World Head And Neck Cancer Day: Deciphering the Epidemic of Head and Neck Cancer - Dr Anushree Chaturvedi

Worldwide, the disease burden of head and neck cancer (HNC) is huge with it ranking the sixth most prevalent amounting to almost 888,000 new cases and 453,000 deaths yearly. A high percentage of these cases are in Asia, particularly in India where it accounts for 30% of all cancers. That makes the number of HNC cancer patients in India, the highest in the world and growing rapidly at 100,000 every year.

As HNC cases rise across the country, a study shows that a wide range of histopathologic tumours are seen to develop in the oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, and salivary glands. This increase in incidence is due to two main risk factors, tobacco, and alcohol consumption, or ethnic and genetic deficiencies. 

The study further states that the primarily affected sites are centred physically and can be categorized into five main types, namely laryngeal and hypopharyngeal cancer, nasal cavity and paranasal sinus cancer, nasopharyngeal cancer, oral and oropharyngeal cancer, and salivary gland cancer.

When signs point towards inconsistencies and symptoms emerge, healthcare professionals recommend a thorough physical examination followed by blood and urine tests. In certain cases, a biopsy and endoscopy may be recommended; or a combination of tests to diagnose the condition. In cases of abnormal lumps or masses, fine needle aspiration cytology (FNAC) or biopsy, is undertaken to test for the Human Papillomavirus (HPV). A panoramic radiography or CT scan is done to spot malignancies that may otherwise be difficult to identify.

HNCs have a high chance of cure and patients diagnosed within the first few years have an even higher chance of survival. However, the challenge remains to protect and preserve the surrounding organs, tissues, and nerves. Since the type and stage of the cancer determine the treatment protocol, the potential side effects, and the patient's general health condition also are key factors that healthcare professionals keep in mind while outlining available treatments. 

With the plethora of treatment options available today, patients are taking an active part in the decision-making process that is conducive to their individual lifestyle choices, their financial capabilities and above all recommendations of their healthcare providers. Surgery, radiation therapy, chemotherapy, and targeted therapy are the primary forms of treatment. Systemic therapy is indicated for metastatic or advanced recurrent squamous cell carcinoma of the head and neck, influenced by clinical factors and pathologic features.

Apart from the regular line of treatment for HNC, biosimilar Cetuximab is used in the treatment of head and neck squamous cell carcinoma (HNSCC). Cetuximab was approved for the treatment of locally advanced HNSCC due to its ability to improve overall survival and locoregional control. 

Bonner et al. identified factors associated with cetuximab efficacy when associated with radiotherapy, such as the early American Joint Committee on Cancer (AJCC) T stage and advanced AJCC N stage. Cetuximab and Immune checkpoint inhibitors have potential synergistic activity in the HNSCC tumour microenvironment. Cetuximab is the most suitable therapeutic choice for platinum-unfit locally advanced HNSCC patients, but a predictive tool to identify eligible patients is needed.

References: The Lancet Infographics Head-and-Neck Cancer, Report of National Cancer Registry Programme 2020

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