Just like any other disease, head and neck cancer is a prevalent health problem with considerably high morbidity and mortality. While early detection and timely treatment help in improved prognosis, it is also important to create awareness to reduce the disease burden. Today, on World Head Neck Cancer Day, observed annually on July 27, Dr Deepak Sarin, Director, Head and Neck Oncology, Cancer Institute, Medanta Hospital answers some frequently asked questions related to the conditions.

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What are head and neck cancers?

Head neck cancers are basically a group of cancers that include cancers of the mouth, throat, voice box, and food pipe. It affects the passages of the body parts responsible for breathing, eating, and speaking. The most common type of head and neck cancer in India is oropharyngeal cancer, also known as oral cavity cancer or mouth cancer.

What are the prevalence, causes, and risk factors of head and neck cancers in India?

We have a very high burden of head and neck cancers in India, and mostly it is contributed by oral cancer. The common cause of head and neck cancer is tobacco and alcohol consumption. Both men and women have a widely prevalent habit of chewing tobacco in vast parts of our country. Smokeless tobacco in the form of gutka, pan, masala in rural as well as some parts of urban India, and smoking cigarettes and beedi has led to a very high burden of mouth cancer in India. Alcohol and tobacco are synergistic, which means they both have separate implications; however, if consumed together the risk could be multifold. Additionally, HPV infection is a newly recognised risk factor for throat cancer, which has become a very prevalent cause of cancer in Western countries. However, it is still relatively uncommon in India at the moment.

How are head and neck cancers diagnosed?

The diagnosis involves two steps. First, a clinical exam is performed by checking the lesion, inflammation, or any suspect that targets cancer in the mouth. Post that, a biopsy is done for confirmation, which involves scrapping up tissue and sending it to the lab for a test. It generally takes about 48 hours to get a report to confirm cancer.

Studies indicate that chewing tobacco is associated with an increased risk. (Source: Getty Images/Thinkstock)

Has the advancements in management of head and neck cancer helped to prevent quality of life of patients?

There has been a significant advancement in the management of head and neck cancers. Earlier, traditional surgeries would leave patients with a lot of deficits, which also affected their daily, social, and professional life. But today, the management of head and neck cancers have evolved substantially, and we are able to reconstruct the defects very well. Microvascular free tissue transfer is one of the techniques that has helped exponentially in  giving a new lease of life to patients. We also have been incorporating new technology like computer modelling, 3D printing, and customised implant fabrication for remaking the jaw bones, etc.

Additionally, other treatments have also taken a leap in advancements. Earlier, radiation delivered from cobalt machines in wide areas would burn a lot of the neck and mouth and leave patients with significant long-term issues. But it has now evolved in conformal types in which we can precisely target the tumour, further preventing the damage that radiation does to surrounding structures.

Earlier, chemotherapy was associated with tremendous hair loss, nausea, health issues, but with the introduction of newer drugs, the management of the side effects has vastly improved, and many patients can now at least go through chemotherapy with very few side effects.

Traditional treatments that lead to toxicity and side effects would often create a psychological hit on the patient hampering their overall wellbeing. Many patients underwent depression and became social recluse. But with these advances, patients resume their near normal activities of living and lead a quality of life. Today with introduction of new drugs with minimal side effects and no toxicity, increased awareness, and assessment to clinical depression we can improve the lives of many. We are now able to understand the psychological needs of the person, rehabilitate them properly and restore for them a normal life.

What role do speech, swallow therapist, and physiotherapists play in rehabilitation?

Treating the cancer is one part of the management, bringing back the patient’s quality of life up to a good level is the second aim of the treatment. The head and neck cancers affect the mouth and the throat which ultimately leads to functional abnormality in speech, eating and aesthetics appearance. The impact could be minimised by operative techniques, and post treatment most of them require rehabilitation where in speech, swallow therapist and physiotherapists play a very vital role. With the help of good experts, a lot of patients are now able to regain their good eating function, speech, and aesthetics of the body part. In addition, their psychological needs are also addressed.

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