Control head and neck cancer through prevention and early detection?

Cancer need not mean a death sentence. The fear of imminent mortality that comes with cancer stems more from ignorance and misconceptions. Cancer is preventable and, with early detection, curable.

There are no proven therapies to prevent cancer, but making conscious lifestyle choices helps mitigate the risks of getting the disease. This is especially true of many head and neck (H&N) cancers which are strongly associated with environmental and behavioural factors. These include tobacco smoking and chewing, alcohol consumption, and certain strains of the sexually transmitted human papillomavirus. Moreover, long sun exposure needs to be avoided as this is the largest risk factor for lip cancer.

One of the commonest cancers in India, H&N cancer refers to a group of cancers originating in the upper respiratory and upper digestive tract — the lip, oral cavity (mouth), nasal cavity, paranasal sinuses, pharynx, and larynx. The most common H&N cancer is squamous cell carcinoma of the head and neck (referred to as SCCHN) which arises in the cells that line the inside of the nose, mouth and throat. Other less common types of H&N cancers include salivary gland tumours, lymphomas and sarcomas.

Early detection

The good news is that H&N cancers are highly preventable and also highly curable if detected early. Since prevention and early detection hold the key to the incidence and successful treatment of H&N cancers, let us see how we can defend ourselves from their onslaught.

Cancer prevention, which refers to the actions we can take to lower the chances of getting cancer, covers both risk and protective factors. While anything that increases chances of developing cancer is a risk factor; anything that lowers chances of developing cancer is a protective factor.

While we can avoid some risk factors, we cannot avoid others. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet are protective factors.

In as many as 90 per cent of the H&N cancer cases, the disease arises after prolonged exposure to avoidable risk factors. Eighty-five percent of head and neck cancers are linked to tobacco use. People who consume both tobacco and alcohol are at greater risk for developing these cancers than those using tobacco or alcohol alone.

In the United States, up to 200,000 people die each year from smoking-related illnesses. While this figure is dwindling as an increasing number of Americans are kicking this habit, some smokers are switching to smokeless or spit tobacco, assuming it is a safe alternative. But this is a grave mistake, for, by doing this, they are merely shifting the risk of cancer to a different part of their body; from their lungs to their mouth.

People who chew tobacco or betel nuts and those who use gutka and paan have a higher risk of developing cancers in the oral cavity. This is especially seen in India where approximately, two lakh cases of H&N cancer are detected each year. Around 1.5 lakh people die of the disease every year in the country. Moreover, a poor diet that contains very little fresh fruit and vegetables can increase the risk of getting certain types of mouth cancer. Breathing in certain chemicals and hardwood dusts increases the risk of cancers of the nose and sinuses.

Awareness initiatives

Since early detection of H&N cancer to a great extent increases the probability for successful treatment, we must consider the two factors that enable us to catch the crab before it does too much damage. The factors are education to promote early diagnosis and screening. Several awareness initiatives are launched during the International Oral, Head and Neck Cancer week — April 27-May 3 — to help further education and screening. Let us see how the factors can help us tackle the disease.

Recognising the possible warning signs of cancer and taking prompt action helps early diagnosis. Increased awareness of possible warning signs of cancer — among physicians, nurses, other healthcare providers, and the people — can have a great impact on controlling the disease. Some early signs of cancer include lumps, sores that fail to heal, abnormal bleeding, persistent indigestion, and chronic hoarseness. Such lumps are generally painless and continue to enlarge steadily. Any hoarseness or other voice changes lasting more than two weeks should not be ignored. While bringing up blood is often caused by something other than cancer, tumours in the nose, mouth, throat, or lungs can also cause bleeding. Cancer of the throat or oesophagus (swallowing tube) may make swallowing solid foods difficult.

Screening refers to the use of simple tests across a healthy population to identify individuals who may have early disease, but do not yet have the symptoms. There are a number of new screening tools that enable either identification of pre-symptomatic status or indicate early onset.

So remember, avoid tobacco and see your doctor before it is too late!

The writer is Medical Director, Apollo Specialty Hospital, Chennai.

Better safe than sorry

Don’t smoke or use any other tobacco products

Don’t drink alcohol frequently or heavily

Don’t combine alcohol and tobacco use

Don’t go back to smoking or drinking after treatment

Have a healthy diet comprising fruits and vegetables and induct regular exercise into your daily regimen

Avoid long sun exposure

Maintain good oral hygiene and see your dentist regularly

Be aware of the danger of HPV (human papillomavirus)