and Neck Cancer

Introduction

A group of malignancies known as head and neck cancers attack the mucosal surfaces of the head and neck, including the salivary glands, mouth, throat, voice box, and nose. Because they typically begin in the squamous cells that line these areas, they are also known as squamous cell carcinomas of the head and neck. Various symptoms, including pain, swelling, bleeding, trouble swallowing, hoarseness, or voice changes, can be brought on by head and neck cancers. Additionally, they are able to spread to nearby lymph nodes or other body regions. Human papillomavirus (HPV) infection, smoking, alcohol usage, exposure to certain chemicals or radiation, and HPV infection are the key risk factors for head and neck malignancies. The kind, location, stage, and extent of the disease, as well as the patient's general health and preferences, all influence the therapy options for head and neck malignancies.

Head and Neck Cancers Definition

Squamous cells that line the mucosal surfaces of the head and neck are the origin of head and neck malignancies. The oral cavity—which consists of the lips, tongue, gums, cheeks, floor, and roof of the mouth—as well as the pharynx, larynx, paranasal sinuses, nasal cavity, and salivary glands are among these surfaces. Other cell types in these regions, such as glandular or nerve cells, can also develop into head and neck malignancies, but they do so less frequently than squamous cell carcinomas. Depending on where they first developed, different types of head and neck cancer are categorised. One type of head and neck cancer that begins in the mouth cavity is oral cancer. Similarly, there are various other types of head and neck cancers based on the area in which they begin: nasopharyngeal cancer (in the nasopharynx), oropharyngeal cancer (in the oropharynx), hypopharyngeal cancer (in the hypopharynx), laryngeal cancer (in the larynx), Sino nasal cancer (in the sinuses or nasal cavity), as well as salivary gland cancer (in the salivary glands).

Risk Factors Overview

The likelihood of getting head and neck cancers is increased by the risk factors for these tumours. It is possible to alter or eliminate some risk factors by altering one's habits or way of life. One cannot influence or control others. Smoking tobacco (including cigarettes, cigars, pipes and chewing tobacco), excessive alcohol consumption (more than two drinks per day for men and one drink per day for women), HPV infection (a sexually transmitted virus that can cause warts or cancer in various parts of the body), and exposure to certain toxins or radiation (including asbestos, wood dust, nickel compounds, radon gas and x-rays) are the most significant risk factors for head and neck cancers. The DNA of the squamous cells in the head and neck region may be harmed by one or more of these risk factors acting alone or in concert. Over time, this damage may result in aberrant cell growth and division and cancer.

Risk Factors

Alcohol and Smoking

The biggest risk factor for head and neck cancers is smoking. According to estimates, tobacco smoking causes 85% of head and neck malignancies. The DNA of the squamous cells in the head and neck region is harmed by smoking. Additionally, it makes the immune system less effective at warding off infections or mending damaged cells. Smoking raises the risk of getting head and neck cancers of all varieties. People who smoke more cigarettes, for a longer period of time, or who inhale more deeply run a higher risk. Additionally, smoking increases the risk of recurrence or additional primary tumours while decreasing the effectiveness of treatment.

Another important risk factor for head and neck cancers is alcohol usage. According to estimates, alcohol usage is a risk factor for roughly 30% of head and neck malignancies. The DNA of the squamous cells in the head and neck region is damaged by alcohol. Additionally, it hinders the metabolism of several nutrients that fight cancer and improves the absorption of cigarette carcinogens. All types of head and neck cancers are more likely to be developed in people who drink alcohol, but especially oral and pharyngeal malignancies. People who consume more alcohol, more frequently, or for longer periods of time are at greater risk. Because smoking and drinking together have a synergistic effect, those who do both have a significantly higher risk of developing head and neck cancer than those who do either one alone.

Genetics

One unchangeable and unavoidable risk factor for head and neck cancers is genetics. Some persons are predisposed to certain cancers due to inherited genetic abnormalities or variances. For instance, some individuals have Fanconi anaemia or Bloom syndrome due to inherited flaws in genes involved in DNA repair. These flaws make it more difficult for the cells to repair the harm done by the carcinogens in alcohol and tobacco. Other people have inherited mutations in genes, such as CYP1A1 or ADH1B, that impact how they metabolise alcohol or tobacco. These changes may affect the amount of these compounds that are transformed into damaging or beneficial metabolites. Additionally, genetics might affect a person's prognosis and treatment response. For instance, some individuals have inherited mutations in the genes TPMT or GSTP1, which alter how they metabolise specific chemotherapeutic medications. These changes may influence how harmful or effective these medications are.

