Head and Neck Cancer

Head and neck cancer covers cancers of the mouth, tongue, throat (pharynx), voice-box (larynx), salivary glands, nose and sinuses, and thyroid. In India, head-and-neck cancers are exceptionally common because of tobacco (chewed and smoked), betel-quid/areca, and alcohol.

Warning signs — more than 2-3 weeks

• Non-healing mouth ulcer or sore.
• Red or white patch in the mouth.
• A lump in the mouth, cheek, neck.
• Persistent hoarse voice.
• Difficulty or pain on swallowing.
• Ear pain with a normal ear examination.
• Nose bleeds, a one-sided blocked nose, double vision (sinus cancers).
• Unexplained weight loss, fatigue.

Risk factors

• Tobacco — in any form.
• Betel-quid and areca-nut chewing.
• Alcohol.
• HPV — an important cause of a subset of throat/tonsil cancers; HPV vaccine relevant.
• EBV — linked to nasopharyngeal cancer, with regional hotspots in north-east India.
• Oral submucous fibrosis — pre-cancerous; stop the underlying habit.
• Poor oral hygiene, chronic dental trauma.
• Sun exposure — lip cancer.

Evaluation

Thorough ENT/dental examination, biopsy of any suspicious lesion, MRI/CT, sometimes PET-CT, endoscopic inspection of throat and voice-box (flexible scope). Dental review is essential before radiation to prevent jaw complications.

Treatment

• Surgery — often the main treatment; reconstructive surgery restores form and function.
• Radiation +/- chemotherapy — major role in many sites.
• Targeted and immune therapies — newer options.
• Rehabilitation — speech, swallowing, nutrition, prosthetic dentistry — central to quality of life; under-used.
• Multi-disciplinary tumour boards make the right choice.

The prevention message

Most Indian head-and-neck cancers are tobacco-related and preventable. Every day you stop reduces risk. Free tobacco-cessation counselling is available through government hospitals and the national helpline 1800-11-2356. Dentists and primary-care doctors should ask every adult about tobacco use and examine the mouth.