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Head & Neck Cancer - Still a Killer

By Antonija Teskera, Croatia

The deadliest cancer that patients have never heard of. Dentists are on the first line of defence against head and neck cancer, but spotting it early is essential. Antonija Taskera tells us more.

Head and neck cancer is one of the seven most common types of cancer in Europe with approximately 150,000 new patients diagnosed every year. The term refers to any cancer that is found in the head and neck area and it usually begins in the squamous cells that line the mucosal surfaces inside the area of head and neck. It is half as common as lung cancer but twice as common as cervical cancer.

There are more than 30 areas within the head and neck where cancer can develop. Despite its increasing prevelance within modern western society (especially in people older than 70 years), there is little awareness about it and outcomes are very poor. Even though it may be visible and a diagnosis can be made during the extraoral and intraoral examination of the patient, it is often not picked up until the later stages where there is a poorer prognosis. When diagnosed, 60% of the people with head and neck cancer have locally advanced disease and 60% of diagnosed patients will die within 5 years. On the other hand, for patients who are diagnosed in the early stages of the disease there is an 80-90% survival rate. Therefore, an early screening and prompt referral are of the utmost importance in the case of head and neck cancer.

Risk factors and common symptoms

Data show that there is lack of awareness in patients when it comes to head and neck cancer and its risk factors. Alcohol and tobacco are the main risk factors for head and neck cancer. Smokers have a 5-7 times higher, compared to non-smokers, and as many as 40% of the patients with head and neck cancer are regular consumers of alcohol. Men who consume more than three units and women who consume more than two units of alcohol per day are at a significantly higher risk of developing head and neck cancer. Even more, alcohol and tobacco work synergistically; alcohol increases cell permeability for cancerous components of tobacco smoke. The Human Papillomavirus (HPV) is also associated with causing a number of head and neck cancers; it can cause cancers of the throat, tongue and tonsils, otherwise known as oropharyngeal cancers (OPSCC). There is an increasing connection between HPV and oral and neck cancer in younger demographics. Other risk factors are poor nutrition, precancerous conditions which present in the oral cavity and precancerous lesions in the oral cavity, various endogenous factors, viral infections, immunodeficient conditions and the state of teeth.

According to a 2015 survey by Hertrampf et al., men are 2.5 more times more likely to be diagnosed with some form of head and neck cancer than women and 3 times more likely to die from this tumour; however, it has also been reported in this survey that the incidence of mortality in women increased during the last decade, while incidence and mortality in men remained stable at a high level.

In its early stages, head and neck cancer is generally without major symptoms; they are often expressed in its late stages. Patients usually report symptoms such as discomfort and tingling sensation in the mouth area; often, they present with dysphagia, aphasia, increased tooth mobility, bleeding in the mouth area and earache. Rarely, the first symptom can be the enlargement of the lymph nodes.

The role of dentists

The importance of early diagnosis of head and neck cancer and the role of dentists in it has been notably emphasised. During the intraoral examination, along with the teeth inspection, dentists should also pay attention to the oral mucosa, especially to the area where the incidence of head and neck cancer is the most common: edge of the tongue, the bottom of the mouth cavity, palatoglossal and palatopharyngeal arches, retromolar spaces and the gingiva of the lower jaw. If there are some abnormalities in those areas, biopsy and pathohistological finding should confirm is there is a malignant formation. The most important thing is the early discovery and to act on time. Cancer diagnosis can affect people in many ways. It is very important that people have the right information, can make quick decisions and effectively cope with it. There are many organisations and support groups which help patients to cope with their illness. Dentists should also be there for their patients in their hard times and be supportive during their therapy.

Collaboration and the future

EDSA, European Dental Students’ Association and Make Sense campaign have recently formed a major collaboration. The Make Sense campaign is a unique initiative by the European Head and Neck Society (EHNS), led by Prof. Wojciech Golusinski and Prof. C. René Leemans. The EHNS itself is a multidisciplinary body that brings medical experts from many disciplines together - head and neck cancer specialists, oral and plastic surgeons, radiation therapists, medical oncologists, imaging specialists and pathologists. The society also brings together other stakeholders, including speech therapists, cancer nurses, psychologists, physiotherapists, dieticians, social workers, basic scientists and patient organisations involved in any aspect of head and neck cancer and in any aspect of the care of the patients. Through the Make Sense campaign, the EHNS aims to raise awareness of head and neck cancer symptoms and subsequently drive earlier presentation, diagnosis and referral.

EDSA supported the Fourth Annual Awareness Week by posting campaign materials and messages on their official Facebook page. Living in the recent years of social media, these posts generated many views which enabled campaign messages to engage with new audiences and be seen by many people. Collaborating with Make Sense, EDSA has designed a project to facilitate patient screenings and awareness events at university dental clinics.

In 2018, the EDSA supported the Fifth Annual Awareness Week and managed to reach more than 30,000 people on Facebook. As the voice for generations to come, EDSA has an important role in promoting health and the best possible practices to the European dental professionals. After all, our proper action and early diagnosis can save a patient’s life!

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