Environmental Considerations

Environmental variables, which are linked to exposure to specific compounds or radiation in the workplace or general environment, are risk factors for head and neck cancers. By taking precautions, some of these factors can be avoided or diminished. One cannot influence or control others. Environmental variables that raise the risk of head and neck cancer include, for instance:

Asbestos: Until it was outlawed or restricted in many countries due to its carcinogenic effects, this mineral fibre was widely utilised in insulation and building materials. The larynx or hypopharynx may develop cancer after asbestos exposure.

Wood dust: A by-product of woodworking processes like drilling, sawing, and sanding. Nasal or paranasal sinus carcinoma can result from exposure to wood dust.

Nickel compounds: Metallic materials utilised in welding, electroplating, and battery production, among other industrial activities. Nasal or paranasal sinus carcinoma can result from exposure to nickel compounds.

Radon gas: A radioactive gas that is found in some rocks and soils naturally. It can enter structures through holes or fissures in the walls or foundation. The pharynx or larynx may develop cancer as a result of radon gas exposure.

Lonising Radiation: This category of radiation possesses sufficient energy to rupture chemical bonds and harm DNA. It can originate from man-made sources like nuclear power plants or medical X-rays as well as from natural sources like cosmic rays or radon gas. Any area of the head and neck can develop cancer as a result of ionising radiation exposure.

Treatments

The types, locations, stages, and extent of the disease, as well as the patient's general health and preferences, all influence the treatment options for head and neck malignancies. Chemotherapy, radiation therapy, and surgery are the three main therapeutic modalities. You can take these remedies separately or in conjunction with one another. The objectives of treatment are to eliminate or kill cancer cells, stop the disease from spreading or coming back, maintain the function and look of the affected area, and enhance the patient's quality of life.

Surgery

A scalpel or other surgical instruments are used during surgery to remove the tumour and some surrounding normal tissue (referred to as a margin). If surrounding lymph nodes contain cancer cells, surgery may also involve having them removed (a procedure known as a lymph node dissection). Surgery can be performed using a special tool called an endoscope through an incision (a cut) in the skin or through a natural hole (like the mouth or nose). Depending on the tumors' size, location, and if it has spread to surrounding tissues or lymph nodes, the type and degree of surgery will vary. Surgery can be used to completely remove the tumour (referred to as a total resection) or just a portion of it (referred to as a partial resection). Additionally, surgery may be performed to rebuild the damaged part and return its appearance and functionality. For instance, to repair the defect caused by surgery, a reconstructive or plastic surgeon may utilise skin, bone, muscle, or other tissue from another section of the body (referred to as a graft or a flap). A maxillofacial prosthodontist can also create a prosthesis to replace a lost tooth, bone, or other component of the mouth, jaw, or face.

For head and neck malignancies that have not moved outside of the head and neck area, surgery is frequently the first course of treatment. For more advanced tumours, surgery may also be combined with chemotherapy, radiation therapy, or both. Pain, bleeding, infection, swelling, scarring, nerve injury, or loss of sensation are all possible side effects of surgery. The capacity to speak, swallow, breathe, hear, or see normally may also be impacted by surgery. As a result, after surgery, patients might require additional assistance and care from rehabilitation specialists and other professionals.

Radiation Treatment

High-energy rays or particles are used in radiation therapy to either kill or slow the growth of cancer cells. Both internal and exteriors radiation therapy are available. A device is used in external radiation therapy to send radiation beams to the tumour and some nearby healthy tissue from outside the body. Internal radiation therapy makes use of radioactive substances that are either injected into the bloodstream (called systemic radiation therapy) or inserted inside the body close to the tumour (called brachytherapy). Depending on the tumors' size, location, and if it has spread to surrounding structures or lymph nodes, radiation therapy's kind and dosage will vary.

• For head and neck cancers, radiation therapy may be used alone or in conjunction with chemotherapy and/or surgery. Some early-stage malignancies that have not progressed past the head and neck area may be treated primarily with radiation therapy.
• Adjuvant radiation treatment is the term for the use of radiation therapy after surgery to eliminate any cancer cells that may still be present or to stop a recurrence.
• The tumour can potentially be reduced in size before surgery to make it simpler to remove (this is known as neoadjuvant radiation therapy).
• For those with advanced or recurrent malignancies, radiation therapy can also be utilised as a palliative care strategy to ease symptoms and enhance quality of life.

Skin irritation, dry mouth, painful throat, trouble swallowing, hoarseness, weariness, hair loss, and loss of taste are a few possible adverse effects of radiation therapy. Additionally, radiation therapy can harm healthy tissues and organs close to the tumour, including the thyroid gland, salivary glands, nerves, blood vessels, bones, and teeth. After radiation therapy, patients could therefore require additional assistance and care from rehabilitation specialists and other professionals.

Chemotherapy

Drugs are used during chemotherapy to either kill cancer cells or inhibit their growth. Chemotherapy medications can be administered orally, intravenously, or intramuscularly by injection. Chemotherapy medications can target a particular region (called regional chemotherapy) or the entire body (called systemic chemotherapy). The kind and stage of the disease, as well as whether it has spread to other bodily parts, determine the kind and dosage of chemotherapy medications.

