Getting ahead of head and neck cancers

Despite the term used to describe them, head and neck cancers usually can’t be seen from the outside. They develop from the moist internal surfaces of the voice box, throat, tonsils, tongue and palate, which means that any symptoms are likely to be hidden.

Two of the most common forms of head and neck cancers in Singapore are:

• Head and neck squamous cell carcinoma. This refers to cancerous cells developing in the oral cavity, tongue, tonsils, or throat.
• Nasopharyngeal carcinoma (NPC), which affects the upper part of the throat behind the nose. The exact cause is not known but genetics is likely to play an important role because Chinese have a higher risk of developing NPC.

SYMPTOMS AND CAUSES

Head and neck cancers often begin with a persistent lump or sore in the affected area. Other symptoms include a sore throat that does not heal, difficulty swallowing, changes in one’s voice or hoarseness. While these may be caused by other health conditions, it’s best to check with a doctor or dentist.

According to Dr Ang Peng Tiam, medical director and senior consultant in medical oncology at Parkway Cancer Centre, there does not appear to be any genetic predisposition associated with cancers of the head and neck. However, he cautions that people who consume 50g or more of alcohol a day are two to three times more at risk than non-drinkers.

Said Dr Ang: “Ethanol, found in alcoholic drinks, increases the risk of cancer. As such, alcoholic drinks with a higher ethanol content will increase the risk of cancer.” Hard liquors such as vodka or whiskey have more ethanol than beer or wine. A standard shot of vodka is estimated to contain around 14g of ethanol.

The risk of developing head and neck cancers increases even more for those who drink excessively and smoke. Separately, both smokers and heavy drinkers are already at higher risk than those who abstain. Indulging in both vices results in a much higher chance of getting head and neck cancers.

Dr Ang lists the other likely causes as radiation exposure, inhalation of dangerous substances like asbestos, wood or nickel dust, poor oral health and hygiene, and the human papillomavirus (HPV) infection.

PREVENTION – MYTHS AND REALITY

Women have a lower incidence of head and neck cancers than men. Furthermore, they can protect themselves to some extent with HPV vaccines.

Said Dr Ang: “The use of HPV vaccines is likely to reduce the risk of squamous cell carcinoma of the head and neck. However, for someone who already has HPV infection, it is uncertain whether the vaccines will alter the risk of developing head and neck cancers.” The HPV vaccine protects recipients from cancer of the uterine cervix, and is approved for use in Singapore for women from the ages of nine to 26.

While oral health and hygiene are important, there are no extra measures one can take beyond the usual advice to brush, floss and visit the dentist regularly. Said Dr Ang: “There are no specific oral health measures that one should take – like using mouthwash or avoiding tongue piercings – that would reduce the risk of developing head and neck cancers.”

TREATING HEAD AND NECK CANCERS

Treatment options range from surgery and radiation therapy to chemotherapy and targeted therapy. A combination of treatments may also be effective, depending on factors such as the patient’s age and health, the location of the tumours and the stage of the cancer.

Dr Ang emphasises the importance of seeking medical advice as early as possible, especially for older and male patients, who tend to be at higher risk. “Patients who present with late-stage disease have a much poorer outlook,” he explained.

“But the cure rate for squamous cell carcinoma of the head and neck is excellent if diagnosed at an early stage. In patients with stage I disease, if good surgical clearance can be achieved, the cure rate ranges from 80 to 90 per cent.”