How does Head and Neck Cancer Happen?
Many of my patients with head and neck cancer ask me why they got it. For some, the answer is simple – they had a history of heavy smoking and drinking. For a lot of others, there are no easy answers. But basic to our understanding of how people get cancer is the fact that carcinogenesis, or the development of cancer, is a series of steps. There may be more than one reason that a patient developed cancer, and each reason is a risk factor. Some risk factors, we can control, if only we knew they were dangerous. Other risk factors, we can’t do anything about. But understanding each of these, and how their interplay causes cancer, helps in the acceptance of the diagnosis, and the eventual firming of the fighting spirit necessary for healing.
Head and neck cancer includes cancer of the ear and temporal bone, the nose and paranasal sinuses, the oral cavity (including the lips, tongue, floor of mouth, palate, cheeks, gums, and jaw), the oropharynx, the thyroid, and the larynx. The brain and eyes are special areas which head and neck cancer surgeons leave to neurosurgeons and ophthalmologists. The intimate relationships of all these structures promote the spread of cancer to nearby areas; exposure of one area to external risk factors suggests exposure of the rest.
The classic example of a head and neck cancer patient is a male in his fifth decade of life who smokes and drinks heavily. However, there is an increasing trend of head and neck cancer in younger patients, and in non-drinkers and non-smokers; a lifestyle check may be necessary to evaluate if your habits are putting you at risk for cancer.
Risk Factors for Head and Neck Cancer
Age: As we live, our DNA is replicated millions of times so our bodies can grow or repair themselves. As we age, damage to our DNA accumulates over time, sometimes promoting cancer genes, other times stopping good genes which suppress tumor growth.
Smoking: Tobacco use is the single most important risk factor for head and neck cancer. The smoking or chewing of tobacco releases more than 30 known carcinogens, including polycyclic aromatic hydrocarbons and nitrosamines. These increase the risk for developing cancer of the larynx 15 times compared to non-users.
Drinking alcohol: Heavy alcohol intake is most strongly associated with oropharyngeal cancer, but plays a role in cancer of all areas of the upper aerodigestive tract.
Heavy smoking with heavy alcohol intake does not only have an additive effect on cancer development, they have a synergistic effect. Having both risk factors exponentially increases the risk for cancer.
Betel nut chewing: The more you chew, the higher your chances of getting oral cavity cancer.
Sun exposure: Similar to skin cancer, exposure to the bad sun from 11 AM to 3 PM increases risk of cancer of the nose, upper lip, and ears. Sunscreen and head coverings offer some protection.
Oral hygiene: Less than daily brushing of teeth and ill-fitting dentures have been associated with increased inflammation which promote cancer.
Viral infections: There is an increasing correlation between infections with the Human Papilloma Virus, Epstein-Barr Virus, Human Immunodeficiency Virus and Herpes Simplex Virus and particular head and neck cancers.
Diet: Red, salted, and processed meats increase the risk for cancer, while a diet rich in fruits and vegetables reduces the risk.
What next?
It is obvious by now that our lifestyle choices contribute to the possible development of head and neck cancer. Careful avoidance of the known risk factors will help a lot in mitigating our chances of getting cancer. But what about age, or genetic predisposition, or other factors yet unknown? One may still get cancer in spite of mindful living. What we can control next is how we manage our diagnosis.
As with most diseases, early detection leads to better chance at cure. Warning signs of cancer include recurrent nose bleeding, chronic nasal obstruction, persistent nasal discharge, blood-tinged phlegm, non-healing mouth sore (“singaw”), non-healing wound, and persistent bad breath. When these are present, it is best to consult your doctor, who may recommend an endoscopy. This entails placing a scope, usually with a camera, inside the body to look at all the mucosal surfaces which have been exposed to carcinogens. The Transnasal Flexible Laryngoscopy is a comprehensive endoscopy which evaluates the nose, nasopharynx, oral cavity, oropharynx, and larynx. There is an option to use Narrow Band Imaging to further highlight any abnormalities. Doing these assures us that any suspicious changes are visualized and biopsied if necessary.
Cancer may sound like a death sentence, but it’s not always so. With careful lifestyle choices, one can avoid cancer. With early detection, and timely treatment, we can beat cancer.
Dr. Christine Joy Arquiza is a graduate of the University of the Philippines College of Medicine INTARMED program. She finished her otorhinolaryngology residency and ORL surgical oncology fellowship at UP-Philippine General Hospital, and was the GB Ong Fellow for Head and Neck Surgery at the University of Hong Kong. She practices otorhinolaryngology - head and neck surgery at St. Luke’s Medical Center-Global City. For inquiries, please contact the St. Luke’s -Global City Voice, Swallowing and Sinus Center at (632) 789-7700 ext. 2055/2056.