For head and neck cancers, chemotherapy can be applied alone or in conjunction with radiation therapy, surgery, or both. Before surgery or radiation therapy, chemotherapy (also known as neoadjuvant chemotherapy) can be administered to reduce the size of the tumour and make it easier to remove or treat. Adjuvant chemotherapy refers to the use of chemotherapy to eliminate any leftover cancer cells or stop recurrence after surgery or radiation therapy. Concurrent chemotherapy refers to the use of chemotherapy in addition to radiation therapy to increase its efficacy. For those with advanced or recurrent malignancies, chemotherapy can also be used as a palliative care strategy to ease symptoms and enhance quality of life.

Chemotherapy side effects include diarrhoea, nausea, vomiting, weight loss, mouth sores, infection, bleeding, bruises, anaemia, exhaustion, nerve damage, and kidney damage. Healthy cells that divide quickly, such as those in the bone marrow, digestive system, hair follicles, or reproductive systems, might also be impacted by chemotherapy. As a result, after chemotherapy, patients might require additional assistance and care from rehabilitation specialists and other professionals.

Conclusion

A type of malignancies known as head and neck cancers target the mucosal surfaces of the head and neck. Squamous cell carcinomas that begin in the squamous cells that line these sites are typically what cause them. Smoking, alcohol usage, HPV infection, and exposure to certain chemicals or radiation are the main risk factors for head and neck cancers. The kind, location, stage, and extent of the disease, as well as the patient's general health and preferences, all affect the therapy options for head and neck malignancies. Chemotherapy, radiation therapy, and surgery are the three main therapeutic modalities. You can take these remedies separately or in conjunction with one another. 

The objectives of treatment are to eliminate or kill cancer cells, stop the disease from spreading or coming back, maintain the function and look of the affected area, and enhance the patient's quality of life. In addition to pain, bleeding, infection, swelling, scarring, nerve damage, loss of feeling, trouble speaking, swallowing, breathing, hearing, or seeing, as well as harm to healthy tissues and organs, adverse effects from therapies are also possible. As a result, after receiving treatment, patients could require ongoing care and assistance from rehabilitation specialists and other professionals.

The best method to prevent head and neck cancers is to stay away from or restrict one's exposure to the risk factors, such as giving up smoking, abstaining from drinking, obtaining an HPV vaccine, and shielding oneself from radiation or toxic substances.

Risk Factors and Treatment Synopsis

Squamous cells that coat the mucosal surfaces of the head and neck region are the origin of head and neck malignancies.

• HPV infection, tobacco use, excessive alcohol use, and exposure to specific chemicals or radiation are the key risk factors for head and neck cancers.
• The kind, location, stage, and extent of the disease, as well as the patient's general health and preferences, all affect the therapy options for head and neck malignancies.
• Surgery, radiation therapy, and chemotherapy are the three main therapeutic modalities. You can take these remedies separately or in conjunction with one another.
• The objectives of treatment are to eliminate or kill cancer cells, stop the disease from spreading or coming back, maintain the function and look of the affected area, and enhance the patient's quality of life.
• The therapies may cause discomfort, bleeding, infections, swelling, scarring, nerve damage, loss of feeling, trouble breathing, speaking, swallowing, hearing, or seeing, as well as harm to healthy tissues and organs.

As a result, after receiving treatment, patients may require ongoing care and assistance from rehabilitation specialists and other professionals.

Summary of Prevention Measures

Avoiding or reducing exposure to risk factors, such as giving up smoking, abstaining from alcohol, receiving an HPV vaccination, and shielding oneself from radiation or toxic substances, is the greatest strategy to prevent head and neck cancers.

• Giving up smoking can cut the risk of head and neck cancer by up to 50% within the first five to ten years. Reducing the likelihood of recurrence or secondary primary tumours and increasing treatment effectiveness are two additional benefits of quitting smoking.
• Cutting back on alcohol consumption can lower the risk of head and neck cancer by up to 30% within ten years. Limiting alcohol consumption can also enhance healing and lower the incidence of secondary tumours or recurrence.
• Receiving an HPV vaccination helps protect against infection with the HPV strains most frequently associated with head and neck cancer, particularly oropharyngeal cancer. Children between the ages of 11 and 12 and adults up to the age of 26 who have not had the HPV vaccine before are advised to get it.
• Reducing one's exposure to carcinogens such as asbestos, wood dust, nickel compounds, radon gas, ionising radiation, and other substances can help minimise the risk of developing head and neck cancers. Wearing safety gear, adhering to safety precautions, and scheduling routine medical exams are all additional ways to protect oneself against toxic substances or radiation.