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Biocon  /  More+  /  Patient Literature  /  Head and Neck Cancer

HEAD AND NECK CANCER

Head and Neck Squamous Cell Carcinoma (HNSCC) encompasses a variety of tumours originating in the, oral cavity, hypopharynx, oropharynx, nasopharynx or larynx.

Know the risks

Important risk factors for head and neck cancers are alcohol and tobacco use, especially cancers of the oral cavity, oropharynx, hypopharynx, and larynx. Approximately 75% of head and neck cancers are caused by tobacco and alcohol use.

Individuals who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone.

Few other risk factors that may increase the risk of head and neck cancer include:

Radiation to the head and neck is a risk factor for cancer of the salivary glands.

Infection with human papillomavirus (HPV), especially HPV type 16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue.

Infection with the Epstein-Barr virus is a risk factor for nasopharyngeal cancer and cancer of the salivary glands.

Poor care of the mouth and teeth may increase the risk of head and neck cancer.

Exposure to wood dust is a risk factor for nasopharyngeal cancer. Certain industrial exposures, including exposures to asbestos or synthetic fibers, have been associated with cancer of the larynx. ndividuals having certain jobs in the construction, metal, textile, ceramic, logging, and food industries may have an increased risk of cancer of the larynx. Industrial exposure to wood or nickel dust or formaldehyde may also be a risk factor for cancers of the paranasal sinuses and nasal cavity.

People who chew betel quid or gutka are at an increased risk of head and neck cancer.

Consumption of certain preserved or salted foods during childhood may be a risk factor for nasopharyngeal cancer.

Small cell lung cancer (SCLC)

It usually initiates in cells lining the bronchi in the center of the lungs. The main subtypes of small cell lung cancer are small cell carcinoma and combined small cell carcinoma (mixed tumor with squamous or glandular cells).

Risks for developing lung cancer

The risk of developing lung cancer increases with age. More than half of all newly diagnosed lung cancer cases occur among people aged 60 years or older. Men develop lung cancer slightly more often than women.

It is the sixth most common malignancy worldwide and accounts for approximately 6% of all cancer cases, responsible for an estimated 1% to 2% of all cancer deaths.

Symptoms

Some of the common symptoms may include:
• A lump or sore that does not heal
• A sore throat that does not go away
• Difficulty in swallowing
• A change or hoarseness in the voice

Treatment options for head and neck cancer

The treatment plan for you will depend on a number of factors, including the exact location of the tumor, the stage of the cancer, and your age and general health. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of these.
While planning a treatment plan for you the doctor will consider how the treatment might affect your quality of life, how you feel, look, talk, eat or breathe.

Surgery

During surgery, the aim is to remove the cancerous tumor and some surrounding healthy tissue. Types of surgery:

Laser technology: This may be used to treat an early-stage tumor, especially if it is found in the larynx.

Excision: An operation to remove the cancerous tumor and some surrounding healthy tissue, known as a margin.

Lymph node dissection or neck dissection: If your doctor suspects the cancer has spread, s/he may remove lymph nodes in the neck.

Radiation therapy

Radiation therapy can be used as the main treatment for head and neck cancer, or it can be used after surgery to destroy small areas of cancer that cannot be removed surgically.

You may experience short and long-term pain or difficulty swallowing, changes in your voice because of swelling and scarring, and loss of appetite due to a change in the sense of taste. It is important that you begin speech and swallowing therapy before radiation therapy begins to help prevent long-term problems with  speaking or eating.

Therapies using medications

Types of systemic therapies include:
• Chemotherapy
• Targeted therapy
• Immunotherapy

Chemotherapy

Chemotherapy usually consists of a specific number of cycles given over a set period of time. You may receive 1 drug at a time or a combination of different drugs given at the same time.

Chemotherapy drugs commonly used for head and neck cancer are:

Cisplatin
Cisplatin kills cancer cells by binding to DNA and interfering with its mechanism, eventually leading to cell death. It is usually given through the vein.

Carboplatin
This drug undergoes activation inside cells forming a complex that cause the intra and inter strand cross-linkage of DNA molecules within the cell modifying the DNA structure and inhibiting DNA synthesis.

Docetaxel
It is a taxoid antineoplastic agent and works by disrupting the normal function of microtubules which are part of the cell apparatus for dividing and replicating itself. Disrupting the function thereby results in cell death.

Paclitaxel
It is one of the several cytoskeletal drugs that targets the tubulin. Paclitexal also works by disrupting the normal function of microtubules, thus inhibiting cancer cells division.

Fluorouracil (5 FU)
Fluorouracil is an antineoplastic antimetabolite, which inhibits the formation of thymidylate from uracil, which leads to the inhibition of DNA and RNA synthesis and cell death.

Gemcitabine
Gemcitabine’s most important mechanism of action is inhibition of DNA synthesis. It inhibits thymidylate synthetase that leads to inhibition of DNA and cell death.

Targeted therapy

Targeted therapy drugs are designed to block the growth and spread of cancer by attacking specific proteins and preventing cancer cells from dividing or destroying them directly.

One of the potential targets in head and neck cancer is the epidermal growth factor receptor (EGFR), like nimotuzumab has important role to play when given with chemoradiation . Your doctor might recommend using an EGFR-targeted drug in combination with chemotherapy or radiation therapy for head and neck cancers.

Immunotherapy

Drugs are designed to help your body’s immune system identify and kill tumor cells. These drugs work by disrupting signalling proteins that allow cancer cells to disguise themselves from your immune system. Eating may be difficult for you after treatment for head and neck cancer. You may receive nutrients directly into your vein after surgery or with a feeding tube until you can eat on your own. A nurse or speech-therapist will help you learn how to swallow again after surgery.

Follow up visits are a good time to ask questions and talk about any changes or problems you notice.
Suggested Links:

• https://www.uptodate.com/contents/epidemiology-and-risk-factors-for-head-and-neck-cancer
• https://www.mskcc.org/cancer-care/types/head-neck/risk-prevention-screening
• https://www.cancer.net/cancer-types/head-and-neck-cancer/risk-factors-and-prevention
• https://www.cancer.net/cancer-types/head-and-neck-cancer/types-treatment-cancers/treating/chemotherapy/chemotherapy-explained/what-is-chemotherapy.html
• https://www.drugbank.ca/drugs/DB01248

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